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Nocturia Increases Mortality Risk
Nocturia significantly increased mortality risk in men and women, according to data from a government health survey.
Overall, awakening more than twice a night to urinate increased mortality risk by 50% in men and by more than 30% among women. Nocturia doubled the mortality risk of people younger than 65, and the effect was independent of comorbidities.
"Chronic sleep loss adversely effects metabolic and endocrine function," said Kupelian, of the New England Research Institutes in Watertown, Mass. "Nocturia may be a marker of impending morbidity, such as cardiovascular disease or diabetes. Nocturia may also be a marker of overall health."
Stratification by age resulted in the unexpected finding of a higher mortality risk in younger people.
Views: 266
Replies to This Discussion
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Permalink Reply by D. W. Conn on
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Great article. We use nocturia related questions when screening for possible sleep apnea related, symptoms and illness
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Permalink Reply by Steven Y. Park, MD on
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Judy,
Thanks for the heads up. Here's what I think:
The researchers mentioned poor sleep as a possible link, but didn't mention anything about obstructive sleep apnea. Studies have recently shown that the main reason why you get up to go to the bathroom is because you stopped breathing, and not because you make too much urine. Actually, you do make some more urine, due to increased production of atrial natriuretic hormone (ANH), due to dilation of the heart's atria during breathing pauses.
The surprising finding in this study was that even in young men (20 to 49), two or more trips to the bathroom more than doubled the risk of death. This is also the age then obstructive sleep apnea begins to take hold.
Knowing what we know, I believe that anyone who has to go to the bathroom too often at night, or even those that have to go often during the day should at least be screened for undiagnosed obstructive sleep apnea.
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Permalink Reply by Judy on
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Dr Park, if I could bottle and sell all the urine I've produced thru the years ...... Bill Gates would look like a pauper.
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Permalink Reply by RockRpsgt on
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The nocturia issue is a great selling point for apnea treatment. Most of the pts that I have seen are worried about their frequent bathroom trips. It is a great opening for me to explain the cause and effects of apnea and SBDs. A great majority of these pts are treated for bladder and prostate problems long before their sleep is considered.
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Yup, yup. That sure was true in my case. Except we didn't go overboard about it since it had been a way of life for me for so long it was something I only twice ever mentioned to the doctor. Interestingly, every urine sample we did check thru the years always had a TRACE of blood in it. I've only had two done (routine stuff) since starting PAP and NEITHER had a trace of blood.
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Permalink Reply by Banyon on
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Disgusting. These researchers need to learn to control for SDB. Nocturia was not the cause of increased mortality. Nocturia was a side effect of SDB and SDB was the cause of increased mortality.
I hear you Rock. A new friend told me he has been taking Flomax for a number of years but still has to make a restroom run several times per night. I looked at his weak jaw and asked him if he snores. He said he does and it is so bad he and his wife have taken to sleeping in separate bedrooms.
I asked him to discuss SDB with the doctor that prescribed Flomax. That was ten months back. This guy is one of the many in denial. He continues to take Flomax, runs to the restroom all night and snores away.
Rock, I am trying to send you more business, but I am not going to drag them in. :(
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Permalink Reply by sleepycarol on
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Even as a young child I have gotten up to go to the bathroom, at least once, but it is not unusual for me to make multiple trips in a night.
In 1990 I was told that was why I was always tired. I was put on meds to help with the nightly trips, only to find that they didn't do anything for me.
In 1999 I had female problems and was told that they could fix my bladder and that would solve my nightly trips and frequent daytime going. Unfortunately the surgery was unsuccessful and still getting up at night to go.
I was in hopes that cpap would decrease the number of times, but hasn't been the case for me.
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I am with you Banyon. I have gotten more people into the lab through pure persistance than anything else. They finally just do it to shut me up.
