Nocturia and Quality of Life: Results from the Boston Area Community Health Survey

doi:10.1016/j.eururo.2011.05.065

European Urology

Volume 61, Issue 1, January 2012, Pages 78-84

https://doi.org/10.1016/j.eururo.2011.05.065 Get rights and content

Abstract

Background

Nocturia, a common complaint in aging men and women, is frequently cited as the cause of nocturnal awakenings leading to sleep loss, daytime fatigue, and reduced quality of life (QOL).

Objective

Investigate the association of nocturia with QOL and depressive symptoms among men and women.

Design, setting, and participants

A population-based epidemiologic survey of urologic symptoms among persons aged 30–79 yr. A multistage stratified cluster sample design was used to randomly sample 5503 residents of Boston, MA, USA.

Measurements

Nocturia was defined as a self-report of two or more voiding episodes nightly or having to get up to urinate more than once nightly “fairly often,” “usually,” or “almost always.” QOL was assessed using the physical and mental health component scores of the 12-Item Short-Form Survey (SF-12). Depression was assessed using the Center for Epidemiological Studies Depression Scale. Multiple linear and logistic regression methods were used to model the nocturia and QOL association and to control for confounders.

Results and limitations

Nocturia was associated with decreased SF-12 scores for both the physical and mental health components after multivariate adjustment. Nocturia was also associated with increased odds of depressive symptoms (men: adjusted odds ratio [OR]: 2.79; 95% confidence interval [CI], 1.81–4.31; women: adjusted OR: 1.80; 95% CI, 1.29–2.51). Among women who reported sleep interference due to urologic symptoms, nocturia was associated with a threefold increase in odds of depression. In this cross-sectional analysis, the temporal sequence of causality of the nocturia and depression association could not be assessed.

Conclusions

Nocturia is associated with decreased QOL and with an increased prevalence of depressive symptoms in both men and women.

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

References (33)

K.A. Tikkinen et al.
Is nocturia equally common among men and women? a population based study in Finland
J Urol
(2006)
M.M. Ohayon
Nocturnal awakenings and comorbid disorders in the American general population
J Psychiatr Res
(2008)
K.A. Tikkinen et al.
Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland
Eur Urol
(2010)
J.T. Hakkinen et al.
Depressive symptoms increase the incidence of nocturia: Tampere aging male urologic study (TAMUS)
J Urol
(2008)
T.V. Johnson et al.
Nocturia associated with depressive symptoms
Urology
(2011)
J.B. McKinlay et al.
Measuring the urologic iceberg: design and implementation of the Boston Area Community Health (BACH) Survey
Eur Urol
(2007)
M.P. Fitzgerald et al.
Beyond the lower urinary tract: the association of urologic and sexual symptoms with common illnesses
Eur Urol
(2007)
M.P. Fitzgerald et al.
The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH Survey
J Urol
(2007)
R.S. Epstein et al.
Validation of a new quality of life questionnaire for benign prostatic hyperplasia
J Clin Epidemiol
(1992)
R.A. Washburn et al.
The physical activity scale for the elderly (PASE): development and evaluation
J Clin Epidemiol
(1993)

B.T. Helfand et al.

The relationship between lower urinary tract symptom severity and sleep disturbance in the CAMUS trial

J Urol

(2011)

K. Spiegel et al.

Impact of sleep debt on metabolic and endocrine function

Lancet

(1999)

Y. Okura et al.

Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure

J Clin Epidemiol

(2004)

K.S. Coyne et al.

The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA

BJU Int

(2003)

L. van Dijk et al.

Nocturia in the Dutch adult population

BJU Int

(2002)

R. Asplund

Nocturia in relation to sleep, somatic diseases and medical treatment in the elderly

BJU Int

(2002)

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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

Abstract

Background

Objective

Design, setting, and participants

Measurements

Results and limitations

Conclusions

Introduction

Section snippets

Overall design

Results

Discussion

Conclusions

J Urol

J Psychiatr Res

Eur Urol

J Urol

Urology

Eur Urol

Eur Urol

J Urol

J Clin Epidemiol

J Clin Epidemiol

J Urol

Lancet

J Clin Epidemiol

The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA

BJU Int

Nocturia in the Dutch adult population

BJU Int

Nocturia in relation to sleep, somatic diseases and medical treatment in the elderly

BJU Int

Platinum Priority – Voiding Dysfunction
Editorial by Jean-Jacques Wyndaele on pp. 85–87 of this issue
Nocturia and Quality of Life: Results from the Boston Area Community Health Survey