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Jeffrey P Weiss - One of the best experts on this subject based on the ideXlab platform.
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ICI-RS 2019 Nocturia think tank: How can experimental science guide us in understanding the pathophysiology of Nocturia?
Neurourology and urodynamics, 2020Co-Authors: Bahareh Vahabi, Rita Jabr, Chris Fry, Karen Mccloskey, Karel Everaert, Christina W Agudelo, Thomas F Monaghan, Mohammad S Rahnama'i, Jalesh N Panicker, Jeffrey P WeissAbstract:The following is a report on the proceedings of the 2019 International Consultation on Incontinence-Research Society Nocturia think tank (NTT). The objectives of the 2019 NTT were as follows: (a) to evaluate the role of urothelium in the pathophysiology of Nocturia; (b) to determine whether Nocturia is a circadian disorder; (c) to discuss the role of melatonin in Nocturia; (d) to consider ambulatory urodynamic monitoring in evaluating patients with Nocturia; (e) to explore studies of water handling in human compartments utilizing heavy water; and (f) to explore whether basic science is the key to understanding the treatment options for diminished bladder capacity in patients with Nocturia. A compendium of discussions of the role of experimental science in understanding the pathophysiology of Nocturia is described herein. Translational science will play an increasing role in understanding the pathophysiology of Nocturia, which may result in improved treatment strategies. © 2020 Wiley Periodicals, Inc.
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ICI-RS 2019 Nocturia think tank: How can experimental science guide us in understanding the pathophysiology of Nocturia?
Neurourology and Urodynamics, 2020Co-Authors: Bahareh Vahabi, Rita Jabr, Karel Everaert, Christina W Agudelo, Thomas F Monaghan, Mohammad S Rahnama'i, Jalesh N Panicker, Christopher H. Fry, Karen D. Mccloskey, Jeffrey P WeissAbstract:© 2020 Wiley Periodicals, Inc. Introduction: The following is a report on the proceedings of the 2019 International Consultation on Incontinence-Research Society Nocturia think tank (NTT). Objectives: The objectives of the 2019 NTT were as follows: (a) to evaluate the role of urothelium in the pathophysiology of Nocturia; (b) to determine whether Nocturia is a circadian disorder; (c) to discuss the role of melatonin in Nocturia; (d) to consider ambulatory urodynamic monitoring in evaluating patients with Nocturia; (e) to explore studies of water handling in human compartments utilizing heavy water; and (f) to explore whether basic science is the key to understanding the treatment options for diminished bladder capacity in patients with Nocturia. Methods: A compendium of discussions of the role of experimental science in understanding the pathophysiology of Nocturia is described herein. Results and Conclusions: Translational science will play an increasing role in understanding the pathophysiology of Nocturia, which may result in improved treatment strategies.
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Management Strategies for Nocturia.
Current urology reports, 2019Co-Authors: Danielle J Gordon, Curran J. Emeruwa, Jeffrey P WeissAbstract:Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of Nocturia is multifactorial and management remains a challenge. Herein, we provide an overview of the management strategies for Nocturia and summarize the existing evidence for treatment of Nocturia across the condition’s broad etiologic categories: nocturnal polyuria, diminished bladder capacity, and global polyuria. Treatment should begin with behavioral modification. A high level of evidence supports the efficacy of desmopressin in the treatment of nocturnal polyuria. Data supporting the efficacy of α-blockers, antimuscarinics, and surgical bladder outlet procedures in the treatment of Nocturia remains limited. Treatment options for Nocturia are determined by underlying mechanism. Desmopressin is effective in treating nocturnal polyuria. Surgical intervention, α-blockers, and antimuscarinics may improve Nocturia when associated with lower urinary tract symptoms or overactive bladder in the setting of diminished bladder capacity.
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current guidelines and treatment paradigms for nocturnal polyuria a new disease state for us physicians patients and payers
International Journal of Clinical Practice, 2019Co-Authors: Eric S W Li, Viktor Flores, Jeffrey P WeissAbstract:: Nocturia is one of the most bothersome symptoms encountered in urology, and its prevalence rises with age. Causes include both urological and non-urological aetiologies, often in combination. The effects of Nocturia on a patient's quality of life can be detrimental. The initial approach to managing this condition includes appropriately classifying Nocturia based on the results of a 24-hour bladder diary. Broadly, the categories under which Nocturia can be classified include: low nocturnal or global bladder capacity, nocturnal polyuria, global polyuria and mixed.Based on the type of Nocturia and possible underlying causes, clinicians can appropriately discuss with patients the treatment plans that may include a combination of behavioural, pharmacologic, and invasive therapy. The available literature on the management of Nocturia was reviewed. Findings were incorporated into a practice-based approach for its workup and treatment.
