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nocturia

Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Comprehensive Patient Care in the Management of Nocturia and Nocturnal Polyuria

Teaser: 

Dean Elterman, MD, FRCSC, Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON.

This supplement provides an overview of nocturia, its impact on patients and various treatment options available to the general practitioner. Nocturia is a common condition, whereby patients are awakened from sleep with the need to urinate. Typically associated with older patients, it can also occur in younger populations. It is often underreported and attributed to aging by patients, indicating the importance of screening by physicians.

Its causes are numerous and multisystem in nature, including congestive heart disease, kidney dysfunction, diabetes and nocturnal polyuria – an over production of urine at night. Nocturia is a lower urinary tract symptom, and may be seen with several common urologic conditions such as overactive bladder and benign prostatic hyperplasia.

Nocturia is particularly important because of its impact on quality of life. Frequently waking to pass urine can leave patients chronically fatigued and sleep deprived, leading to impairment during the day and at work. For those at risk of falls and fractures it can be a cause, especially with poor visibility at night. Patients who are unable to make it to the washroom urgently may experience episodes of incontinence during the night. As a possible symptom of many different diseases, nocturia may be the presenting complaint that prompts further investigations and eventually leads to a diagnosis and treatment. It may be associated with other urinary tract conditions including infection and inflammation. Its diagnosis is equally important because of available treatments for either the underlying disease or for nocturnal polyuria—a common cause of nocturia.

This publication focuses on nocturnal polyuria as a common and treatable cause of nocturia. Diagnosis of nocturnal polyuria is made via history, physical exam and frequency-voiding charts. Treatment is tailored to the degree that the patient is symptomatic and begins conservatively with reduction in fluid intake (alcohol and caffeine) before bed, timed voiding and sleep hygiene. Many patients are unaware of the impact that their habits have on nocturia, and simple changes may be very effective.

Medical management involves desmopressin taken as an oral disintegrating tablet before bed which acts as an antidiuretic hormone to reduce urine production overnight in a short acting manner. Newer formulations have significantly lower rates of hyponatremia which must be measured before initiating therapy.

Related Terms: Men’s Health, Women’s Health, nocturia, nocturnal polyuria, Nocdurna, Desmopressin
Disclaimer: 
This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource. The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Nocturia and Nocturnal Polyuria: What Keeps the Urologist Awake at Night

Teaser: 

Dean Elterman, MD, FRCSC, 1Co-authors: Brandon Van Asseldonk B. Eng 2

1Assistant Professor, University of Toronto, Toronto Western Hospital, Toronto, ON

2Faculty of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Nocturia is a common urologic condition with prevalence increasing in the elderly and can result in fragmented sleep, impaired daytime functioning, and falls. It can be a symptom of BPH or OAB but is commonly multifactorial with fluid intake, sleep apnea, and diabetes contributing. Nocturia is often a result of nocturnal polyuria which is best diagnosed by recording voiding frequency and volumes. Treatment is driven by patient symptoms and reported level of bother, with first-line therapy being lifestyle modification and second-line therapy being desmopressin (Nocdurna).
Key Words: Nocturia, Nocturnal Polyuria, Nocdurna, Desmopressin.
Nocturia is a common urologic condition, particularly in elderly populations.
Nocturia, or waking twice or more during the night to void, can cause fragmented sleep and can impair function during the day.
It is essential that primary care physicians and specialists diagnose nocturia because it can lead to poor health, including conditions like: an increased risk of falls and accidents, cardiovascular disease, diabetes, depression, and increased morbidity and mortality.
A thorough history will aid in the diagnosis of nocturia.
Lifestyle modifications, including: timed voiding, dietary and fluid restrictions, medication timing, sleep hygiene, and evening leg elevation can provide some relief for nocturia patients.
Second-line treatment is the use of desmopressin, an antidiuretic that can reduce the number of nighttime voids and thus improve sleep, particularly in women.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Men’s Health, nocturia, nocturnal polyuria, Nocdurna, Desmopressin
Disclaimer: 

This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource.
The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Faits en bref : Aperçu de la nycturie

Faits en bref : Aperçu de la nycturie

Teaser: 

