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Sleep related problems and urological symptoms: Testing the hypothesis of bidirectionality in a longitudinal, population based study

By A.B. Araujo, H.K. Yaggi, M. Yang, K.T. McVary, S.C. Fang and D.L. Bliwise

Journal of Urology, Volume 191, Issue 1, January 2014, Pages 100-106

Editor’s comments:
When discussing the relationship between disturbed sleep and nocturia, two primary hypotheses emerge. The first perspective, embraced most typically by those in sleep medicine, is that poor sleep quality and discontinuous sleep and that these predispose a person to awaken, arise from bed and then void. The second perspective, more customarily acknowledged by urologists, is that nocturia may itself cause the awakening from sleep, because of afferent stimulation induced by an overactive or full bladder. Cross-sectional surveys remain mired attempting to discern cause and effect in this situation, since, by their very nature, they can demonstrate mere associations. Head-to-head pharmacologic comparisons between sleep-maintenance medications and drug operating on urine production or bladder activity could represent a more direct attempt to infer causality, but such studies are essentially non-existent. Observational studies of natural history of sleep and urologic symptoms over time offer yet another viable possibility for teasing out causality. If individuals with sleep complaints (but not nocturia) develop nocturnal voiding over time, one might cautiously infer that poor sleep predisposes to nocturnal urination. Conversely, if nocturia exists in the absence of frank sleep complaints but the latter develop in individuals over time, this might be reason to infer that nocturia leads to poor sleep. In this study, we found that, within a large, population-based (c.f., clinic-based) cohort (BACH) studied over 5-year intervals, evidence exists for both models, i.e., nocturia both disturbs sleep and poor sleep predisposes for nocturnal voiding. Improved patient care should clearly acknowledge both relevant pathways.