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Nocturia as an unrecognized symptom of uncontrolled hypertension in black men aged 35 to 49 years
Journal of the American Heart Association, 2019Co-Authors: Ronald G Victor, Jeffrey P Weiss, Ciantel A Blyler, Oneil Mason, Cindy L Chang, Norma B Moy, Mohammad A Rashid, Joel Handler, Jeffrey Brettler, Michael B SagisiAbstract:Background Hypertension is assumed to be asymptomatic. Yet, clinically significant Nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to Nocturia because of blunted nocturnal blood pressure ( BP ) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to Nocturia. Here, we test the hypothesis that Nocturia is a common and potentially reversible symptom of uncontrolled hypertension in black men. Methods and Results We determined the strength of association between Nocturia (≥2 nightly voids) and high BP (≥135/85 mm Hg) by conducting in-person health interviews and measuring BP with an automated monitor in a large community-based sample of black men in their barbershops. Because Nocturia is prevalent and steeply age-dependent after age 50 years, we studied men aged 35 to 49 years. Among 1673 black men (mean age, 43±4 years [ SD ]), those with hypertension were 56% more likely than men with normotension to have Nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95% CI , 1.25-1.94 [ P<0.0001]). Nocturia prevalence varied by hypertension status, ranging from 24% in men with normotension to 49% in men whose hypertension was medically treated but uncontrolled. Men with untreated hypertension were 39% more likely than men with normotension to report Nocturia ( P=0.02), whereas men whose hypertension was treated and controlled were no more likely than men with normotension to report Nocturia ( P=0.69). Conclusions Uncontrolled hypertension was an independent determinant of clinically important Nocturia in a large cross-sectional community-based study of non-Hispanic black men aged 35 to 49 years. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unqiue identifier: NCT 02321618.
Theodore M Johnson - One of the best experts on this subject based on the ideXlab platform.
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differences in the association of Nocturia and functional outcomes of sleep by age and gender a cross sectional population based study
Clinical Therapeutics, 2016Co-Authors: Camille P Vaughan, Theodore M Johnson, Constance H Fung, Alison J Huang, Alayne D MarklandAbstract:Abstract Purpose Nocturia is associated with poor sleep quality; however, little is known about the relationship between Nocturia and sleep quality across different workforce-relevant age groups of adults. This has implications for developing new treatment strategies that are well tolerated across populations. Methods We conducted a cross-sectional study involving merged data from the 2005–2006 and 2007–2008 waves of the National Health and Nutrition Examination Survey. Participants responded to validated questions on Nocturia frequency and sleep from the Functional Outcomes of Sleep Questionnaire General Productivity subscale (FOSQ-gp, range 1–4). Analyses included multivariable linear regression with stratification by gender to examine associations between Nocturia frequency (higher worse) and the FOSQ-gp scores (lower scores indicating worse daytime function related to sleep disturbance). Findings Of 10,512 adults aged ≥20 years who completed the survey, 9148 (87%) had complete Nocturia and FOSQ-gp data. The population age-adjusted prevalence of Nocturia at least twice nightly was 21.1% among men and 26.6% among women ( P P 65 years) with greater Nocturia frequency reported worse FOSQ-gp scores compared with younger adults with similar Nocturia frequency ( P Implications In a population-based sample of community-dwelling men and women, the association between Nocturia and worsened functional outcomes of sleep was greater among adults older than 65 years—a group more vulnerable to drug side effects, and in whom Nocturia is typically multifactorial. Additionally, these analyses found that the association between Nocturia and functional outcomes of sleep is stronger with increasing age among men. Effective treatment strategies that are well tolerated by older adults, such as multicomponent treatments that simultaneously address the combined effects of lower urinary tract and sleep dysfunction, are needed.
