The Association Between Obesity and the Nocturia in the U.S. Population

Inverse association between dietary flavonoid intake and nocturia in middle-aged and older adults from NHANES 2007-2010

Nocturia is an increasingly prevalent chronic disease that affects the quality of an individual's life. The prevalence of nocturia exceeds 50% among older adults in the U.S. Inflammation and oxidative stress are considered potential factors affecting nocturia, according to prior research. Flavonoids have attracted considerable interest due to their anti-inflammatory, antioxidant, and anti-aging properties. The association between flavonoid consumption and nocturia has been rarely investigated. For this cross-sectional study, we selected 5926 middle-aged and older adults over 40 from the 2007-2010 National Health and Nutrition Examination Survey (NHANES). Daily dietary flavonoid consumption was assessed through two 24-hour dietary recall interviews and the principal outcome was assessed based on a standardized questionnaire administered by trained interviewers. Weighted multivariate logistic regression and stratified analysis were employed to evaluate the impact of dietary total flavonoid consumption on nocturia. Restricted cubic spline (RCS) was utilized to explore whether there is a non-linear association between total flavonoid intake and nocturia. In addition, we performed weighted logistic regression and weighted quantile sum (WQS) regression by six flavonoid species (isoflavones, anthocyanins, flavan-3-ols, flavanones, flavonoids and flavonols) to estimate a combined mixture sum effect as well as the contribution of each mixture component. Subgroup analysis help us identify heterogeneity in these relationships and enhances the applicability of the research findings across different groups. After fully adjusting for confounders, weighted logistic regression models indicated that dietary flavonoid intake was significantly associated with a decreased prevalence of nocturia (OR: 0.93; 95% CI: 0.88-1.00, P-value = 0.036). This trend remained significant in the analysis stratified by quartile level of flavonoid intake. RCS analysis demonstrated an inverse linear correlation between total flavonoid consumption and nocturia. Analysis conducted through quartile stratification of six flavonoid species and WQS regressions showed that anthocyanins, flavan-3-ols, and flavonols were crucial elements. Within these subclasses, Peonidin in anthocyanins, Catechin and Theaflavin-3,3'-digallate in flavan-3-ols, and Isorhamnetin, Kaempferol, and Quercetin in flavonols were also investigated and may have contributed significantly. Our study revealed an inverse association between dietary flavonoid intake and nocturia in middle-aged and older adults, and anthocyanins, flavan-3-ols and flavonols were protectively associated with nocturia.

The relationships between blood lead levels and nocturia prevalence in adults: A retrospective study

PURPOSE

The purpose of this study was to examine the association between blood lead levels and the prevalence of nocturia in American adults.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020, focusing on individuals aged 20 years or older (n = 11,919). Blood lead levels were categorized into two groups (<2 µg/dL and ≥2 µg/dL), and the presence of nocturia was assessed based on questionnaire responses. We used multivariable logistic regression models to explore the association between blood lead levels and nocturia while adjusting for various covariates, including sex, ratio of family income to poverty (RIP), lipid profile, age, body mass index (BMI), race, citizenship, sleep trouble, diabetes, and hypertension. To verify whether certain covariates influence blood lead levels and the risk of nocturia, we conducted subgroup analyses.

RESULTS

Of the study participants, 31.70% reported experiencing nocturia. Individuals with higher blood lead levels (≥2 µg/dL) exhibited a higher likelihood of experiencing nocturia compared to those with lower levels (<2 µg/dL) in all three models (Model 1: OR 1.46, 95% CI 1.29-1.66, p < 0.0001; Model 2: OR 1.25, 95% CI 1.09-1.44, p = 0.002; Model 3: OR 1.22, 95%CI 1.06-1.41, p = 0.01). Subgroup analyses revealed that factors such as age, sex, sleep trouble, diabetes, hypertension, BMI, RIP, and race did not affect the association between blood lead levels and the risk of nocturia (P for interaction >0.05).

CONCLUSIONS

This study reported the correlation between blood lead levels and nocturia. We found that compared to blood lead levels below 2 µg/dL, when lead levels reached or exceeded 2 µg/dL, the risk of nocturia occurrence increased by 22%.

CLINICAL TRIAL REGISTRATION

This study is based on existing data from a public database and not from a specific clinical trial; hence, clinical registration information is not provided.

The relationship between nocturia and suicidal ideation: A study on The National Health and Nutrition Survey data

OBJECTIVES

The focus of this research was to explore any potential link between nocturia and the risk of suicidal ideation.

METHODS

Drawing from the National Health and Nutrition Survey, data relating to 25 241 participants was scrutinized. This included 13 421 individuals identifying as male and 11 820 individuals identifying as female. Participants provided information on nocturia and suicidal ideation via self-completed questionnaires. To determine if nocturia was independently related to suicidal ideation, a multivariable logistic regression analysis was employed. Analyses were also undertaken separately for adult males and females.

RESULTS

It was found that around 3.5% of participants had experienced suicidal ideation. The results indicated that nocturia increased the risk for suicidal ideation in all adult groups (odds ratio [OR] = 1.67, 95% confidence interval[CI]: 1.37-2.03, p < 0.0001), including both males (OR = 1.91, 95% CI: 1.38-2.65, p < 0.001) and females (OR = 1.48, 95% CI: 1.158-1.90, p = 0.002). The risk for suicidal ideation increased with the severity of nocturia, with significant trends observed in adult males (p for trend = 0.04) and adult females (p for trend = 0.01). Additionally, subgroup examination showed a significant interaction between nocturia and educational level in adult males (p for interaction = 0.03). Among adult females, a noteworthy interaction was observed between nocturia and body mass index (p for interaction = 0.02).

