6 June 2003
New research reveals that a largely ignored health problem, affecting nearly 40 million people in Europe*, is unnecessarily putting lives at risk** and costing the economy millions of Euros a year***.
Danish researchers who conducted a 13 year study of adults with nocturia,2 a condition where individuals are woken regularly and frequently during the night with an urgent need to pass urine, revealed a significant detrimental effect on daytime functioning in sufferers and, an increased risk to their health and life expectancy.
"Our results clearly demonstrate that nocturia is responsible for adverse levels of disturbed sleep," explained Dr Poul Jennum, presenting the data to medical specialists gathered in Malta this week to discuss a need for improved diagnosis and treatment of nocturia. (First International Nocturia Workshop, 6 - 8 June, 2003).
"This leads to a degree of sleep deprivation that has devastating effects on an individual's performance and relationships and, is also linked to the development of medical and neurological disorders, particularly where sleep is regularly broken during the first 4 hours."
Such interruptions have been shown to affect primarily the front part of the brain, the area responsible for concentration, working memory and rational and creative thinking. "This explains the high levels of daytime sleepiness, depression, bad mood swings, poor memory and difficulties managing work reported by those with nocturia, around double that in people without nocturia," said Dr Jennum.
The extensive data also demonstrated that disturbed sleep due to nocturia is a risk factor for health problems and a shortened life expectancy, with a higher incidence of raised blood pressure, diabetes, epilepsy, sleep apnoea and accidents being reported in those with the condition.
Figures show that 30 percent of working people get up at least once a night because of nocturia, a number that rises to 60 percent in people over 70 years of age.1 "Getting up in the night to pass urine can also result in falls and broken bones, particularly among the elderly," continued Dr Jennum.
The most common contributing factor in cases of nocturia, is an over production of urine during the night (polyuria). This is due to the body being unable to produce adequate quantities of the antidiuretic hormone, vasopressin, released during sleep to ensure the volume of urine produced does not outstrip the capacity of the bladder.
"Up to 75 percent of cases of nocturia****, involve a degree of this form of polyuria," according to Dr Gary Robertson, Professor of Medicine and Neurology at the Northwestern University Medical School in Chicago, USA. He went on to report on the results of several trials that successfully used desmopressin, a synthetic analogue of the natural antidiuretic hormone to treat nocturia.
The meeting learned that desmopressin, easily administered in the form of a tablet, significantly reduced nocturnal polyuria and nocturia in 45 - 75 percent of treated patients,4 and increased the duration of their initial sleep phase.
The results showed that sleepers could gain at least twice more sleep than achieved without -- proving desmopressin to be a simple remedy for improving quality sleep in patients with nocturia.
A Swedish evaluation into the impact of nocturia,3 presented to the meeting by researchers from Lund University Hospital, showed that waking up in the night to empty the bladder to be as debilitating on daytime performance as the early stage of multiple sclerosis.
Work performance and activity were significantly impaired, with a 9.2 percent reduction in productivity in individuals with nocturia, who also had significantly lower levels of vitality and utility.
Detrimental effects were also more severe in those individuals with more frequent nighttime disturbances. Work impairment was shown to increase by a further 2 percent for each additional wakening, with women being found to be significantly more affected than men in all areas.
The team also looked into the economics of nocturia. Estimating that the reduction in work productivity equated to an indirect cost of €3,700 a year, for each individual with nocturia.
Dr Jennum said that the growing evidence presented at the meeting is so compelling that all doctors should be taking the condition more seriously, and called for improved diagnosis and treatment of any underlying causes.
Nocturia can occur in either sex and at any age but is a problem, despite its prevalence, that is largely ignored by sufferers and under-treated by doctors, often regarded as being trivial, or a unavoidable consequence of growing older.
"We are looking at an otherwise healthy and professional active group of individuals whose work performance, ability to take part in leisure activities and long-term health is being affected unecessarily," said Dr Jennum.
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*Blanker M, Bohnen A, Normal Voiding Patterns and Determinants of Increased Diurnal and Nocturnal Voiding Frequency In Elderly Men. J of Urology. 2000.
**Jennum P, The Impact of Nocturia on Sleep. Abstract of study presented at First International Nocturia Workshop, 6 - 8 June 2003
***Kobelt G, Mattiasson A, Borgström F, Kildegaard Nielsen S. The Impact of Nocturia on Productivity, Vitality and Utility in Healthy Active Individuals. Poster presented at at First International Nocturia Workshop, 6 - 8 June 2003
****Robertson G, Which Patients Benefit from Desmopressin Treatment? Abstract of study presented at First International Nocturia Workshop, 6 - 8 June 2003
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