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efficacy of adding behavioural treatment or antimuscarinic drug therapy to α blocker therapy in men with Nocturia
BJUI, 2013Co-Authors: Theodore M Johnson, Alayne D Markland, Patricia S Goode, Camille P Vaughan, Janet Colli, Joseph G Ouslander, David T Redden, Gerald Mcgwin, Kathryn L BurgioAbstract:What's known on the subject? and What does the study add? Nocturia is a common and bothersome lower urinary tract symptom, particularly in men. Many single drug therapies have limited benefit. For men who have persistent Nocturia despite alpha-blocker therapy, the addition of behavioural and exercise therapy is statistically superior to anticholinergic therapy. Objective To compare reductions in Nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to α-adrenergic antagonist (α-blocker) therapy in men. Patients and Methods Participants were men who had continuing urinary frequency >8 voids/day) and urgency after 4 weeks of α-blocker therapy run-in and who had ≥1 nightly episode of Nocturia. Participants received individually titrated drug therapy (extended-release oxybutynin) or multicomponent behavioural treatment (pelvic floor muscle training, delayed voiding and urge suppression techniques). Seven-day bladder diaries were used to calculate reductions in mean Nocturia. Results A total of 127 men aged 42–88 years with ≥1 Nocturia episode per night were included in the study. There were 76 men who had a mean of ≥2 Nocturia episodes. Among those with ≥1 Nocturia episode, behavioural treatment reduced nightly Nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (mean reduction = 0.56 episodes; P = 0.01). Participants with ≥2 episodes Nocturia at baseline also showed larger changes with behavioural treatment compared with antimuscarinic therapy (mean reduction = 1.26 vs 0.61; P = 0.008). Conclusions Both behavioural treatment and drug therapy reduced Nocturia in men with ≥1 episode of Nocturia/night when added to α-blocker therapy. These results were similar even when only those with ≥2 episodes of Nocturia were considered. The addition of behavioural treatment was statistically better than bladder-relaxant therapy for Nocturia.
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Nocturia frequency bother and quality of life how often is too often a population based study in finland
European Urology, 2010Co-Authors: Kari A O Tikkinen, Theodore M Johnson, Teuvo L J Tammela, Harri Sintonen, Jari Haukka, Heini Huhtala, Anssi AuvinenAbstract:Abstract Background Nocturia (ie, waking at night to void) is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless, yet the justification for this belief remains weak. Objective To evaluate the association among frequency of Nocturia and bother and health-related quality of life (HRQoL). Design, setting, and participants In 2003–2004, a survey was mailed to a random sample of 6000 subjects aged 18–79 yr who were identified from the Finnish Population Register Centre (response proportion was 62.4%; 53.7% were females). Measurements HRQoL and bother from Nocturia were examined in relation to self-reported Nocturia frequency (using the American Urological Association Symptom Index and the Danish Prostatic Symptom Score). Bother from Nocturia was assessed on a four-point scale (none, small, moderate, major). HRQoL was measured with the generic 15D instrument on a 0–1 scale with a minimum clinically important difference of 0.03. Results and limitations Degree of bother increased with Nocturia frequency ( p Conclusions At least two voids per night is associated with impaired HRQoL. The majority of people report having bother when the number of Nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from Nocturia and, thus, is not a suitable criterion for clinically relevant Nocturia.
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a multicomponent behavioural and drug intervention for Nocturia in elderly men rationale and pilot results
BJUI, 2009Co-Authors: Camille P Vaughan, Joseph G Ouslander, Yohannes W Endeshaw, Zobair Nagamia, Theodore M JohnsonAbstract:OBJECTIVES To evaluate the number of medical and urological conditions associated with Nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce Nocturia and its bother. SUBJECTS AND METHODS Men aged ≥50 years and with two or more episodes of Nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for Nocturia. Outcome measures included self-reported Nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries. RESULTS Fifty-five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to Nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded Nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a ‘medium’ to a ‘very small’ problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep). CONCLUSIONS Given that individual older patients often have multiple coexistent risk factors for Nocturia, identifying a principal cause of Nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced Nocturia frequency, bother from Nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.