I believe that Conn explained the nocturia issue really well a little while back. He talked about the effect the negatives pressures caused by apnea presented swelling, or contractions in the heart valves. This sends a message to the brain that blood and liquid volume has increased, which in turn causes the brain to flush the kidneys. Well that is my cliff note version of what he said anyway. I use the explanation quite a bit to get through to just about everyone. I have found that the key to getting through is finding the one symptom that drives that individual crazy then explain how they are connected.
For most the nocturia conversation works. Others go due to hypertension, or snoring. I had to research gout for my father to do it. My grandmothers concern was her glaucoma. Glaucoma and apnea, thank god for the Ohio State Sleep program on that one. I have found that older men are very worried about penile dysphunction. You know whatever gets them in. Very rarely will people go just because they are tired.
Banyon said:Disgusting. These researchers need to learn to control for SDB. Nocturia was not the cause of increased mortality. Nocturia was a side effect of SDB and SDB was the cause of increased mortality.
I hear you Rock. A new friend told me he has been taking Flomax for a number of years but still has to make a restroom run several times per night. I looked at his weak jaw and asked him if he snores. He said he does and it is so bad he and his wife have taken to sleeping in separate bedrooms.
I asked him to discuss SDB with the doctor that prescribed Flomax. That was ten months back. This guy is one of the many in denial. He continues to take Flomax, runs to the restroom all night and snores away.
Rock, I am trying to send you more business, but I am not going to drag them in. :(
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Permalink Reply by 99 on
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judy will have plenty of floating stock and all her competators will be liquidated
Judy said:Dr Park, if I could bottle and sell all the urine I've produced thru the years ...... Bill Gates would look like a pauper.
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Permalink Reply by Heather Dent on
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Dear Dr.Park
I have been using a CPAP machine for almost 3 months. From the night I used it I did not wake to go to the bathroom during the night. Although this was nice, I developed a problem immediately (from the first night) with swelling in my legs (calves, ankles, feet) and in my hands. I did NOT mention it to the sleep doctor because It was a month until my follow-up appointment and I never saw it listed as a side effect of CPAP therapy in materials I read. However, since I was already scheduled for on-going app'ts with my GP who had begun treating me for high blood pressure, (a month before referring me to the sleep clinic for a polysomnogram), on two of these visits I complained to her about the swelling in legs and feet and she prescribed daily use of a 20 mg. diuretic (prior to that, I had only had to take a diuretic occasionally on hot summer days....not any other time of year). The diuretic was not effective in reducing the swelling, so she (the GP) changed my blood pressure meds to one with a diruretic (Micardis 80 mg. with 12.5 mg. diuretic) figuring that when combined with the 20 mg. furosemide the swelling would subside. It didn't lessen and so at my next BP monitoring appt. I asked her why the swelling was so severe, and she said "Leaky veins, it runs in families.....try losing some weight." So I never mentioned this to the sleep doctor at the post-tritration appointment. However, I know that there is more to it than that, because prior to CPAP therapy I did not experience this, and with the increase in CPAP pressure to 12 cm H20 following titration, the swelling is quite severe. More telling is the fact that when I suspended CPAP therapy for almost a week (due to difficulties with the DME provider), the swelling went down (and night time visits to the bathroom to urinate returned). A return to using CPAP resulted in immediate severe swelling (as well as NO trips to the washroom). I don't know if it is relevant info to mention that I have more hypopneas than apneas, and oxygen levels at first sleep study (before diagnosis) fell to 71%. This has improved significantly with CPAP therapy. I feel stupid that I didn't mention it to the sleep doc on my last visit, and am not scheduled to see him for 6 months. But I thought maybe it was just "leaky veins" as GP said. I now KNOW beyond any doubt that it is NOT that. Due to washroom use changing with use of the CPAP machine it not only have something to do with "atrial natriuretic hormone", but is directly linked to CPAP treatment. I don't know what can be done, but this severe swelling day and night is driving me bonkers. Is there a solution?
Heather
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