Reciprocal Relationship Between Age‐related Sleep Disruption and Urological Symptoms

Abstract

INTRODUCTIONNocturia is common in middle-aged and older patients, affecting 40-60% of people > 55 years old [1][2][3]. It is classically considered to be a urological disorder, whereby excess production of urine at night, or a reduced nocturnal bladder capacity, leads to an awakening to void. An alternative possibility is that sleep disruption, a common feature of aging [4][5][6], leads to a nocturnal awakening and a decision to void. To explore the associations between urinary symptoms, sleep disruption and daytime sleepiness, we conducted a survey in two groups of older adults: patients visiting our urology clinic and healthy adults volunteering for sleep or circadian rhythm studies in our research laboratory. METHODSSubjects in the urology group (UG; n = 144) were recruited from patients ≥ 55 years old with appointments at the Brigham and Women's Hospital Division of Urology clinic. Subjects in the sleep group (SG; n = 130) were healthy individuals ≥ 55 years old who were being screened to participate in a research study at Brigham and Women's Hospital Division of Sleep Medicine; we excluded those with sleep, psychiatric or active medical disorders. Written informed consent was obtained from each participant. The Human Research Committee at the Partners HealthCare System approved the protocols, which were conducted in accordance with the Declaration of Helsinki.All subjects were given three questionnaires: the AUA Symptom Index (AUASI [7]), the Pittsburgh Sleep Quality Index (PSQI [8]; a questionnaire designed to measure subjective sleep quality from the past month), and the Epworth Sleepiness Scale (ESS [9]; a questionnaire to evaluate daytime sleepiness). The questionnaires were scored according to published criteria.The UG was older than the SG (mean age ± SD : UG: 63.7 ± 8.8; SG: 61.7 ± 6.7; Student's ttest, P = 0.03) and the groups had different sex distributions (UG: 25 women, 119 men; SG: 60 women, 70 men; Fisher's exact test, P < 0.001). STATISTICAL ANALYSISWe compared men and women within each group for their AUASI, PSQI and ESS scores. We then compared the questionnaire scores between the two groups, pooling women and men. Comparisons were done using Wilcoxon's rank-sum test.To explore the association between urological and sleep-wake complaints, we used Spearman's correlation coefficient ( r ) analysis in each group to relate AUASI questionnaire scores with scores from the PSQI and ESS questionnaires. We then quantified the relationship between AUASI and PSQI scores with univariate linear regression analysis. To test whether the slopes of the regression lines were significantly different between the groups, and because the groups were different for age and sex composition, we then performed a multivariate linear regression on the pooled data, adjusting for sex, group and age. Statistical tests were run using SAS® software (SAS 9.1.2) and results are presented as mean values ( SD ). RECIPROCAL RELATIONSHIP BETWEEN AGE-RELATED SLEEP DISRUPTION AND UROLOGICAL SYMPTOMS RESULTSWithin each group, women ...

Age-Related Sleep Disruption and Reduction in the Circadian Rhythm of Urine Output: Contribution to Nocturia?

“…Daytime sleepiness, as measured by the Epworth Sleepiness Scale, was significantly correlated with the cause of waking at night to void in both women and men in both the Cardiovascular Health Study and in the National Sleep Foundation Poll (9, 10). In our survey study, we found that greater urological complaints were also associated with greater levels of self-reported daytime sleepiness (25). …”

“…After correcting for other medical conditions, nocturia presented a 75% increased risk of self-reported insomnia in the study respondents. In a survey study we conducted of middle-aged and older adults, we found a positive correlation between urological symptoms and sleep disruption (25). The Cardiovascular Health Study surveyed more than 4,000 people over age 65 about their daytime sleepiness and nighttime sleep quality.…”

“…As survey studies have found, there is a high correlation between the self-report of waking during the night to void with symptoms of excessive daytime sleepiness (9, 10, 25). Nocturia can also lead to other medical problems, due to the increased risk of injury from falling at night (94, 95), depressive symptoms (96) and major depression (97, 98), and problems with memory consolidation.…”

Age-Related Sleep Disruption and Reduction in the Circadian Rhythm of Urine Output: Contribution to Nocturia?