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evaluating potentially modifiable risk factors for prevalent and incident Nocturia in older adults
Journal of the American Geriatrics Society, 2005Co-Authors: Theodore M Johnson, Richard W Sattin, Patricia Parmelee, Nancy H Fultz, Joseph G OuslanderAbstract:OBJECTIVES: To examine associations between Nocturia and potentially modifiable risk factors in older adults. DESIGN: Secondary analysis of cross-sectional and longitudinal data. SETTING: Respondents were selected using populationbased sampling, drawing from a single Michigan county in 1983. They were followed through 1990. PARTICIPANTS: Community-living adults aged 60 and older. MEASUREMENTS: Episodes of Nocturia, development of Nocturia at 2 years after baseline survey, age, sex, hypertension, diabetes mellitus, drinking fluids before bedtime, amount of fluid intake before bedtime, diuretic use, and 24-hour coffee intake. All measures were self-reported. RESULTS: Bivariate cross-sectional analysis revealed significant associations with two or more episodes of Nocturia for hypertension (odds ratio (OR) 51.7, 95% confidence interval (CI) 51.37‐2.1), diabetes mellitus (OR 51.51, 95% CI 51.1‐2.0), diuretic use (OR 51.7, 95% CI 51.3‐ 2.1), age (OR 51.05 per additional year over 60, 95% 1.03‐1.06), and number of cups of coffee (OR 50.93 for each cup of coffee, 95% CI 50.89‐0.97). In multivariate analysis, hypertension (OR 51.52, 95% CI 51.2‐1.9), diuretic use (OR 51.3, 95% 95% CI 51.0‐1.7), and age (OR 51.04 per additional year over 60, 95% 1.03‐1.06) were independently associated with two or more Nocturia episodes per night. No baseline factors predicted future development of Nocturia (save for age, in one model). CONCLUSION: Hypertension, older age, and diuretic use were independently associated with two or more episodes of Nocturia in cross-sectional analysis. No baseline factor was related to the development of Nocturia over a 2-year interval in this sample. Nighttime fluid intake and coffee intake, practices providers commonly target in patients with Nocturia, were not associated with Nocturia in this population-based sample of community-living older adults. J Am Geriatr Soc 53:1011‐1016, 2005.
Karel Everaert - One of the best experts on this subject based on the ideXlab platform.
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ICI-RS 2019 Nocturia think tank: How can experimental science guide us in understanding the pathophysiology of Nocturia?
Neurourology and urodynamics, 2020Co-Authors: Bahareh Vahabi, Rita Jabr, Chris Fry, Karen Mccloskey, Karel Everaert, Christina W Agudelo, Thomas F Monaghan, Mohammad S Rahnama'i, Jalesh N Panicker, Jeffrey P WeissAbstract:The following is a report on the proceedings of the 2019 International Consultation on Incontinence-Research Society Nocturia think tank (NTT). The objectives of the 2019 NTT were as follows: (a) to evaluate the role of urothelium in the pathophysiology of Nocturia; (b) to determine whether Nocturia is a circadian disorder; (c) to discuss the role of melatonin in Nocturia; (d) to consider ambulatory urodynamic monitoring in evaluating patients with Nocturia; (e) to explore studies of water handling in human compartments utilizing heavy water; and (f) to explore whether basic science is the key to understanding the treatment options for diminished bladder capacity in patients with Nocturia. A compendium of discussions of the role of experimental science in understanding the pathophysiology of Nocturia is described herein. Translational science will play an increasing role in understanding the pathophysiology of Nocturia, which may result in improved treatment strategies. © 2020 Wiley Periodicals, Inc.
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ICI-RS 2019 Nocturia think tank: How can experimental science guide us in understanding the pathophysiology of Nocturia?
Neurourology and Urodynamics, 2020Co-Authors: Bahareh Vahabi, Rita Jabr, Karel Everaert, Christina W Agudelo, Thomas F Monaghan, Mohammad S Rahnama'i, Jalesh N Panicker, Christopher H. Fry, Karen D. Mccloskey, Jeffrey P WeissAbstract:© 2020 Wiley Periodicals, Inc. Introduction: The following is a report on the proceedings of the 2019 International Consultation on Incontinence-Research Society Nocturia think tank (NTT). Objectives: The objectives of the 2019 NTT were as follows: (a) to evaluate the role of urothelium in the pathophysiology of Nocturia; (b) to determine whether Nocturia is a circadian disorder; (c) to discuss the role of melatonin in Nocturia; (d) to consider ambulatory urodynamic monitoring in evaluating patients with Nocturia; (e) to explore studies of water handling in human compartments utilizing heavy water; and (f) to explore whether basic science is the key to understanding the treatment options for diminished bladder capacity in patients with Nocturia. Methods: A compendium of discussions of the role of experimental science in understanding the pathophysiology of Nocturia is described herein. Results and Conclusions: Translational science will play an increasing role in understanding the pathophysiology of Nocturia, which may result in improved treatment strategies.