Références

  1. Gilbert J. Nocturia and Diabetes. Journal of Current Clinical Care Educational Supplement. 017.
  2. Shapiro C. Nocturia & Sleep. Journal of Current Clinical Care Educational Supplement. 2017.
  3. Elterman D. Nocturia & Urology. Journal of Current Clinical Care Educational Supplement. 2017.
  4. Von Ruesten A, Weikert C, Fietze I, Boeing H. Association of sleep duration with chronic diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. PLoS One. 2012;7(1):e30972.
  5. InterAct Consortium, Scott RA, Langenberg C, et al. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study. Diabetologia. 2013;56(1):60-9.
  6. Redeker NS, Adams L, Berkowitz R, et al. Nocturia, sleep and daytime function in stable heart failure. J Card Fail. 2012;18(7):569-75.
  7. Morris JL, Sereika SM, Houze M, Chasens ER. Effect of nocturia on next-day sedentary activity in adults with type 2 diabetes. Appl Nurs Res. 2016; 32:44-46.
  8. Destors M, Tamisier R, Sapene M, et al. Nocturia is an independent predictive factor of prevalent hypertension in obstructive sleep apnea patients. Sleep Med. 2015;16(5):652-8.
  9. Ayik S, Bal K, Akhan G. The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: data derived from the polysomnographic evaluations of 730 patients. Turk J Med Sci. 2014;44(2):249-54.
  10. Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK. Nocturia and disturbed sleep in the elderly. Sleep Med. 2009;10 (5):540–8.
  11. Stanley, N. The underestimated impact of nocturia on quality of life. Eur Urol. 2005;4(Suppl):17-19.
  12. Denys MA, Cherian J, Rahnama'i MS, O'Connell KA, et al. ICI-RS 2015-Is a better understanding of sleep the key in managing nocturia? Neurourol Urodyn. 2016 Sep 21 (in press).
  13. Hajduk IA, Strollo PJJ, Jasani RR, Atwood CWJ, Houck PR, Sanders MH. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study. Sleep. 2003;26(1):61-64.
  14. Yalkut D, Lee LY, Grider J, Jorgensen M, Jackson B, Ott C. Mechanism of atrial natriuretic peptide release with increased inspiratory resistance. J Lab Clin Med. 1996;128(3):322-328.
  15. McIntyre R. Nocturia and marjor Depressive Disorder. Journal of Current Clinical Care Educational Supplement. 2017.
  16. Breyer BN, Shindel AW, Erickson BA, Blaschko SD, Steers WD, Rosen RC. The association of depression, anxiety and nocturia: a systematic review. J Urol. 2013;190(3):953-7.
Related Terms: Urogenital Disorders, nocturia, nocturnal polyuria, Desmopressin

Quick Facts about Nocturia

Quick Facts about Nocturia

Teaser: 

References

  1. Gilbert J. Nocturia and Diabetes. Journal of Current Clinical Care Educational Supplement. 017.
  2. Shapiro C. Nocturia & Sleep. Journal of Current Clinical Care Educational Supplement. 2017.
  3. Elterman D. Nocturia & Urology. Journal of Current Clinical Care Educational Supplement. 2017.
  4. Von Ruesten A, Weikert C, Fietze I, Boeing H. Association of sleep duration with chronic diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. PLoS One. 2012;7(1):e30972.
  5. InterAct Consortium, Scott RA, Langenberg C, et al. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study. Diabetologia. 2013;56(1):60-9.
  6. Redeker NS, Adams L, Berkowitz R, et al. Nocturia, sleep and daytime function in stable heart failure. J Card Fail. 2012;18(7):569-75.
  7. Morris JL, Sereika SM, Houze M, Chasens ER. Effect of nocturia on next-day sedentary activity in adults with type 2 diabetes. Appl Nurs Res. 2016; 32:44-46.
  8. Destors M, Tamisier R, Sapene M, et al. Nocturia is an independent predictive factor of prevalent hypertension in obstructive sleep apnea patients. Sleep Med. 2015;16(5):652-8.
  9. Ayik S, Bal K, Akhan G. The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: data derived from the polysomnographic evaluations of 730 patients. Turk J Med Sci. 2014;44(2):249-54.
  10. Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK. Nocturia and disturbed sleep in the elderly. Sleep Med. 2009;10 (5):540–8.
  11. Stanley, N. The underestimated impact of nocturia on quality of life. Eur Urol. 2005;4(Suppl):17-19.
  12. Denys MA, Cherian J, Rahnama'i MS, O'Connell KA, et al. ICI-RS 2015-Is a better understanding of sleep the key in managing nocturia? Neurourol Urodyn. 2016 Sep 21 (in press).
  13. Hajduk IA, Strollo PJJ, Jasani RR, Atwood CWJ, Houck PR, Sanders MH. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study. Sleep. 2003;26(1):61-64.
  14. Yalkut D, Lee LY, Grider J, Jorgensen M, Jackson B, Ott C. Mechanism of atrial natriuretic peptide release with increased inspiratory resistance. J Lab Clin Med. 1996;128(3):322-328.
  15. McIntyre R. Nocturia and marjor Depressive Disorder. Journal of Current Clinical Care Educational Supplement. 2017.
  16. Breyer BN, Shindel AW, Erickson BA, Blaschko SD, Steers WD, Rosen RC. The association of depression, anxiety and nocturia: a systematic review. J Urol. 2013;190(3):953-7.
Related Terms: Urogenital Disorders, nocturia, nocturnal polyuria, Desmopressin
Disclaimer: 
This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource. The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Nocturia and Sleep Disorders

