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Nocturic Episodes in Patients with Benign Prostatic Enlargement May Suggest the Presence of Obstructive Sleep Apnea

By H.Tandeter, S. Sammy, J. Dreiher and A. Tarasiuk

Journal of the American Board of Family Medicine, March-April 2011, Volume 24, Issue 2, Pages 146-151

Editor’s comments:
In recent years it was clear that nocturia is related to obstructive sleep apnea (OSA).  A retrospective review of clinical and laboratory polysomnographic data revealed that nocturia is common among patients with OSA, and that OSA is an independent cause of frequent urination during sleep among elderly men.In the study the authors investigated whether primary care patients with nocturia attributed to Benign prostatic Enlargement have a higher prevalence of symptoms of OSA which could explain nocturnal waking to void. Their hypothesis was that patients urinate when they wake up (even ifpatients do not feel the need to urinate they go to the bathroom anyway) rather than wake up because they need to urinate. The study included men between the ages of 55 and 75 years who had been diagnosed with BPH  and reported nocturia at least once per night. The results of the study confirmed the authors’ hypothesis: patients affected by OSA awake from their primary sleep disorder and feel the need to urinate, and also supported the results of previous studies showing improvement of nocturia in OSA patients after institution of continuous positive airway pressure therapy.  To explain the possible physiopathologic mechanism of this phenomenon, the authors reported previous explanations represented by a possible release of atrial natriuretic peptide because of cardiac distension in OSA patients, or an abnormal renal function related to hypoxemia during sleep.

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Abstract

Background: 
Nocturia is a common symptom of benign prostatic enlargement (BPE) that is generally attributed to a urologic pathology. This study assessed whether nocturia severity in BPE patients may be related to an underlying sleep disorder.

Methods:
Cross-sectional study based in urban community primary care clinics. Study population included men aged 55 to 75 years old. The research group included patients with documented BPE and nocturia of at least once per night versus a comparison group without BPE and with either no or one nocturia episode per night. The presence of symptoms of obstructive sleep apnea (SOSA) was assessed using the Berlin questionnaire.

Results:
Patients with BPE were significantly more likely to report weight gain (21% vs 10%), loudness of snoring (22.6% vs 4%), daytime sleepiness (35.3% vs 12.0%), and hypertension (61.8% vs 41.0%). Fifty-nine patients (57.8%) in the research group were considered high risk for OSA compared with 31 patients (31.0%) from the comparison group (P < .001). The odds ratio (OR) for SOSA gradually increased from 1.00 in patients reporting no nocturia to 2.44, 5.75, and 12.3 in patients reporting 1, 2 to 3, and >3 episodes of nocturia per night, respectively.

Conclusion:
The odds for SOSA increased log-linearly in correlation with the number of nocturia episodes. We imply that nocturic episodes in patients with BPE may suggest the presence of OSA. Physicians following patients with BPE who report frequent awakenings from sleep to urinate should suspect OSA as a possible comorbidity.