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Questions to ask a patient with Nocturia.
Australian journal of general practice, 2018Co-Authors: Wendy Bower, Karel Everaert, Tee J Ong, Claire F Ervin, J.p. Nørgaard, Michael WhishawAbstract:BACKGROUND Patients may not raise Nocturia as a concern as they mistakenly consider the symptom to be a normal part of ageing. Nocturia is associated with significant morbidity and is likely to be a marker of poor health. OBJECTIVE This paper provides questions to guide diagnosis, evaluation and individualised treatment of Nocturia. DISCUSSION Nocturia results from the interplay between nocturnal polyuria, reduced bladder storage and sleep disruption. Changes in the function of the urinary bladder, kidneys, brain and cardiovascular system, and hormone status underlie the development and progression of Nocturia. Medications commonly prescribed to older people can affect development or resolution of Nocturia. The bother caused to a patient by waking to void relates to disturbance of slow-wave sleep, the physical act of getting out of bed and resulting chronic fatigue. An assessment process that identifies relevant and co-existing causes of an individual's Nocturia will facilitate a targeted approach to treatment.
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how can we develop a more clinically useful and robust algorithm for diagnosing and treating Nocturia ici rs 2017
Neurourology and Urodynamics, 2018Co-Authors: Karel Everaert, Roger R Dmochowski, Alan J Wein, Wendy Bower, Francois Herve, J C Djurhuus, Noam Fine, Michel Wyndaele, Jeffrey P WeissAbstract:Aims: Nocturia, or waking up at night to void, is a highly prevalent and bothersome symptom. Currently, there is a lack of clear and consistent recommendations regarding evaluation and management of Nocturia. The aim of this report is to discuss how to fill the gaps in our knowledge in order to develop a practical patient-oriented diagnostic and therapeutic algorithm for Nocturia. Methods: This paper is a report of the presentations and subsequent discussion of a Think Tank session at the annual International Consultation on Incontinence Research Society (ICI-RS) in June 2017 in Bristol. Results and Conclusion: Further investigations are needed to better understand the pathophysiology of Nocturia, to allow improvement in diagnosis, and to optimize treatment by increasing efficacy and reducing adverse events. Patient-oriented practical guidelines on Nocturia are needed to help clinicians from different disciplines diagnose and treat Nocturia.
Camille P Vaughan - One of the best experts on this subject based on the ideXlab platform.
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Sleep and Nocturia in Older Adults
Sleep medicine clinics, 2017Co-Authors: Camille P Vaughan, Donald L. BliwiseAbstract:Older adults frequently experience Nocturia and sleep disturbance concurrently, and problems with sleep resulting from Nocturia are a major factor accompanying the bother associated with Nocturia. A multicomponent treatment strategy is usually warranted. Initial treatment includes lifestyle modification and behavioral treatment with consideration of pelvic floor muscle exercise-based therapy. Early evidence suggests that behavioral treatment results in similar Nocturia reductions compared with the most frequently used drug therapies. Providers should consider formal sleep evaluation if initial treatment strategies for Nocturia do not result in significant improvement, because specific sleep disorders may predispose to Nocturia.
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Nocturia is associated with poor sleep quality among older women in the study of osteoporotic fractures
Journal of the American Geriatrics Society, 2017Co-Authors: Constance H Fung, Alayne D Markland, Camille P Vaughan, Donald L. Bliwise, Alison J Huang, Michael N Mitchell, Sonia Ancoliisrael, Susan Redline, Cathy A Alessi, Katie L StoneAbstract:Objectives (1) To examine relationships between frequency of Nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of Nocturia. Design and setting Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). Participants Community-dwelling women aged ≥80 years. Measurements Frequency of Nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). Results Of 1,520 participants, 25% (n = 392) reported their Nocturia frequency was 3–4 times/night and an additional 60% (n = 917) reported their Nocturia frequency was 1–2 times/night. More frequent Nocturia was associated with poor sleep quality (3–4/night: 26.8% reported fairly bad or very bad sleep quality; 1–2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3–4/night: 89.8 minutes; 1–2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a Nocturia frequency of 3–4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of Nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R2 = 0.06). Conclusions Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve Nocturia may be useful in improving sleep quality and wake time at night.
