Association of obstructive sleep apnea risk factors with nocturnal enuresis in postmenopausal women.
OBJECTIVE
The prevalence of obstructive sleep apnea (OSA) in women increases significantly after menopause. However, identifying at-risk women is difficult because they tend to underreport symptoms and their complaints may differ from those traditionally associated with OSA. We investigated whether OSA risk factors are associated with the presence of a "nontraditional" complaint, such as nocturnal enuresis, in postmenopausal women.


METHODS
A cross-sectional study of postmenopausal women aged 50 to 79 years who participated in the Women's Health Initiative Observational Study and clinical trials (1993-2005) at 40 clinical centers in the United States was performed. Multiple variable logistic regression analysis was used to determine the association of OSA risk factors with nocturnal enuresis.


RESULTS
A cohort of 2,789 women (1.7%) reported having nocturnal enuresis. Obesity (odds ratio [OR], 2.29; 95% CI, 2.00-2.62), snoring (OR, 2.01; 95% CI, 1.74-2.32), poor sleep quality (OR, 1.70; 95% CI, 1.52-1.91), sleep fragmentation (OR, 2.44; 95% CI, 2.14-2.79), daytime sleepiness (OR, 1.50; 95% CI, 1.33-1.68), and hypertension (OR, 1.13; 95% CI, 1.01-1.26) were associated with nocturnal enuresis. Each additional OSA risk factor in a predefined OSA score significantly increased the odds of having nocturnal enuresis in a dose-response fashion (OR of 1.38, 2.00, 2.80, 3.87, 5.10, and 7.02 for scores of 1-6, respectively) compared with no risk factors.


CONCLUSIONS
OSA risk factors are associated with nocturnal enuresis in postmenopausal women. Mechanisms relating nocturnal enuresis to OSA may include apnea-associated changes in intrathoracic pressure, leading to increased urine output. Questioning at-risk postmenopausal women presenting with nocturnal enuresis about other OSA risk factors should be considered.
1Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI2Program in Public Health, Stony Brook Medicine, Stony Brook, NY3California Pacific Medical Center Research Institute, University of California, San Francisco, San Francisco, CA4Department of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, RI.
Patrick
P
Koo
F Dennis
FD
McCool
Lauren
L
Hale
Katie
K
Stone
Charles B
CB
Eaton
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D017698:Postmenopause; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D012913:Snoring / Q000453:epidemiology; D014481:United States