Increased mortality rates in patients with nocturia

Patients with nocturia may have increased mortality rates.
Patients with nocturia may have increased mortality rates.

Nocturia is the frequent need to urinate during the night. It is commonly seen in patients aged 60 years and older. In the National Sleep Foundation's 2003 Sleep in America Poll, nearly two-thirds (65%) of adult respondents between 55 and 84 years reported getting up at least a few nights a week to urinate. Causes of nocturia include untreated diabetes mellitus, increased fluid intake, pregnancy, congestive heart failure, benign prostatic hyperplasia, and the use of diuretics.

Nocturia is commonly seen with sleep disorders. Sleep conditions related to increased risk of nocturia include insomnia, restless legs syndrome, and obstructive sleep apnea (OSA). When patients don't sleep well, they are more aware of their bladders and thus get up more frequently to use the bathroom. It is very common to see nocturia in patients with OSA, and it is something I am sure to ask about in patients who have symptoms. It is believed that with OSA, there is an increased secretion of atrial natriuretic peptide, which causes increased urination.

Data from the Health Aging Body Composition (Health ABC) study found a significantly higher mortality rate in patients with 3 or more nocturia episodes per night. They did not find that sleep disorders including insomnia, sleep duration, or the use of sleep medications caused increased mortality rates. As expected, 2 of the most common reasons for nocturia were diabetes mellitus and cardiovascular disease, which are both leading causes of death in older patients.

When you have a patient with nocturia, especially someone with 3 or more episodes per night, consider untreated/uncontrolled diabetes mellitus, cardiovascular disease, and OSA. OSA is associated with cardiovascular disease, so the patient could be at risk for both illnesses.

For nocturia related to other maladies, consider restricting fluids later in the evenings, changing dosing of diuretics to earlier in the day, wearing compression stockings, and prescribing the appropriate anticholinergic medication to help with symptoms, if necessary.

Sharon M. O'Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, NC.

Reference

  1. Endeshaw YW, Schwartz AV, Stone K, et al. Nocturia, insomnia symptoms and mortality among older men: the health, aging and body composition study. J Clin Sleep Med 2016;12(6):789–796.
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