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differences in the association of Nocturia and functional outcomes of sleep by age and gender a cross sectional population based study
Clinical Therapeutics, 2016Co-Authors: Camille P Vaughan, Theodore M Johnson, Constance H Fung, Alison J Huang, Alayne D MarklandAbstract:Abstract Purpose Nocturia is associated with poor sleep quality; however, little is known about the relationship between Nocturia and sleep quality across different workforce-relevant age groups of adults. This has implications for developing new treatment strategies that are well tolerated across populations. Methods We conducted a cross-sectional study involving merged data from the 2005–2006 and 2007–2008 waves of the National Health and Nutrition Examination Survey. Participants responded to validated questions on Nocturia frequency and sleep from the Functional Outcomes of Sleep Questionnaire General Productivity subscale (FOSQ-gp, range 1–4). Analyses included multivariable linear regression with stratification by gender to examine associations between Nocturia frequency (higher worse) and the FOSQ-gp scores (lower scores indicating worse daytime function related to sleep disturbance). Findings Of 10,512 adults aged ≥20 years who completed the survey, 9148 (87%) had complete Nocturia and FOSQ-gp data. The population age-adjusted prevalence of Nocturia at least twice nightly was 21.1% among men and 26.6% among women ( P P 65 years) with greater Nocturia frequency reported worse FOSQ-gp scores compared with younger adults with similar Nocturia frequency ( P Implications In a population-based sample of community-dwelling men and women, the association between Nocturia and worsened functional outcomes of sleep was greater among adults older than 65 years—a group more vulnerable to drug side effects, and in whom Nocturia is typically multifactorial. Additionally, these analyses found that the association between Nocturia and functional outcomes of sleep is stronger with increasing age among men. Effective treatment strategies that are well tolerated by older adults, such as multicomponent treatments that simultaneously address the combined effects of lower urinary tract and sleep dysfunction, are needed.
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efficacy of adding behavioural treatment or antimuscarinic drug therapy to α blocker therapy in men with Nocturia
BJUI, 2013Co-Authors: Theodore M Johnson, Alayne D Markland, Patricia S Goode, Camille P Vaughan, Janet Colli, Joseph G Ouslander, David T Redden, Gerald Mcgwin, Kathryn L BurgioAbstract:What's known on the subject? and What does the study add? Nocturia is a common and bothersome lower urinary tract symptom, particularly in men. Many single drug therapies have limited benefit. For men who have persistent Nocturia despite alpha-blocker therapy, the addition of behavioural and exercise therapy is statistically superior to anticholinergic therapy. Objective To compare reductions in Nocturia resulting from adding either behavioural treatment or antimuscarinic drug therapy to α-adrenergic antagonist (α-blocker) therapy in men. Patients and Methods Participants were men who had continuing urinary frequency >8 voids/day) and urgency after 4 weeks of α-blocker therapy run-in and who had ≥1 nightly episode of Nocturia. Participants received individually titrated drug therapy (extended-release oxybutynin) or multicomponent behavioural treatment (pelvic floor muscle training, delayed voiding and urge suppression techniques). Seven-day bladder diaries were used to calculate reductions in mean Nocturia. Results A total of 127 men aged 42–88 years with ≥1 Nocturia episode per night were included in the study. There were 76 men who had a mean of ≥2 Nocturia episodes. Among those with ≥1 Nocturia episode, behavioural treatment reduced nightly Nocturia by a mean of 0.97 episodes and was significantly more effective than drug therapy (mean reduction = 0.56 episodes; P = 0.01). Participants with ≥2 episodes Nocturia at baseline also showed larger changes with behavioural treatment compared with antimuscarinic therapy (mean reduction = 1.26 vs 0.61; P = 0.008). Conclusions Both behavioural treatment and drug therapy reduced Nocturia in men with ≥1 episode of Nocturia/night when added to α-blocker therapy. These results were similar even when only those with ≥2 episodes of Nocturia were considered. The addition of behavioural treatment was statistically better than bladder-relaxant therapy for Nocturia.