CONCLUSION

The research uncovered a connection between nocturia and an elevated risk of suicidal ideation.

The relationship between arthritis and nocturia among adults under 60: A cross-sectional study based on National Health and Nutrition Examination Survey

OBJECTIVE

This study aims to investigate how arthritis, including osteoarthritis and rheumatoid arthritis, affects the incidence of nocturia in adults aged 20-59.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey from 2005 to 2020, involving 18 745 adults aged 20-59. Arthritis, including osteoarthritis and rheumatoid arthritis, was considered as the exposure factor, with nocturia as the outcome variable. We first compared the baseline characteristics of individuals with and without nocturia. The impact of arthritis on nocturia was assessed using weighted multivariate logistic regression models. To ensure the stability of the results, propensity score matching analysis and subgroup analyses were conducted.

RESULTS

The incidence of nocturia was approximately 22.31%, and the incidence of arthritis was about 15.32% (2871/18 745), with osteoarthritis accounting for 35.49% (1019/2871) and rheumatoid arthritis accounting for 20.20% (580/2871). Adjusted multivariate logistic regression analysis revealed that the risk of nocturia was increased by arthritis (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.28-1.65, p < 0.0001), including osteoarthritis (OR = 1.45, 95% CI: 1.18-1.78, p < 0.001) and rheumatoid arthritis (OR = 1.51, 95% CI: 1.14-2.00, p = 0.004). After propensity score matching using nearest neighbor methods at a 1:1 ratio, this relationship still exists. Subgroup analyses showed no significant differences in the interactions between arthritis and the risk of nocturia across various factors, such as age, family income to poverty ratio, education level, body mass index, smoking status, hypertension, and diabetes. However, significant differences were observed across different sex groups and sleep trouble groups.

CONCLUSIONS

This study revealed that arthritis, including osteoarthritis and rheumatoid arthritis, increased the risk of nocturia in adults under the age of 60.

Associations between waist circumference and nocturia in adults: National health and nutrition examination survey 2005-2020

BACKGROUND

The relationship between waist circumference and nocturia has not been previously studied. This study investigated the association between waist circumference and the occurrence of nocturia in adults.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey covering 2005-2020, encompassing 6287 adults aged ≥20. Nocturia was defined as the need to urinate two or more times during the night. First, we compared baseline characteristics between the nocturia and non-nocturia groups. Subsequently, we used multivariate logistic regression analysis to investigate the relationship between waist circumference and nocturia prevalence. We also employed restricted cubic spline analysis to study the potential nonlinear correlation between waist circumference and the prevalence of nocturia. Recognizing the baseline data's heterogeneity based on nocturia prevalence, we conducted subgroup analyses according to age, sex, body mass index (BMI), and ethnicity.

RESULTS

Our findings indicated that females, individuals aged ≥50, citizens, Non-Hispanic Black, those with lower education levels (high school or less), higher BMIs, lower family income-to-poverty ratios, higher waist circumference, hypertension, and diabetes were more likely to experience nocturia. Compared with individuals in the lowest waist circumference quartile (Q1), those in the higher quartiles (Q4) exhibited an increased risk of nocturia in Model 1 (Q4, OR:2.00, 95% CI:1.64, 2.45, p < 0.0001). These results remained consistent after adjusting for covariates in models 2 and 3. A restricted cubic spline analysis suggested a linear association between waist circumference and nocturia (P for nonlinearity = 0.066). Subgroup analyses based on age, sex, BMI, and ethnicity revealed no significant differences in the interaction tests between waist circumference and nocturia (P for interaction = 0.437, 0.331, 0.121, and 0.889, respectively), indicating that these baseline characteristics did not influence the association.

CONCLUSIONS

Our findings indicated an association between increased waist circumference and a higher prevalence of nocturia. Knowledge of this association reinforces the importance of lifestyle modifications in maintaining a healthy waist circumference and informs public health strategies to address other potential risk factors for nocturia.

Association between nocturia and serum albumin in the U.S. adults from NHANES 2005-2012

BACKGROUND

Nocturia, a prevalent chronic condition, impacts individuals' quality of life but remains underexplored. This study aimed to assess the association between serum albumin levels and nocturia.

METHODS

Based on the analysis of the National Health and Nutrition Examination Survey (NHANES) database (2005-2012), our study included a total of 6345 adults (≥20 years old). Nocturia was defined as ≥2 nocturnal voiding episodes. Logistic regression and smooth curve fitting analyzed the linear and nonlinear correlations between serum albumin and nocturia, with subgroup analysis.

RESULTS

Among 6345 participants, 1821 (28.7%) experienced nocturia. Logistic regression analysis revealed a linear negative correlation between serum albumin and nocturia risk (OR = 0.9549, 95% CI = 0.9280 ~ 0.9827, P = 0.002). Even after quartile division of serum albumin concentration, this correlation persisted within each group, and a smooth curve fitting validated the nonlinear negative correlation between the two. Subgroup analysis further demonstrated significant impacts of body mass index (BMI), alcohol consumption, and age on this association.

CONCLUSION

This cross-sectional study indicated that higher serum albumin levels were associated with a reduced risk of nocturia in U.S. adults aged 20 and older, highlighting the importance of serum albumin in the prevention and treatment of nocturia and providing clinical guidance.

Racial Disparities in Nocturia Persist Regardless of BMI Among American Women

IMPORTANCE

It is crucial to understand the racial and ethnic disparities that exist in nocturia prevalence to appropriately manage nocturia.