Nocturia and Sleep Disorders

Teaser: 

Dr. Colin M. Shapiro, MBBCh, PhD, MRCPsych, FRCPC,1 Co-author: Sharon A. Chung, PhD 2

1Toronto Western Hospital, Toronto, ON.

2Youthdale Treatment Centres and Paediatric Sleep Research Inc., Toronto, ON.

CLINICAL TOOLS

Abstract: Nocturia, or the condition where the patient wakes two or more times per night to void the bladder, is linked to a multiplicity of physical and mental health disorders. Whether causal or caused by these disorders, treatment of nocturia and the associated slow-wave sleep disruption is essential to avoid long-term health issues and increased mortality in the individual.
Key Words: nocturia, sleep, physical health, mental health, slow-wave sleep.

Nocturia is a condition that causes the patient to wake two or more times per night to void the bladder.
Nocturia results in a disruption of restorative slow-wave sleep.
Nocturia results in a disruption of restorative slow-wave sleep.
Desmopressin can prolong or even eliminate time to first awakening, thereby augmenting slow-wave sleep and the associated improved physical and mental health.
Nocturia is associated with a multiplicity of physical and mental disorders.
Nocturia is more prevalent in aging patients.
Physicians should include screening for sleep disorders , particularly in elderly patients who report waking twice or more per night to void the bladder.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Men’s Health, Women’s Health, nocturia, sleep, physical health, mental health, slow-wave sleep
Disclaimer: 

This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource.
The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.

Nocturia and Major Depressive Disorder

Nocturia and Major Depressive Disorder

Teaser: 

Roger S. McIntyre, MD, FRCPC

Professor of Psychiatry and Pharmacology, University of Toronto, Executive Director, Brain and Cognition Discovery Foundation (BCDF), Head, Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON.

CLINICAL TOOLS

Abstract: Research has shown that nocturia and major depressive disorder are often correlated. The clinician should take a complete history along with performing a physical examination when patients present with symptoms that may be associated with nocturia. Patients rarely seek medical attention solely for treatment of nocturia, so direct questions along with use of the Frequency Volume Chart (FVC) should be used to assess whether underlying disorders or conditions are present. Clinicians should also be alert to the possible presence of nocturia in patients who suffer from major depressive disorder since nocturia rates for this population is significantly higher. Behavioural modifications alone may be insufficient to improve nocturia where clinically depressive symptoms are also present. Pharmacological treatments may provide improvement when nocturia and major depressive disorder are both present.
Key Words: Nocturia, major depressive disorder, anxiety, lithium, SSRIs, Frequency Volume Chart (FVC), sleep hygiene, desmopressin.

Research has shown that nocturia and major depressive disorder are often correlated.
It is essential that the clinician take a comprehensive history since patients often report symptoms associated with nocturia rather than nocturia itself.
The Frequency Volume Chart (FVC) is a reliable tool the clinician can use to assess whether underlying disorders or conditions are present, which will help determine treatment.
Given the poor physical and mental health that can result when nocturia and major depressive disorder are both present, the clinician should consider pharmacological treatment for nocturia if behavioural changes prove ineffective.
When a patient suffers from nocturia, the clinician should also screen for major depressive disorder.
Individuals who suffer from nocturia are more likely to report feelings of anxiety and depression than the general population.
Individuals who suffer from major depressive disorder are more likely suffer from nocturia.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Men’s Health, Women’s Health, nocturia, major depressive disorder, anxiety, Lithium, SSRIs, Frequency Volume Chart (FVC), sleep hygiene, Desmopressin
Disclaimer: 
This article was published as part of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource. The development of THE LATEST IN THE DIAGNOSIS AND MANAGEMENT OF NOCTURIA eCME resource was supported by an educational grant from Ferring Inc.