Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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Prevalence and Predictors of Nocturia in Patients with Obstructive Sleep Apnea Syndrome

폐쇄성수면무호흡증 환자의 야간뇨 유병률 및 관련인자

  • Kang, Hyeon Hui (Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Catholic University of Korea, College of Medicine) ;
  • Lee, Jongmin (Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Catholic University of Korea, College of Medicine) ;
  • Lee, Sang Haak (Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Catholic University of Korea, College of Medicine) ;
  • Moon, Hwa Sik (Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Catholic University of Korea, College of Medicine)
  • 강현희 (가톨릭대학교 의과대학 내과학교실) ;
  • 이종민 (가톨릭대학교 의과대학 내과학교실) ;
  • 이상학 (가톨릭대학교 의과대학 내과학교실) ;
  • 문화식 (가톨릭대학교 의과대학 내과학교실)
  • Received : 2014.06.09
  • Accepted : 2014.06.16
  • Published : 2014.06.30
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Abstract

Objectives: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. Methods: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) ${\geq}5$. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. Results: A total of 161 men >18 years of age (mean age $46.7{\pm}14.1$), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (${\beta}$=0.227, p=0.003), and AHI (${\beta}$=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). Conclusion: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.

목 적: 본 연구는 수면 무호흡증이 의심되어 수면 클리닉을 내원한 남성 환자를 대상으로 야간뇨의 유병률 및 이를 예측할 수 있는 인자를 알아보고자 하였다. 방 법: 2009년부터 2012년까지 수면무호흡증이 의심이 되어 수면 클리닉을 방문한 남성 환자를 대상으로 임상적 소견 및 수면다원검사 결과를 후향적으로 분석하였다. 배뇨 증상은 국제전립선증상점수를 기준으로 측정하였다. 임상적으로 유의한 야간뇨은 밤 동안에 2회 이상 배뇨를 하기 위해 깨는 경우로 정의하였다. 폐쇄성수면무호흡증은 무호흡-저호흡 지수가 5 이상인 경우로 정의하였다. 결 과: 전체 161명의 분석 대상자의 평균 연령은 $46.7{\pm}14.1$세였다. 이 중 27명은 단순 코골이 환자였으며 134명은 폐쇄성수면무호흡증 환자로 진단 되었다. 야간뇨는 53명의 폐쇄성수면무호흡증 환자, 8명의 단순 코골이 환자에서 관찰되었다. 전체 분석 대상환자에서 야간뇨의 유병률은 37.9%, 폐쇄성수면무호흡증 환자에서 야간뇨의 유병률은 39.6%였으나, 폐쇄성수면무호흡증의 유무에 따른 야간뇨 발생의 통계학적 차이는 없었다. 야간뇨를 호소한 환자가 야간뇨가 없는 환자보다 무호흡-저호흡 지수가 통계적으로 유의하게 더 높았다(p=0.001). 야간뇨를 동반한 폐쇄성수면무호흡증 환자는 야간뇨를 호소하지 않은 폐쇄성수면무호흡증 환자에 비하여 각성 지수가 더 높았고, 혈중 산소 포화도는 더 낮은 것으로 분석 되었다. 다중회귀분석에서 나이와 무호흡-저호흡 지수가 야간뇨의 유무를 예측할 수 있는 인자로 분석 되었으며, 나이에 따른 야간뇨의 위험도는 1.4, 무호흡-저호흡 지수에 따른 위험도는 1.02로 나타났다. 결 론: 본 연구에서 폐쇄성수면무호흡증 환자에서 야간뇨의 빈도는 높은 것으로 나타났다. 폐쇄성수면무호흡증 환자에서 야간뇨의 동반여부를 예측할 수 있는 유용한 인자는 나이와 무호흡-저호흡 지수였다.