OBJECTIVES

Nocturia is associated with increased body mass index (BMI) and is most prevalent in Black and Hispanic women, who also have the highest and second highest prevalence of obesity, respectively. We sought to better understand the association of nocturia with BMI category by race and ethnicity in U.S. women.

STUDY DESIGN

This was a cross-sectional study using publicly available data from the National Health and Nutrition Examination Survey data from 2005 to 2018. We estimated the prevalence of moderate to severe nocturia (defined as 2 or more episodes of nighttime urination) by BMI category within each racial and ethnic (Black, White, Hispanic, and other) group of adult women. Logistic regression was performed to determine the odds ratio of nocturia by race.

RESULTS

The odds of nocturia was 2.25 (2.04-2.49) for Black women, 1.27 (1.15-1.4) for Hispanic women and 0.96 (0.82-1.13) for other women compared to White women. After accounting for BMI, socioeconomic status and comorbidities, the adjusted odds ratio was 1.76 (1.42-2.16) for Black women, 1.1 (.0.88-1.38) for Hispanic women, and 0.81 (0.5-1.29) for other women compared to White women.

CONCLUSIONS

Black women were nearly twice as likely to have nocturia than White women. The increased odds of nocturia, while not sustained for Hispanic women, persisted for Black women regardless of socioeconomic status, BMI, and comorbidities. Our study suggests that there are factors other than weight driving the prevalence of nocturia in Black women that require further investigation.

Association between family income to poverty ratio and nocturia in adults aged 20 years and older: A study from NHANES 2005-2010

BACKGROUND

Nocturia, the most common lower urinary tract symptom (LUTS), significantly impacts socioeconomic factors and individuals' quality of life and is closely related to many diseases. This study utilized data from NHANES 2005-2010 to explore the relationship between family income to poverty ratio (PIR) and the presence of nocturia symptoms in adults aged 20 or older in the United States.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) in 2005-2010, including 6,662 adults aged 20 or older, were utilized for this cross-sectional study. The baseline data was used to display the distribution of each characteristic visually. Multiple linear regression and smooth curve fitting were used to study the linear and non-linear correlations between PIR and nocturia. Subgroup analysis and interaction tests were conducted to examine the stability of intergroup relationships.

RESULTS

Out of the 6,662 adult participants aged 20 or older, 1,300 households were categorized as living in poverty, 3,671 households had a moderate income, and 1,691 households were classified as affluent. Among these participants, 3,139 individuals experienced nocturia, representing 47.12% of the total, while 3,523 individuals were nocturia-free, constituting 52.88% of the total population. After adjusting for all other covariates, it was found that PIR was significantly negatively correlated with nocturia (OR: 0.875, 95%CI: 0.836-0.916 P<0.0001). This trend persisted when PIR was divided into three groups (PIR <1, PIR 1-4, PIR > 4) or quartiles. There was a non-linear negative correlation between PIR and nocturia.

CONCLUSION

Our findings indicated that lower PlR was associated with a higher risk of nocturia in adults aged 20 or older in the United States. These findings highlight the importance of considering socioeconomic factors in preventing and managing nocturia. Nonetheless, further exploration of the causal nexus between these factors was precluded due to the constraints of a cross-sectional design.

Association between TV and/or video time and nocturia in adults: An analysis of the National Health and Nutrition Examination Survey

AIMS

This study aimed to examine the correlation between television (TV) and/or video viewing time and the occurrence of nocturia in adults.

METHODS

An analysis of data from the National Health and Nutrition Examination Survey for 2011-2016 was conducted, involving 13 294 adults aged 20 and older. The main outcome was specified as nocturia, which refers to the requirement of urinating two or more times during the night. Initially, baseline characteristics were contrasted between individuals with and without nocturia. The effects of TV and/or video viewing time on nocturia were further explored using multivariable logistic regression models. To acknowledge the variation in baseline data regarding the prevalence of nocturia, subgroup analyses were performed.

RESULTS

Adjusted multivariate analysis revealed that individuals in the group with the longest TV and/or video viewing time had a significantly 48% higher risk of experiencing nocturia compared to those with the shortest TV and/or video viewing time. The results of subgroup analyses revealed no significant differences in the interaction tests between TV and/or video viewing time and nocturia.

CONCLUSIONS

Our research showed that individuals who spent 5 or more hours a day watching TV and/or videos were significantly more likely to develop nocturia.

Application of the Sleep C.A.L.M. Tool for Assessing Nocturia in a Large Nationally Representative Cohort

PURPOSE

Nocturia significantly impacts patients' quality of life but remains insufficiently evaluated and treated. The "Sleep C.A.L.M." system categorizes the factors thought to collectively reflect most underlying causes of nocturia (Sleep disorders, Comorbidities, Actions [i.e., modifiable patient behaviors such as excess fluid intake], Lower urinary tract dysfunction, and Medications). The purpose of this study was to assess the association of nocturia with the Sleep C.A.L.M. categories using a nationally representative dataset.

METHODS

Retrospective analysis of the National Health and Nutrition Examination Survey from 2013/14-2017/18 cycles was conducted. Pertinent questionnaire, laboratory, dietary, and physical examination data were used to ascertain the presence of Sleep C.A.L.M. categories in adults ≥20 years of age. Nocturia was defined as ≥2 nighttime voids.

