New patient survey data presented at the European Association of Urology (EAU 14) congress, showed that nocturia (waking to void one or more times a night followed by sleep), has a strong negative impact on utility, work productivity and health-related quality of life (HRQL), which increases with the severity of the condition[i],[ii].
An analysis of survey data drawn from a cross-sectional survey of physicians and their urology patients (n=8738) in Europe and the USA showed that as the number of voids caused by nocturia increased, measures of utility, work productivity and HRQL decreased.[i]
A serious consequence of nocturia is the disruption it causes to a patient's sleep as a result of frequently waking with a need to urinate. In particular, it is the disruption of restorative slow wave sleep in the first four hours that tends to have the biggest effect. Results from a real-world setting showed that the severity of a patient's nocturia (as measured by the number of hours in the first undisturbed sleep period, (FUSP), had a significant negative impact on their activity levels, how refreshed they felt the next day, the average number of daily naps they took and their HRQL (p<0.0001) [ii].
For those patients getting more than four hours of undisturbed sleep before waking to urinate, there were highly significant improvements in symptom bother, HRQL, activity levels, health status and how refreshed they felt the next day compared to those getting four or less hours of undisturbed sleep (p<0.0001) [ii].
Furthermore, results also showed that as nocturia gets worse (as measured by an increase in number of night-time voids), there was a significant negative impact across all outcome measures including HRQL, utility and work productivity (p<0.0001). Patients that woke to void two or more times per night were significantly more negatively impacted on measures of HRQL, utility and work productivity compared to those patients that voided once or not at all per night (p<0.001). [i]
Commenting on these results, Professor Bliwise, Professor of Neurology, Emory University School of Medicine, Atlanta, USA said: "Nocturia is common and bothersome, but it is often under-recognised as a separate condition and its burden underestimated. This new data highlights the need for physicians to take nocturia seriously, given how profound its impact can be on a patient's quality of life. For people that suspect they have nocturia, they should visit their doctor to discuss treatment options."
Sufferers of nocturia consider disturbed sleep to be the most burdensome symptom, and around a third of people with nocturia are unable to get back to sleep after urinating, leading to insomnia[iii]. Given the prevalence of nocturia is high with estimates suggesting 77% of men and women aged 60-80 years suffering, it is important that this condition is recognised and treated accordingly[iv].
About the study
Primary care physicians and urology specialists in France, Germany, Spain, UK and the USA, actively managing urology patients were asked to complete patient record forms prospectively for the next 14 OAB/BPH/nocturia patients who consulted their clinic. The same patients were asked to fill in a self-completion form (PSC) including FUSP duration, mean number of voids over the previous 7 nights, how they felt the next day, and average daily naps (using a 1-10 scale where 1=poor and 10=excellent). The PSC also included measures of utility, HRQL and impact on work/activities (EuroQol 5-D (EQ-5D), Overactive Bladder Questionnaire (OAB-q), Nocturia Impact (NI) Diary®, and Work Productivity and Activity Index (WPAI)[i],[ii].
Nocturia is a bothersome and highly prevalent condition defined by the International Continence Society as the need to wake one or more times nightly to void with each void preceded and followed by sleep[v]. Studies of the relationship between QoL and nocturia suggest that the condition becomes clinically significant when two or more voids nightly are experienced. Among lower urinary tract symptoms (LUTS), nocturia is consistently reported to be one of the most bothersome symptoms by men as well as women and significantly compromises sleep and overall QoL[vi]. Often trivialised and assumed to be an inevitable part of the ageing process, nocturia is a serious condition with far-reaching social, health and economic implications for patients, their families and society[vii].