Pitfalls and opportunities in multidisciplinary research about nocturia in adults

Abstract

Objectives: Describe current shortcomings in clinical research on the treatment of nocturia in adults, and suggest new directions for future studies in this field.

Methods: A literature search was conducted using the keywords ‘nocturia,’ ‘nocturnal polyuria,’ ‘sleep,’ and ‘hypertension.’

Results: Nocturia, or waking up at night to void, is a highly prevalent and bothersome lower urinary tract symptom (LUTS) affecting up to 40% of adults. Since the majority of patients are diagnosed with nocturnal polyuria (NP) as one of the underlying causes, it is not surprising that the effect of treatments for overactive bladder (OAB) and bladder outlet obstruction (BOO) are disappointing with regard to nocturia. Therefore, we suggest to conduct studies in which nocturic patients are treated according to the underlying pathophysiology: (1) antimuscarinics or β3-agonists for OAB symptoms, (2) α-blockers or 5α-reductase inhibitors in men with BOO caused by enlarged prostates, (3) desmopressin or diuretics for NP, (4) continuous positive airway pressure in nocturic patients with obstructive sleep apnea, and (5) all its combinations in case of combined pathophysiology. Not only the effect on treatment efficacy or side effects needs to be assessed, but also the impact on related comorbidities such as sleep disorders, hypertension, and endocrine functions such as blood glucose regulation.

Conclusion: Future research needs to subtype nocturic patients in order to adapt treatment according to the underlying cause.

Keywords:

• Nocturia
• Nocturnal polyuria
• Hypertension
• Sleep
• Pathophysiology

Acknowledgements

We want to thank An-Sofie Goessaert, Candy Kumps, Karlien Dhondt, An Mariman, Dirk Vogelaers, Joris Delanghe and Johan Vande Walle for the discussions that preceded this writing.