RESULTS

A total of 12,274 included subjects were included (51.6% female; median age, 49.0 years [interquartile range, 34.0-62.0 years]; 27.6% nocturia). Among subjects with nocturia, the prevalence of 0, ≥1, and ≥2 Sleep C.A.L.M. categories was 3.5% (95% confidence interval [CI], 2.8%-4.4%), 96.5% (95% CI, 95.6%-97.2%), and 81.2% (95% CI, 78.9%-83.3%), respectively. Compared to those with 0-1 Sleep C.A.L.M. categories, the adjusted odds of nocturia in subjects with 2, 3, and 4-5 Sleep C. A.L.M. categories were 1.77 (95% CI, 1.43-2.21), 2.33 (1.89-2.87), and 3.49 (2.81-4.35), respectively (P<0.001). Similar trends were observed for most age and sex subgroups. When assessed individually, each of the 5 Sleep C.A.L.M. categories were independently associated with greater odds of nocturia, which likewise persisted across multiple age and sex subgroups.

CONCLUSION

Sleep C.A.L.M. burden is associated with increased odds of nocturia in a dose-dependent fashion, and potentially a relevant means by which to organize the underlying etiologies for nocturia among community-dwelling adults.

Association of nocturia with cardiovascular and all-cause mortality: a prospective cohort study with up to 31 years of follow-up

Background

Nocturia is a highly prevalent and under-considered condition and impacts the quality of life for many individuals. The long-term impact of nocturnal voiding on mortality, especially mortality from cardiovascular disease, remains unknown. The current study aimed to evaluate the relationship of nocturnal voiding episodes with cardiovascular and all-cause mortality among adults in the United States.

Methods

This is a prospective cohort study of a nationally representative sample of 13,862 U.S. adults aged 20 years or older who participated in the National Health and Nutrition Examination Survey III (1988-1994). Nighttime urination frequency was reported during an in-house interview. All-cause and cause-specific mortality were ascertained by linking to National Death Index mortality data through December 31, 2019. The associations of nocturia with cardiovascular and all-cause mortality were estimated using weighted Cox proportional hazards regression models.

Results

Throughout a median follow-up of 26.7 years, 5,029 deaths were reported, comprising 1,720 deaths from cardiovascular disease. In the fully adjusted model, participants who reported once, twice, and three or more times nocturnal voiding episodes have a higher risk of cardiovascular mortality (HR1, 1.22 [95% CI, 0.997-1.49], HR2, 1.47 [95% CI, 1.13-1.91], and HR ≥ 3, 1.96 [95% CI, 1.52-2.53]) as well as all-cause mortality (HR1, 1.12 [95% CI, 0.90-1.39], HR2, 1.54 [95% CI, 1.23-1.93], and HR ≥ 3, 2.48 [95% CI, 1.81-3.40]), compared to those without nocturia, and heart disease-specific mortality (HR1, 1.33 [95% CI, 1.08-1.64], HR2, 1.62 [95% CI, 1.25-2.10], and HR≥3, 2.07 [95% CI, 1.61-2.67]). Nevertheless, there was no significant relationship between the number of nocturia episode changes and stroke-specific mortality.

Conclusion

Nocturia was associated with a significantly augmented risk of overall and heart disease-specific mortality in a dosage-dependent manner. Early recognition and taking precautions may benefit individuals with nocturia by promoting quality of life and cardiac health.

Single-Centre Retrospective Study on the Effects of Bariatric Surgery on Nocturia

PURPOSE

The incidence of nocturia is increased in obesity, which causes significant negative impact on quality of life. Bariatric surgery is a reliable method in which to achieve major weight loss and this study aims to determine the effect of bariatric surgery on nocturia and other lower urinary tract symptoms (LUTS) in men and women.

MATERIALS AND METHODS

Retrospective study of patients undergoing bariatric surgery had pre- and post-operative questionnaires using the validated International Prostate Symptoms Score (IPSS) to assess nocturia between 2018 and 2021. The primary outcome was effect of bariatric surgery on nocturia RESULTS: A total of 99 patients were included with median age of 52.9 (44.9-60.2) and 83.8% being female. The median weight was 129.9kg (110-151.9) and median BMI was 45.5 (41.4-53.4). Improvements were demonstrated in all criteria assessed in IPSS and nocturia significantly improved with a decrease in 1.14 points (p < 0.05). Linear regression analysis showed that, in the post operative period assessed, there were no significant effect on variables measured such as obstructive sleep apnoea, type 2 diabetes on the effect of IPSS post-bariatric surgery within the follow-up period of 4-6 months.

CONCLUSION

Bariatric surgery can have significant improvements on nocturia symptoms in men and women with obesity. This is another means in how bariatric surgery can reduce morbidity and improve quality of life.

Association of nocturia of self-report with estimated glomerular filtration rate: a cross-sectional study from the NHANES 2005-2018

Nocturia is a manifestation of systemic diseases, in which chronic kidney disease (CKD) is an independent predictor of nocturia due to its osmotic diuretic mechanism. However, to our knowledge, previous studies have not examined the association between nocturia and estimated glomerular filtration rate (eGFR). The purpose of this study was to assess the association between nocturia exposure and eGFR in the general US population. This study presents a cross-sectional analysis of the general US population enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. To account for potential confounding factors, linear regression analysis was conducted to investigate the association between nocturia and eGFR. Stratified analyses and interaction tests were employed to examine the variables of interest. Additionally, sensitivity analyses were conducted across diverse populations. A total of 12,265 individuals were included in the study. After controlling for confounding factors, the results of the linear regression analysis indicated that a single increase in nocturnal voiding frequency was associated with a decrease in eGFR by 2.0 mL/min/1.73 m2. In comparison to individuals with a nocturnal urinary frequency of 0, those who voided 1, 2, 3, 4, and ≥ 5 times at night experienced a decrease in eGFR by 3.1, 5.4, 6.4, 8.6 and 4.0 mL/min/1.73 m2, respectively. Nocturia was found to be associated with a decreased eGFR of 4 mL/min/1.73 m2 when compared to individuals without nocturia. The sensitivity analysis yielded consistent findings regarding the association between nocturia and eGFR in both CKD and non-CKD populations, as well as in hypertensive and non-hypertensive populations. Nevertheless, inconsistent conclusions were observed across various prognostic risk populations within the CKD context. The presence of nocturia and heightened frequency of nocturnal urination have been found to be associated with a decline in eGFR.

