Could nocturia be an indicator of an undiagnosed sleep disorder in male veterans?
OBJECTIVE
To determine if men presenting with nocturia and/or voiding complaints may have undiagnosed symptoms of sleep-disordered breathing (SDB).


METHODS
We conducted a cross-sectional study with men presenting to the Veterans Administration Boston Healthcare System Urology clinic between August 2012 and January 2013. Patients were asked to complete the American Urological Association symptom score and the Berlin sleep questionnaire to evaluate their voiding complaints and sleep quality. We performed univariable and multivariable statistical analyses to identify correlations between a positive Berlin score and voiding symptoms, with an emphasis on nocturia.


RESULTS
A total 618 completed questionnaires were included. More than 65% of patients reported nocturia. Of those reporting nocturia, 55% also had a positive Berlin score. The American Urological Association symptom score components of frequency and nocturia, as well as body mass index and hypertension, were shown to be significant independent predictors of a positive Berlin questionnaire, suggesting high likelihood of SDB. Conversely, a positive Berlin questionnaire was a significant independent predictor of nocturia, suggesting high degree of correlation between the 2 conditions.


CONCLUSIONS
Nocturia and other voiding symptoms, such as frequency, predict a positive Berlin score, and vice versa. Patients with a positive Berlin score may have an undiagnosed sleep disorder, the sequelae of which can lead to significant health consequences. If present, treatment of SDB can ameliorate voiding symptoms. Urologists should consider administration of the Berlin score in their office, particularly in patients refractory to treatment for their voiding complaints, and if positive, consider referral to a sleep specialist.
Department of Urology, Boston Medical Center, Boston, MA.
Arun
A
Rai
Department of Surgery, VA Boston Healthcare System, West Roxbury, MA.
Tony
T
Nimeh
Vattikuti Urology Institute, Detroit, MI.
Akshay
A
Sood
Department of Urology, Boston Medical Center, Boston, MA; Department of Urology, Boston University School of Medicine, Boston, MA.
Nannan
N
Thirumavalavan
Department of Surgery, VA Boston Healthcare System, West Roxbury, MA.
Portia E
PE
Thurmond
Department of Surgery, VA Boston Healthcare System, West Roxbury, MA; Department of Urology, Boston University School of Medicine, Boston, MA.
Kazem M
KM
Azadzoi
Department of Surgery, VA Boston Healthcare System, West Roxbury, MA; Department of Urology, Boston University School of Medicine, Boston, MA. Electronic address: Lerner_lori@hotmail.com.
Lori B
LB
Lerner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053158:Nocturia / Q000209:etiology*; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D058014:Veterans Health; D055815:Young Adult