Platinum Priority – Voiding DysfunctionEditorial by Jean-Jacques Wyndaele on pp. 85–87 of this issueNocturia and Quality of Life: Results from the Boston Area Community Health Survey
Introduction
Nocturia (nighttime voiding) is a common and bothersome urologic symptom [1], [2], [3] and is the most frequently cited cause of nocturnal awakenings resulting in sleep loss, daytime fatigue, and mood disturbance [1], [4], [5], [6]. Previous studies have reported symptom bother and reduced quality of life (QOL) associated with nocturia [1], [7]. However, data are inconsistent on frequency of nocturnal voiding and the level at which the frequency significantly affects QOL and bother. One study reported adverse effects with only one voiding episode nightly [1], while another showed significant effects with two or more nightly episodes [7]. Studies have consistently shown an increase in depression with nocturia, but they were conducted among men and primarily in older age groups [8], [9], [10].
Previous results from the Boston Area Community Health (BACH) Survey show decreased overall QOL with increasing severity of lower urinary tract symptoms as assessed by the International Prostate Symptom Score (IPSS) [11]. Current objectives are (1) to determine the effect of nocturia on QOL and symptom bother, (2) to investigate the association of nocturia with depression, and (3) to determine whether the association of number of nightly voids with QOL and depression follows a dose-response pattern.
Section snippets
Overall design
BACH is a population-based epidemiologic survey of urologic symptoms and risk factors. Detailed methods have been described elsewhere [12]. Eligibility criteria include the ability to speak English or Spanish and being cognitively able to provide informed consent. A multistage stratified design was used to randomly recruit approximately equal numbers according to age (30–39, 40–49, 50–59, and 60–79 yr), gender, and race and ethnic group (black, Hispanic, and white). Cross-sectional data from
Results
Analytic sample characteristics are presented in Table 1. Prevalence of nocturia was 25.3% in men and 31.3% in women, and the prevalence increased to approximately 40% in men and women aged ≥60 yr.
A decrease in both mean physical and mean mental health component scores was observed by nocturia and number of nightly voids after accounting for potential confounders (Fig. 1). A significant trend of decreasing SF-12 scores with increasing number of nightly voids was observed. The largest drop in
Discussion
The results of the BACH study demonstrate a significant association of nocturia with decreased QOL and interference with daily activities in both men and women. Nocturia was also associated with increased likelihood of depression, especially among younger men and women.
An adverse effect of nocturia on QOL has been reported previously. A nested case-control study of overactive bladder and QOL showed that nocturia was associated with a decrease in the physical function, vitality, and mental
Conclusions
Results of the BACH study show that nocturia is associated with decreased QOL, increased symptom bother, and an increased prevalence of depression, especially in younger men and women. Similarly, significant trends in decreased QOL and increased odds of depression were observed with increasing number of nightly voids. These results support previous findings suggesting that voiding two or more times nightly is a threshold value of nocturia beyond which the disorder has adverse effects on QOL and
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