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a multicomponent behavioural and drug intervention for Nocturia in elderly men rationale and pilot results
BJUI, 2009Co-Authors: Camille P Vaughan, Joseph G Ouslander, Yohannes W Endeshaw, Zobair Nagamia, Theodore M JohnsonAbstract:OBJECTIVES To evaluate the number of medical and urological conditions associated with Nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce Nocturia and its bother. SUBJECTS AND METHODS Men aged ≥50 years and with two or more episodes of Nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for Nocturia. Outcome measures included self-reported Nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries. RESULTS Fifty-five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to Nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded Nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a ‘medium’ to a ‘very small’ problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep). CONCLUSIONS Given that individual older patients often have multiple coexistent risk factors for Nocturia, identifying a principal cause of Nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced Nocturia frequency, bother from Nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.
Matthias Oelke - One of the best experts on this subject based on the ideXlab platform.
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Nocturia: state of the art and critical analysis of current assessment and treatment strategies
World Journal of Urology, 2014Co-Authors: Matthias Oelke, Erika Adler, Daniela Marschall-kehrel, Thomas R. W. Herrmann, Richard BergesAbstract:This editorial of the topic issue of the World Journal of Urology provides a state of the art on Nocturia which includes descriptions of the terminology, epidemiology, health-related quality of life, medical and financial consequences, pathophysiology, assessment tools and treatment strategies of Nocturia. This summary also includes a flowchart on the pathophysiology of Nocturia with illustration of the various causes of reduced bladder capacity, increased fluid intake or increased diuresis; a flowchart with the key findings of frequency–volume charts to determine the underlying pathophysiology; and a flowchart on the treatment of the various causes of Nocturia. The editorial critically discusses current assessment and treatment strategies in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and Nocturia. The outcome of Nocturia remains hidden in drug trials of patients with LUTS/BPH because Nocturia-specific measures were not included. The authors recommend using frequency–volume charts, measurement of the hours of undisturbed sleep, and Nocturia-specific quality of life questionnaires (e.g., ICIQ-N or N-Qol) in all future studies in patients with LUTS/BPH and Nocturia.
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Consistent and significant improvement of nighttime voiding frequency (Nocturia) with silodosin in men with LUTS suggestive of BPH: pooled analysis of three randomized, placebo-controlled, double-blind phase III studies
World Journal of Urology, 2014Co-Authors: Andreas Eisenhardt, Tim Schneider, Francisco Cruz, Matthias OelkeAbstract:Objectives Nocturia is prevalent and bothersome in men with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). α-Adrenoceptor antagonists without subtype selectivity have inconsistently shown significant effects on Nocturia in these patients. We explored the effects of the α_1A-adrenoceptor subtype-selective antagonist silodosin on Nocturia by analyzing three placebo-controlled registration studies. Methods Responses to question 7 of the IPSS questionnaire were analyzed for the entire study population and patients with ≥2 voids/night at baseline. Improvement/worsening rates for Nocturia were calculated for once-daily silodosin 8 mg and placebo. Silodosin effects on the mean number of nocturnal voids were compared with placebo, and the number of patients in whom Nocturia was reduced to
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Nocturia state of the art and critical analysis of current assessment and treatment strategies
World Journal of Urology, 2014Co-Authors: Matthias Oelke, Erika Adler, Thomas R. W. Herrmann, Daniela Marschallkehrel, Richard BergesAbstract:Open image in new window This editorial of the topic issue of the World Journal of Urology provides a state of the art on Nocturia which includes descriptions of the terminology, epidemiology, health-related quality of life, medical and financial consequences, pathophysiology, assessment tools and treatment strategies of Nocturia. This summary also includes a flowchart on the pathophysiology of Nocturia with illustration of the various causes of reduced bladder capacity, increased fluid intake or increased diuresis; a flowchart with the key findings of frequency–volume charts to determine the underlying pathophysiology; and a flowchart on the treatment of the various causes of Nocturia. The editorial critically discusses current assessment and treatment strategies in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and Nocturia. The outcome of Nocturia remains hidden in drug trials of patients with LUTS/BPH because Nocturia-specific measures were not included. The authors recommend using frequency–volume charts, measurement of the hours of undisturbed sleep, and Nocturia-specific quality of life questionnaires (e.g., ICIQ-N or N-Qol) in all future studies in patients with LUTS/BPH and Nocturia.