Relationship between nocturia and hypertension: findings from the NHANES 2005-2016

Objectives

The objective of this study was to explore the association between nocturia and hypertension in a large, nationally representative adult sample.

Methods

We used data from 2005 to 2016 National Health and Nutritional Examination Surveys (NHANES). A total of 29,505 participants aged 20 years old or older were included. A participant was considered to have nocturia if he or she had two or more voiding episodes at night. Multivariable logistic regression models were used to explore the association between nocturia and hypertension.

Results

Participants with nocturia were associated with a higher risk of hypertension (OR, 1.36; 95% CI, 1.28-1.45). Interaction tests revealed no significant effect of sex, age, race, or body mass index on the association of nocturia with hypertension. As the severity of nocturia increases, the risk of hypertension increases (P for trend <0.0001). In addition, nocturia was also related to different grades of hypertension (II vs. I: OR, 1.34, 95% CI, 1.16-1.55; III vs. I: OR, 1.67, 95% CI, 1.32-2.13).

Conclusion

In this cross-sectional study, our results suggest that nocturia is associated with an increased risk for hypertension.

Health Complications of Obesity: 224 Obesity-Associated Comorbidities from a Mechanistic Perspective

Obesity is associated with a wide range of comorbidities that transverse multiple specialties in clinical medicine. The development of these comorbidities is driven by various mechanistic changes including chronic inflammation and oxidative stress, increased growth-promoting adipokines, insulin resistance, endothelial dysfunction, direct loading and infiltrative effect of adiposity, heightened activities of the renin-angiotensin-aldosterone system and sympathetic nervous system, impaired immunity, altered sex hormones, altered brain structure, elevated cortisol levels, and increased uric acid production, among others. Some of the comorbidities might develop secondary to one or more other comorbidities. Considering the obesity-associated comorbidities in the context of the mechanistic changes is helpful in understanding these conditions and in guiding treatment and future research.

Age and metabolic syndrome are associated with unsatisfactory improvement in nocturia after holmium laser enucleation of the prostate

Objective

To investigate the association between age, metabolic syndrome (MetS) and improvement in nocturia in patients with benign prostate hyperplasia (BPH) receiving holmium laser enucleation of the prostate (HoLEP).

Methods

The retrospective study was conducted on patients treated for BPH using HoLEP between January 2021 and May 2022. Lower urinary tract symptoms (LUTS) were measured before surgery and at 3 months postoperatively using the International Prostate Symptom Score (IPSS). The criteria of the Adult Treatment Panel III (ATP III) were adopted to diagnose the MetS. Unsatisfactory improvement in nocturia was defined as <50% reduction in nocturia from baseline on the IPSS.

Results

One hundred and seventy-five patients were eventually enrolled, with a median age of 69 years (IQR: 63/73). Unsatisfactory improvement in nocturia was reported in 95 patients (54%) after HoLEP. These patients were older (73; IQR: 67/79 vs. 66; IQR: 60/71, P < 0.001) and more likely to present with higher postoperative total (6; IQR: 4/9 vs. 3; IQR:2/5, P < 0.001), voiding (1; IQR: 0/3 vs. 1; IQR: 0/2, P = 0.017), and storage (4; IQR: 3/6 vs. 2; IQR: 1/4, P < 0.001) IPSS when compared to patients with satisfactory improvement in nocturia. Overall, 63 of 175 (36%) patients were diagnosed with MetS and of these, 44 (70%) reported unsatisfactory improvement in nocturia (P = 0.002) after HoLEP. Multivariate analysis revealed that age (OR = 1.117, 95% CI: 1.068-1.169, P < 0.001) and MetS (OR = 3.613, 95% CI: 1.727-7.562, P = 0.001) were independent risk factors for unsatisfactory improvement in nocturia after HoLEP.

Conclusion

Our findings suggest that increased age and MetS were associated with unsatisfactory improvement in nocturia in patients with BPH after HoLEP. Lifestyle management, including weight loss, may be of great importance in the improvement of nocturia.

Urodynamic findings in female patients with nocturia: An age-matched case-control study

INTRODUCTION

Nocturia negatively impacts the quality of life and is associated with poor general health, but our understanding of its etiologies is incomplete. Urodynamic studies (UDS) findings in patients with nocturia are not well described and may help guide management. Our objective was to compare UDS findings with age-matched patients with and without nocturia.

MATERIALS AND METHODS

We retrospectively reviewed UDS findings of 1124 patients (2010-2017). A total of 484 (43%) presented with nocturia and 821 (73%) were female. Female patients were separated into age-matched groups with and without nocturia. Urinary symptoms, past medical diagnoses, demographic information, and UDS findings were compared.

RESULTS

A total of 596 female patients were included, 298 (50%) with nocturia and 298 without. Past medical history, including diabetes mellitus and cardiovascular disease, did not differ between groups. Patients with nocturia were more likely to have pelvic pain (p = 0.0014) and other daytime symptoms (frequency, urgency, and urgency incontinence). On UDS, patients with nocturia were more likely to have bladder outlet obstruction (BOO) (p = 0.025) and dysfunctional voiding (DV) (p < 0.0001). There was no difference in the frequency of detrusor overactivity (DO). Bladder capacity and postvoid residual volumes were lower, though not significantly, in the nocturia group.

