Sleep‐Disordered Breathing and Nocturia in Older Adults

Endeshaw, Yohannes; Johnson, Theodore M.; Kutner, Michael; Ouslander, Joseph G.; Bliwise, Donald L.

doi:10.1111/j.1532-5415.2004.52264.x

Cited by 99 publications

(66 citation statements)

References 34 publications

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“…Although it obviously seems logical that snoring and witnessed apnoeas would improve, the effect of CPAP on other clinical aspects related to OSA more likely to appear in elderly patients have been far less investigated (symptoms of presentation such as nightmares and nocturia). These symptoms are less specific in elderly patients as they can often be associated with other conditions, such as sleep alterations, prostate adenoma, medication or heart failure [28]. The present study shows, however, that when these symptoms appear in elderly patients with OSA they can be significantly associated with an excess of sleep-disordered breathing that can be corrected, or at least alleviated, by CPAP treatment.…”

Section: Discussionmentioning

confidence: 37%

Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

et al. 2015

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Almost all the information about the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnoea (OSA) comes from clinical trials involving only middle-aged patients. The objective of this study was to assess the effect of CPAP treatment in elderly patients with severe OSA on clinical, quality-of-life and neurocognitive spheres.We performed an open-label, randomised, multicentre clinical trial in a consecutive clinical cohort of 224 elderly (⩾70 years old) patients with confirmed severe OSA (apnoea-hypopnea index ⩾30) randomised to receive CPAP (n=115) or no CPAP (n=109) for 3 months. A sleep study was performed by either full polysomnography or respiratory polygraphy. CPAP titration was performed by an autoCPAP device. The primary endpoint was quality of life (Quebec Sleep Questionnaire) and secondary endpoints included sleeprelated symptoms, presence of anxiety/depression, office-based blood pressure and some neurocognitive tests.The mean±SD age was 75.5±3.9 years. The CPAP group achieved a greater improvement in all qualityof-life domains ( p<0.001; effect size: 0.41-0.98), sleep-related symptoms ( p<0.001; effect size 0.31-0.91) as well as anxiety ( p=0.016; effect size 0.51) and depression ( p<0.001; effect size: 0.28) indexes and some neurocognitive tests (digit symbol test ( p=0.047; effect size: 0.20) and Trail Making Test A ( p=0.029; effect size: 0.44)) in an intention-to-treat analysis.In conclusion, CPAP treatment resulted in an improvement in quality of life, sleep-related symptoms, anxiety and depression indexes and some neurocognitive aspects in elderly people with severe OSA. @ERSpublications CPAP is effective in elderly patients with severe OSA in clinical and neurocognitive terms improving quality of life

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Section: Discussionmentioning

confidence: 37%

Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

et al. 2015

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“…6,7,[10][11][12][13] Other factors implicated in the pathogenesis of nocturia include polyuria and/or nocturnal polyuria which could be due to uncontrolled diabetes mellitus, vasopressin deficiency, fluid redistribution in supine position associated with edematous states such as congestive heart failure, low albumin, chronic kidney disease, as well as primary sleep disorders such as obstructive sleep apnea and hypopnea. [14][15][16][17][18] In some cases, individuals may report the need to urinate as the reason for their waking up from sleep, even if they wake up for reasons unrelated to bladder pathology. 3 As previously suggested, 19 the cause of nocturia among older men is most probably multifactorial, and this could explain the previously reported associations between frequent nocturia episodes and higher disease burden.…”

Section: Introductionmentioning

confidence: 99%

Nocturia, Insomnia Symptoms and Mortality among Older Men: The Health, Aging and Body Composition Study

Endeshaw

Schwartz

Stone

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: To examine the association between nocturia (walking up from sleep for urination) and mortality risk among community dwelling older men. Methods: This is a secondary data analysis using data obtained from the Health Aging Body Composition (Health ABC) study. Frequency of nocturia was determined at baseline using a questionnaire. Results: A total of 1,478 older men, mean (SD) age 73.8 (2.9) years, were included in the analysis. During a follow up period of 9.9 years, a total of 760 deaths were reported. Mortality rate was significantly higher for participants with 3 or more nocturia episodes per night, in comparison to those with 0-1 episodes (HR [CI] : 1.21 [1.00-1.47], p = 0.055), even after controlling for baseline characteristics which included demographic variables, body mass index, lower urinary tract symptoms, use of loop diuretics, insomnia symptoms, feeling excessively sleepy during the day/daytime naps, sleep duration, and use of sleep medications. However, the association between ≥ 3 nocturia episodes per night and mortality risk was no longer statistically significant once prevalent diabetes mellitus and cardiovascular disease were included in the model (HR ], p = 0.100). Conclusions: Nocturia is associated with mortality independent of insomnia symptoms and sleep duration. The relationship is explained in part by prevalent cardiovascular disease and diabetes mellitus. The results underscore the impact of these medical conditions on the association between 3 or more nocturia episodes and increased mortality risk among older men.

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“…While many studies have examined the relationship between nocturia and SDB (8)(9)(10)(11), no previous studies have investigated the prevalence of SDB among patients specifically who visit urology clinics complaining of nocturia, specifically from the standpoint of a comparison with nocturia in those visiting sleep apnea clinics. Our study provides four important findings in this context.…”

Section: Discussionmentioning

confidence: 99%

“…As patients with nocturia usually visit urology clinics rather than sleep clinics, even if they feel sleepiness, SDB may be overlooked by many urologists, resulting in inadequate treatment for such patients. While many studies have examined the relationship between nocturia and SDB (8)(9)(10)(11), no studies have investigated the prevalence or symptoms of SDB among patients visiting urology clinics who complain of nocturia (URO group) compared with patients visiting sleep clinics who complain of excessive daytime sleepiness, apnea or snoring (SA group).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Sleep Disordered Breathing among Patients with Nocturia at a Urology Clinic

et al. 2016

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Objective We assessed the prevalence of sleep disordered breathing (SDB) and characteristics among patients who visited a urology clinic complaining of nocturia (URO group) and those who visited a sleep apnea (SA) clinic complaining of excessive daytime sleepiness (EDS) (SA group). Additionally, we evaluated the effects of continuous positive airway pressure (CPAP) therapy in the URO group patients with nocturia and SDB resistant to conventional therapy for nocturia. Methods Questionnaires were used to assess EDS, nocturia and lower urinary tract symptoms in 34 URO group patients and 49 age-matched SA group patients. We also compared these factors in the male patients in both groups and the male and female patients in the SA group. Significant SDB was diagnosed as a 3% oxygen desaturation index (3%ODI) on pulse oximeter of >5/h. The treatment response was analyzed in six URO group patients treated with CPAP after not responding to the conventional medical treatment. Results SDB was found in 91.8% of the SA group patients and 70.6% of the URO group patients. The level of EDS and lower urinary tract symptoms were similar in both groups. The SA group showed higher 3%ODI values, while the frequency of urination during bedtime was higher in the URO group. The frequency of nocturnal urination was reduced after CPAP in the subjects resistant to conventional therapy. Conclusion SDB is as prevalent in patients who visit a urology clinic complaining of nocturia as in those who visit a sleep apnea clinic. Patients who complains of nocturia must be assessed for SDB before starting therapy for nocturia.

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Sleep‐Disordered Breathing and Nocturia in Older Adults

Abstract: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.

Cited by 99 publications

References 34 publications

Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

Nocturia, Insomnia Symptoms and Mortality among Older Men: The Health, Aging and Body Composition Study

Prevalence of Sleep Disordered Breathing among Patients with Nocturia at a Urology Clinic

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