title: Nocturia, sleep-disordered breathing, and cardiovascular morbidity in a community-based cohort.
abstract: BACKGROUND
  Nocturia has been independently associated with cardiovascular morbidity and all-cause mortality, but such studies did not adjust for sleep-disordered breathing (SDB), which may have mediated such a relationship. Our aims were to determine whether an association between nocturia and cardiovascular morbidity exists that is independent of SDB. We also determined whether nocturia is independently associated with SDB.
  
  
  RESULTS
  In order to accomplish these aims we performed a cross-sectional analysis of the Sleep Heart Health Study that contained information regarding SDB, nocturia, and cardiovascular morbidity in a middle-age to elderly community-based population. In 6342 participants (age 63±11 [SD] years, 53% women), after adjusting for known confounders such as age, body mass index, diuretic use, diabetes mellitus, alpha-blocker use, nocturia was independently associated with SDB (measured as Apnea Hypopnea index >15 per hour; OR 1.3; 95%CI, 1.2-1.5). After adjusting for SDB and other known confounders, nocturia was independently associated with prevalent hypertension (OR 1.23; 95%CI 1.08-1.40; P = 0.002), cardiovascular disease (OR 1.26; 95%CI 1.05-1.52; P = 0.02) and stroke (OR 1.62; 95%CI 1.14-2.30; P = 0.007). Moreover, nocturia was also associated with adverse objective alterations of sleep as measured by polysomnography and self-reported excessive daytime sleepiness (P<0.05).
  
  
  CONCLUSIONS
  Nocturia is independently associated with sleep-disordered breathing. After adjusting for SDB, there remained an association between nocturia and cardiovascular morbidity. Such results support screening for SDB in patients with nocturia, but the mechanisms underlying the relationship between nocturia and cardiovascular morbidity requires further study. MeSH terms: Nocturia, sleep-disordered breathing, obstructive sleep apnea, sleep apnea, polysomnography, hypertension.
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona, United States of America. spartha@arc.arizona.edu
authors.forename: Sairam
authors.initials: S
authors.lastname: Parthasarathy
authors.forename: MaryPat
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: James L
authors.initials: JL
authors.lastname: Goodwin
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerra
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053158:Nocturia / Q000453:epidemiology / Q000503:physiopathology*; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000503:physiopathology*