CONCLUSIONS

When comparing UDS findings in contemporary, age-matched groups of female patients with and without nocturia, we found only BOO and DV to be associated with nocturia. While the treatment of nocturia is often aimed at managing DO, our data suggest that this may not be the primary urodynamic correlation with nocturia. Further studies are needed to assess whether successful treatment of BOO and DV can improve nocturia.

Nocturia independently predicts left ventricular hypertrophy and left atrial enlargement among patients with cardiac symptoms

Nocturia can be caused by urological disorders and systemic diseases, including heart diseases. We aimed to investigate the relationship between nocturia and structural abnormalities on echocardiography. Adult patients who underwent echocardiography for cardiac symptoms or heart murmur or had a history of structural heart disease were included. The voiding times during sleep hours were collected prospectively. Univariate and multivariate analyses were performed to evaluate the predictive value of bothersome nocturia (nocturia ≥ 2) on echocardiographic abnormalities. Of 299 patients, 182 (60.9%) reported bothersome nocturia. In patients aged ≥ 65 years, hypertension and left atrial enlargement (LAE) were associated with higher occurrences of bothersome nocturia. On multivariate analysis, bothersome nocturia was a predictive factor of LAE (odds ratio [OR] 2.453, 95% confidence interval [CI] 1.363–4.416, p = 0.003). Moreover, bothersome nocturia could predict both LAE and left ventricular hypertrophy (LVH) (OR 2.285, 95% CI 1.151–4.536, p = 0.018; OR 2.056, 95% CI 1.025–4.124, p = 0.043) in the elderly. Older age, hypertension, and LAE were risk factors for bothersome nocturia. Moreover, bothersome nocturia was predictive of LAE and LVH in the elderly. Patients with bothersome nocturia without other significant lower urinary tract symptoms should be referred to cardiologists.

Urination Frequency Ranges in Healthy Women

BACKGROUND

Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts.

OBJECTIVES

This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake.

METHODS

A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake.

RESULTS

Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies.

DISCUSSION

Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.

The Impact of Bariatric Surgery on Nocturia Symptoms: a Systematic Review and Meta-Analysis

There is a significant association between obesity and nocturia, which can cause a significant negative impact on quality of life. This meta-analysis aims to determine the effects of bariatric surgery on nocturia in both men and women. Studies searched via MEDLINE and Embase databases. The primary outcome was difference in nocturia scores before and after bariatric surgery. A total of 522 patients were included in the analysis of this paper. Statistically significant decreases in nocturia scores were observed post-bariatric surgery. Bariatric surgery also resulted in statistically significant reduction of BMI. Bariatric surgery can have significant improvements on nocturia symptoms in men and women with obesity. This would thereby reduce morbidity and improve quality of life following bariatric surgery.

The Relationship Between Nocturia and Mortality: Data From the National Health and Nutrition Examination Survey

Purpose

We investigated the relationship between nocturia and mortality risk in the United States.

Methods

Data were obtained from the National Health and Nutrition Examination Survey 2005–2010. Mortality data were obtained by linking the primary database to death certificate data found in the National Death Index with mortality follow-up up to December 31, 2015. Nocturia was defined based on symptoms reported in the symptom questionnaire. We categorized patients into 2 groups: mild nocturia (2–3 voids/night) and moderate-to severe nocturia (≥4 voids/night). Multiple Cox regression analyses were performed with adjustment for confounding variables at the baseline survey.

Results

This study included 9,892 adults (4,758 men, 5,134 women). Nocturia occurred in 3,314 individuals (33.5%). Nocturia was significantly associated with all-cause mortality (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.10–1.39) and cardiovascular disease (CVD) mortality (HR, 1.55; 95% CI, 1.19–2.01). Moreover, the mortality risk increased with increasing nocturia severity. Further analysis with propensity score matching showed that nocturia was still significantly associated with all-cause mortality and CVD mortality. In subgroup analysis according to sex, nocturia was significantly associated with allcause mortality and CVD mortality in men. In women, moderate-to-severe nocturia was significantly associated with allcause mortality and CVD mortality. In subgroup analysis according to cardio-metabolic diseases, nocturia was associated with CVD mortality in patients with diabetes mellitus, hypertension, dyslipidemia, or CVD at baseline. In subgroup analysis of patients without diabetes mellitus, hypertension or CVD, nocturia was significantly associated with all-cause mortality.

Conclusions

Nocturia was significantly associated with mortality in men and women after adjusting for major confounding factors.

Gender-specific predictive ability for the risk of hypertension incidence related to baseline level or trajectories of adiposity indices: a cohort study of functional community

BACKGROUND

Early prevention of hypertension is important for global cardiovascular disease morbidity and mortality. This study aims to explore better predictors for hypertension incidence related to baseline level or trajectories of adiposity indices, as well as the gender-specific effect.

METHODS

6085 subjects from a functional community cohort in urban Beijing participated in our study. Restricted cubic splines were used to estimate nonlinear associations of body mass index (BMI) and waist-to-height ratio (WHtR) as continuous variable with risk of hypertension. Stepwise logistic regression model was performed to estimate the relative risks (RRs) of adiposity indices and metabolic status, adjusted for covariates. Nomogram models and receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of BMI trajectory groups and WHtR trajectory groups on hypertension incidence. Further, all analysis were performed by gender.