“…Daytime sleepiness, as measured by the Epworth Sleepiness Scale, was significantly correlated with the cause of waking at night to void in both women and men in both the Cardiovascular Health Study and in the National Sleep Foundation Poll (9, 10). In our survey study, we found that greater urological complaints were also associated with greater levels of self-reported daytime sleepiness (25). …”

“…After correcting for other medical conditions, nocturia presented a 75% increased risk of self-reported insomnia in the study respondents. In a survey study we conducted of middle-aged and older adults, we found a positive correlation between urological symptoms and sleep disruption (25). The Cardiovascular Health Study surveyed more than 4,000 people over age 65 about their daytime sleepiness and nighttime sleep quality.…”

“…As survey studies have found, there is a high correlation between the self-report of waking during the night to void with symptoms of excessive daytime sleepiness (9, 10, 25). Nocturia can also lead to other medical problems, due to the increased risk of injury from falling at night (94, 95), depressive symptoms (96) and major depression (97, 98), and problems with memory consolidation.…”

A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of SagaPro on nocturia in men

“…Sleep disorders can be an important primary cause of nocturia [20]. Nocturnal voids due to sleep disorders increase the number of nocturnal voids and decrease the average void volume, and could thus lead to an elevated NBC index, although the nocturnal bladder capacity is not diminished.…”

Sleep, Sleep Disorders, and Sexual Dysfunction

“…Once awake, they may then decide to void. In fact, sleep disruption has been suggested as a cause of decreased nocturnal bladder capacity and nocturia [145146147].…”

Age-Related Sleep Disruption and Reduction in the Circadian Rhythm of Urine Output: Contribution to Nocturia?

“…Daytime sleepiness, as measured by the Epworth Sleepiness Scale, was significantly correlated with the cause of waking at night to void in both women and men in both the Cardiovascular Health Study and in the National Sleep Foundation Poll (9, 10). In our survey study, we found that greater urological complaints were also associated with greater levels of self-reported daytime sleepiness (25). …”

“…After correcting for other medical conditions, nocturia presented a 75% increased risk of self-reported insomnia in the study respondents. In a survey study we conducted of middle-aged and older adults, we found a positive correlation between urological symptoms and sleep disruption (25). The Cardiovascular Health Study surveyed more than 4,000 people over age 65 about their daytime sleepiness and nighttime sleep quality.…”

“…As survey studies have found, there is a high correlation between the self-report of waking during the night to void with symptoms of excessive daytime sleepiness (9, 10, 25). Nocturia can also lead to other medical problems, due to the increased risk of injury from falling at night (94, 95), depressive symptoms (96) and major depression (97, 98), and problems with memory consolidation.…”

A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of SagaPro on nocturia in men

“…Sleep disorders can be an important primary cause of nocturia [20]. Nocturnal voids due to sleep disorders increase the number of nocturnal voids and decrease the average void volume, and could thus lead to an elevated NBC index, although the nocturnal bladder capacity is not diminished.…”

Sleep, Sleep Disorders, and Sexual Dysfunction

“…Once awake, they may then decide to void. In fact, sleep disruption has been suggested as a cause of decreased nocturnal bladder capacity and nocturia [145146147].…”

Age-Related Sleep Disruption and Reduction in the Circadian Rhythm of Urine Output: Contribution to Nocturia?

“…Daytime sleepiness, as measured by the Epworth Sleepiness Scale, was significantly correlated with the cause of waking at night to void in both women and men in both the Cardiovascular Health Study and in the National Sleep Foundation Poll (9, 10). In our survey study, we found that greater urological complaints were also associated with greater levels of self-reported daytime sleepiness (25). …”

“…After correcting for other medical conditions, nocturia presented a 75% increased risk of self-reported insomnia in the study respondents. In a survey study we conducted of middle-aged and older adults, we found a positive correlation between urological symptoms and sleep disruption (25). The Cardiovascular Health Study surveyed more than 4,000 people over age 65 about their daytime sleepiness and nighttime sleep quality.…”

“…As survey studies have found, there is a high correlation between the self-report of waking during the night to void with symptoms of excessive daytime sleepiness (9, 10, 25). Nocturia can also lead to other medical problems, due to the increased risk of injury from falling at night (94, 95), depressive symptoms (96) and major depression (97, 98), and problems with memory consolidation.…”

A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of SagaPro on nocturia in men

“…Sleep disorders can be an important primary cause of nocturia [20]. Nocturnal voids due to sleep disorders increase the number of nocturnal voids and decrease the average void volume, and could thus lead to an elevated NBC index, although the nocturnal bladder capacity is not diminished.…”

Sleep, Sleep Disorders, and Sexual Dysfunction

“…Once awake, they may then decide to void. In fact, sleep disruption has been suggested as a cause of decreased nocturnal bladder capacity and nocturia [145146147].…”