Keywords

References

  1. Anderson JV, Maxwell DL, Payne NN, Slater JD, Bloom SR. Atrial natriuretic peptide: physiological release associated with natriuresis during negative pressure breathing in man. Clin Sci (Lond) 1989;76:423-429. https://doi.org/10.1042/cs0760423
  2. Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American urological association symptom index for benign prostatic hyperplasia. The measurement Committee of the American urological association. J Urol 1992;148:1549-1557.
  3. Bing MH, Moller LA, Jennum P, Mortensen S, Skovgaard LT, Lose G. Prevalence and bother of nocturia, and causes of sleep interruption in a Danish population of men and women aged 60-80 years. BJU Int 2006;98:599-604. https://doi.org/10.1111/j.1464-410X.2006.06390.x
  4. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000;160:2289-2295. https://doi.org/10.1001/archinte.160.15.2289
  5. Choo MS, Ku JH, Park CH, Lee YS, Lee KS, Lee JG, et al. Prevalence of nocturia in a Korean population aged 40 to 89 years. Neurourol Urodyn 2008;27:60-64. https://doi.org/10.1002/nau.20458
  6. Endeshaw YW, Johnson TM, Kutner MH, Ouslander JG, Bliwise DL. Sleep-disordered breathing and nocturia in older adults. J Am Geriatr Soc 2004;52:957-960. https://doi.org/10.1111/j.1532-5415.2004.52264.x
  7. Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110:364-367. https://doi.org/10.1161/01.CIR.0000136587.68725.8E
  8. Gulur DM, Mevcha AM, Drake MJ. Nocturia as a manifestation of systemic disease. BJU Int 2011;107:702-713. https://doi.org/10.1111/j.1464-410X.2010.09763.x
  9. Hajduk IA, Strollo PJ Jr, Jasani RR, Atwood CW Jr, Houck PR, Sanders MH. Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study. Sleep 2003;26:61-64.
  10. Hunskaar S. Epidemiology of nocturia. BJU Int 2005;96:4-7.
  11. Kang SH, Yoon IY, Lee SD, Kim JW. The impact of sleep apnoea syndrome on nocturia according to age in men. BJU Int 2012;110:E851-E856. https://doi.org/10.1111/j.1464-410X.2012.11342.x
  12. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol 2011;185:571-577. https://doi.org/10.1016/j.juro.2010.09.108
  13. Lee YS, Lee KS, Jung JH, Han DH, Oh SJ, Seo JT, et al. Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study. World J Urol 2011;29:185-190. https://doi.org/10.1007/s00345-009-0490-1
  14. Lin CC, Tsan KW, Lin CY. Plasma levels of atrial natriuretic factor in moderate to severe obstructive sleep apnea syndrome. Sleep 1993;16:37-39. https://doi.org/10.1093/sleep/16.1.37
  15. Margel D, Shochat T, Getzler O, Livne PM, Pillar G. Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology 2006;67:974-977. https://doi.org/10.1016/j.urology.2005.11.054
  16. Moriyama Y, Miwa K, Tanaka H, Fujihiro S, Nishino Y, Deguchi T. Nocturia in men less than 50 years of age may be associated with obstructive sleep apnea syndrome. Urology 2008;71:1096-1098. https://doi.org/10.1016/j.urology.2008.02.038
  17. Oztura I, Kaynak D, Kaynak HC. Nocturia in sleep-disordered brea-thing. Sleep Med 2006;7:362-367. https://doi.org/10.1016/j.sleep.2005.10.004
  18. Parthasarathy S, Fitzgerald M, Goodwin JL, Unruh M, Guerra S, Quan SF. Nocturia, sleep-disordered breathing, and cardiovascular morbidity in a community-based cohort. PLoS One 2012;7:e30969. https://doi.org/10.1371/journal.pone.0030969
  19. Perry S, Shaw C, Assassa P, Dallosso H, Williams K, Brittain KR, et al. An epidemiological study to establish the prevalence of urinary symptoms and felt need in the community: the Leicestershire MRC Incontinence Study. Leicestershire MRC Incontinence Study Team. J Public Health Med 2000;22:427-434. https://doi.org/10.1093/pubmed/22.3.427
  20. Raheem OA, Orosco RK, Davidson TM, Lakin C. Clinical predictors of nocturia in the sleep apnea population. Uro Ann 2014;6:31-35. https://doi.org/10.4103/0974-7796.127019
  21. Redline S, Strohl KP. Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med 1998;19:1-19. https://doi.org/10.1016/S0272-5231(05)70428-7
  22. Rembratt A, Norgaard JP, Andersson KE. Nocturia and associated morbidity in a community-dwelling elderly population. BJU Int 2003;92:726-730. https://doi.org/10.1046/j.1464-410X.2003.04467.x
  23. Romero E, Krakow B, Haynes P, Ulibarri V. Nocturia and snoring: predictive symptoms for obstructive sleep apnea. Sleep Breath 2010;14:337-343. https://doi.org/10.1007/s11325-009-0310-2
  24. Tikkinen KA, Johnson TM 2nd, Tammela TL, Sintonen H, Haukka J, Huhtala H, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol 2010;57:488-496. https://doi.org/10.1016/j.eururo.2009.03.080
  25. Umlauf MG, Chasens ER, Greevy RA, Arnold J, Burgio KL, Pillion DJ. Obstructive sleep apnea, nocturia and polyuria in older adults. Sleep 2004;27:139-144.
  26. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705-706.