RESULTS

The risk of hypertension incidence was related to BMI trajectory groups (persistent overweight: RR = 1.88, 95% CI: 1.48-2.37; persistent obesity: RR = 2.79, 95% CI: 2.18-3.56; persistent the highest: RR = 4.30, 95% CI: 3.20-5.78) and WHtR trajectory groups (persistent medium: RR = 2.69, 95% CI: 2.07-3.50; persistent high: RR = 3.85, 95% CI: 2.92-5.09; increasing to higher: RR = 7.00, 95% CI: 4.96-9.89). In total population, BMI trajectories and WHtR trajectories showed similar ability to predict the risk of hypertension incidence with AUC 0.723 and 0.726, respectively. After stratified by gender, both BMI trajectories and WHtR trajectories showed higher power in female than male (BMI trajectories: 0.762 vs. 0.661; WHtR trajectories: 0.768 vs. 0.661).

CONCLUSIONS

BMI and WHtR trajectories have higher predictive power for hypertension incidence compared to baseline data. Females are more vulnerable to obesity than males.

The predictive factors of nocturia in young Asian adult males: an online survey

The present study investigated the association between severity of depressive mood and nocturia in young Asian adult men. Participants were 3127 adult male Facebook users aged 20–40 years who could read and write traditional Chinese. Participants completed online questionnaires on demographic characteristics, frequency of waking to urinate during the night (International Prostate Symptoms Score [IPSS]), and frequency of depressive symptoms (Taiwanese Depression Questionnaire [TDQ]). Those who awoke to pass urine during the main sleep period were considered to have nocturia. Student’s t test and Pearson’s chi square test were used to compare participants with and without nocturia. Univariate and multivariate logistic regression were used to evaluate predictive factors for nocturia. One thousand four hundred thirty (45.7%) participants had nocturia, and 21.9% were suspected to have depression. Age over 30 years, body mass index over 25 kg/m², and higher IPSS score (except times of nocturnal voiding) were factors predictive of nocturia. Higher TDQ somatic subscores, rather than affective/cognitive subscores, were also predictive of nocturia. Associations were found between normal-high TDQ scores and nocturia. Young men with nocturia at risk of developing depression should be identified with a culturally relevant questionnaire. Early referral for psychiatric assessment and intervention may be warranted.

Association of nocturia and cardiovascular disease: Data from the National Health and Nutrition Examination Survey

AIMS

To investigate the association of nocturia with the prevalence of cardiovascular disease (CVD) using the National Health and Nutrition Examination Survey (NHANES) data.

METHODS

Among the 40 790 individuals who participated in NHANES from 2005 to 2012, 14 114 adults were analyzed in this study. A participant was considered to have nocturia if they have two or more voiding episodes nightly. In addition, participants with nocturia more than four times in a day were considered to have severe nocturia. A multivariate logistic regression analysis with adjustment for confounding variables, including age, sex, race, body mass index (BMI), smoking status, alcohol consumption, sleeping time, dyslipidemia, hypertension, and diabetes mellitus was performed with 1:1 propensity score matching (PSM).

RESULTS

Nocturia occurred in 4610 individuals (32.7%). The prevalence of CVD was significantly higher in men, older individuals, those with higher BMI, smokers, and those with diabetes, hypertension, and hyperlipidemia. There was also a significantly higher prevalence of nocturia in the participants with CVD. Multivariate analysis showed that odds ratios (ORs) of mild and severe nocturia for CVD were 1.23 (95% confidence interval [CI]: 1.08-1.39) and 1.74 (95% CI: 1.39-2.17), respectively. After 1:1 PSM, the ORs of mild and severe nocturia were 1.27 (95% CI: 1.10-1.48) and 1.73 (95% CI: 1.33-2.26), respectively, showing statistical significance.

CONCLUSION

Data from the NHANES indicate that CVD was significantly associated with the prevalence of nocturia, after taking major confounding factors into account. Furthermore, the risk for CVD increases with increasing nocturia severity.

Potential associations of adult nocturia. Results from a national prevalence study

AIM

To determine the prevalence of nocturia and associated risk factors in the Colombian population aged ≥18 years old.

METHODS

This is a cross-sectional population-based study conducted in 1060 participants in Colombia. Nocturia was assessed with the Spanish version of the ICIQ-OAB, using the ICS terminology. Descriptive statistics were used to evaluate nocturia prevalence. Logistic regression analysis was carried out to determine the association of nocturia with predefined variables.

RESULTS

The prevalence of nocturia was 55.9% and it was more common in women than men (53.96% vs. 46.04%; p = .004). At least three episodes of nocturia were observed in 20.37% of the participants who had a severe alteration in their quality of life (p < .01). The bivariate model showed an association between nocturia and obesity (odds ratio [OR], 1.69; 90% confidence interval [CI]: 1.22-2.34), diabetes mellitus (OR, 2.99; 90% CI: 1.86-4.83), high blood pressure (OR, 2.04; 90% CI: 1.52-2.72), cardiovascular disease (OR, 1.75; 90% CI: 1.08 - 2.83), depression (OR, 1.89; 90% CI: 1.23-2.89), obstructive sleep apnea (OR, 1.70; 90% CI: 1.17 - 2.46), and childhood enuresis (OR, 1.45; 90% CI: 1.04-2.02). The multivariate model showed an association with obesity (OR, 2.0; 95% CI: 1.14 - 3.51) in women, as well as age ≥ 65 years (OR, 3.18; 95% CI: 1.26 - 8.02) and erectile dysfunction (OR, 3.44; 95% CI: 1.21 - 9.72) in men. Childhood enuresis was significantly associated with nocturia in both genders (OR, 1.61; 95% CI: 1.09 - 2.40 in women and OR, 1.66; 95% CI: 1.09-2.52 in men).

CONCLUSION

There is a significant prevalence of nocturia in our population and a clear association with impaired quality of life. We consider important to inquire about history of childhood enuresis to define the risk of presenting nocturia in adulthood. Nocturia was associated with multiple comorbidities. Obesity and erectile dysfunction play an important role as modifiable risk factor.

Nocturia is Associated with High Atherosclerotic Cardiovascular Disease Risk in Women: Results from the National Health and Nutrition Examination Survey

Growing evidence has identified nocturia as a potential manifestation of several cardiovascular disease states. We aimed to determine whether a relationship exists between nocturia and global atherosclerotic cardiovascular disease (ASCVD) risk, defined by the American College of Cardiology/American Heart Association (ACC/AHA) ASCVD risk calculator, using a large nationally-representative study sample from the United States. We explored potential associations between nocturia and ASCVD risk in adults aged 40-79 years with no prior history of overt/known atherosclerotic disease from 7 consecutive cycles of the National Health and Nutrition Examination Survey. Subjects were classified by whether they met the ASCVD high-risk threshold following current ACC/AHA consensus guidelines (10-year major adverse cardiovascular event risk ≥ 20%). Logistic regression analyses were used to explore associations between nocturia (defined as ≥ 2 nocturnal voids) and ASCVD risk. The prevalence of nocturia and high ASCVD risk were 27.0% and 10.9%, respectively. Nocturia, older age, increased body mass index, and diuretic use were associated with high ASCVD risk on univariate logistic regression. After adjusting for age, body mass index, and diuretic use, nocturia remained associated with significantly greater odds of high ASCVD risk in females but not in males. Elicitation of nocturia on clinical history taking may serve to identify high cardiovascular risk in females. Future studies are needed to elucidate mechanisms underlying this association.

Polysomnography and Nocturia Evaluations after Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome

A higher incidence rate of nocturia in patients with obstructive sleep apnea (OSA) has been observed. We investigated the differences in clinical examinations between OSA patients with and without nocturia, and further compared those with successful and unsuccessful uvulopalatopharyngoplasty (UPPP). This retrospective study enrolled 103 patients with OSA undergoing UPPP. Patients were diagnosed with OSA by following the 2018 American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.5. Patients were divided into two groups depending on if they urinated more than twice per night. The medical data of body mass index (BMI), nocturia frequency per night, apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), International Prostatic Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS) were analyzed before and after uvulopalatopharyngoplasty (UPPP) surgery. All of the measurements were compared between successful and unsuccessful surgery in the non-nocturia or nocturia groups, respectively. Fifty patients (41 males and nine females) without nocturia were assigned to group 1, and 53 patients (43 males and 10 females) with nocturia were assigned to group 2. Nocturia frequency and post-surgery AHI in group 2 were significantly higher than those in group 1 (p < 0.05). Significant decreases in IPSS and OABSS were observed in the successful surgery subgroup of group 2 (p < 0.05). A significant decrease in post-surgery AHI was observed between unsuccessful and successful surgery in patients with nocturia (p < 0.05), but not in the non-nocturia group (p > 0.05). Although AHI had a significant correlation to nocturia frequency in all OSA patients before UPPP, no significant correlation between AHI reduction and nocturia frequency was found. UPPP appeared to be an effective treatment for nocturia associated with OSA. OSA should be taken into consideration for patients who complain of nocturia syndrome. The relationship of AHI reduction and nocturia improvement after OSA treatment with UPPP is still unclear. In addition, it is necessary to establish the existence of nocturia in patients with OSA, as a result of its high prevalence in OSA patients. UPPP could reduce the symptoms of OSA and could also contribute to a reduction of nocturia even in the unsuccessful surgery group.

Trends and prevalence of nocturia among US adults, 2005-2016

PURPOSE

Increased nocturia episodes can be a clinical marker of poor health status. The present study aimed to evaluate patterns and temporal trends in nocturia and sociodemographic and lifestyle correlates in the US population.

METHODS

Participants, aged 20 years or older, were included in this repeated cross-sectional study. The National Health and Nutrition Examination Survey from 2005 to 2016 was used. Participants were asked "During the past 30 days, how many times per night did you most typically get up to urinate, from the time you went to bed at night until the time you got up in the morning?". Individuals were categorized as either ≥ 1 nocturia episode or ≥ 2 nocturia episodes per night.

RESULTS

The estimated prevalence of ≥ 1 nocturia was high among men (20-39 years, 56.8%; 40-59 years, 70.2%; ≥ 60 years, 82.7%) and women (20-39 years, 68.9%; 40-59 years, 74.3%; ≥ 60 years, 84.7%), particularly in Non-Hispanic-blacks. From 2005-2016, the trends in prevalence of ≥ 1 nocturia increased for the age groups 20-39 and 40-59 years among men (p < 0.001 and p = 0.001, respectively) and women 20-39 and 40-59 years (p < 0.001 and p = 0.032, respectively), but a stable trend was observed among men and women who were 60 years and older (p = 0.814, and p = 0.64, respectively). A significant increasing trend of ≥ 2 nocturia episodes was observed among men only aged 40-59 years (p = 0.007).

CONCLUSIONS

From 2005 through 2016, the secular trend in the frequency of nocturia increased in both men and women in general, which was significant under the age of 60 years, particularly in Non-Hispanic-blacks.