Effect of nocturia in patients with different severity of obstructive sleep apnea on polysomnography: A retrospective observational study

doi:10.1016/j.ajur.2023.02.003

Asian Journal of Urology, 2024, 11 (3): 486-496 doi: 10.1016/j.ajur.2023.02.003

Regular Papers: Original Articles

Effect of nocturia in patients with different severity of obstructive sleep apnea on polysomnography: A retrospective observational study

Chin-Heng Lu^a,b,c,1,Hung-Min Chang^d,1,Kuang-Hsi Chang^e,f,g,Yen-Chuan Ou^a,h,Chao-Yu Hsu^a,b,c,Min-Che Tung^a,i,Frank Cheau-Feng Lin^j,k,*(

),Stella Chin-Shaw Tsai^d,h,*(

)

^aDivision of Urology, Department of Surgery, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan, China
^bRong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan, China
^cCollege of Life Sciences, Chung Hsing University, Taichung, Taiwan, China
^dDepartment of Otolaryngology, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan, China
^eDepartment of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan, China
^fGeneral Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, China
^gGraduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, China
^hDepartment of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung, Taiwan, China
ⁱDepartment of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, China
^jDepartment of Surgery, Chung Shan Medical University, Taichung, Taiwan, China
^kCollege of Medicine, Chung Shan Medical University, Taichung, Taiwan, China

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Abstract

Objective: Obstructive sleep apnea (OSA) is one of the etiologies of nocturia. We analyzed polysomnography (PSG) results to determine correlated factors related to nocturia in OSA patients with different severity.

Methods: Patients with suspected OSA were examined using PSG. They were divided into two groups based on the presence of nocturia. Nocturia was defined as a patient who needed to void at least once. Apnea-hypopnea index (AHI) was employed to classify patients according to degrees of severity: AHI<5 events/h, 5 events/h≤AHI<15 events/h, 15 events/h≤AHI<30 events/h, and AHI≥30 events/h, defined as normal, mild OSA, moderate OSA, and severe OSA, respectively. Demographic variables, PSG parameters, International Prostate Symptom Scores (IPSSs), and quality of life scores due to urinary symptoms were analyzed.

Results: In total 140 patients, 114 patients had OSA (48 had mild OSA; 34 had moderate OSA; and 32 had severe OSA) and 107 patients had nocturia. The total IPSS was significantly higher in nocturia patients in all groups except the group of severe OSA patients. With the increasing severity of OSA, more correlated factors related to nocturia were determined. In mild OSA patients, nocturia related to increased age (p=0.025), minimum arterial blood oxygenation saturation (p=0.046), and decreased AHI of non-rapid eye movement (p=0.047), AHI of total sleep time (p=0.010), and desaturation index (p=0.012). In moderate OSA patients, nocturia related to increased age (p<0.001), awake time (p=0.025), stage 1 sleep (p=0.033), and sleep latency (p=0.033), and decreased height (p=0.044), weight (p=0.025), and sleep efficiency (p=0.003). In severe OSA patients, nocturia related to increased weight (p=0.011), body mass index (p=0.009), awake time (p=0.008), stage 1 sleep (p=0.040), arousal number (p=0.030), arousal index (p=0.013), periodic limb movement number (p=0.013), and periodic limb movement index (p=0.004), and decreased baseline arterial blood oxygenation saturation (p=0.046).

Conclusion: Our study revealed that there were more correlated factors related to nocturia with increasing severity of OSA. This study helps in clinical education and treatment for OSA patients with different severity.

Key words： Nocturia Obstructive sleep apnea Polysomnography Apnea-hypopnea index International Prostate Symptom Score

Received: 19 July 2022 Available online: 20 July 2024

Corresponding Authors: *Department of Surgery, Chung Shan Medical University, Taichung, Taiwan, China (F. Cheau-Feng Lin) E-mail address: frnklin@gmail.com (F. Cheau-Feng Lin). Department of Otolaryngology, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan, China (S. Chin-Shaw Tsai) E-mail address: t5722@ms.sltung.com.tw (S. Chin-Shaw Tsai).

About author:: ¹Both authors contributed equally.

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	Chin-Heng Lu
	Hung-Min Chang
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	Min-Che Tung
	Frank Cheau-Feng Lin
	Stella Chin-Shaw Tsai

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Chin-Heng Lu,Hung-Min Chang,Kuang-Hsi Chang, et al. Effect of nocturia in patients with different severity of obstructive sleep apnea on polysomnography: A retrospective observational study[J]. Asian Journal of Urology, 2024, 11(3): 486-496.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.02.003 OR http://www.ajurology.com/EN/Y2024/V11/I3/486

Analysis of variables for patients with and without nocturia in all patients.

Parameter of PSG	AHI<5: normal patients			AHI≥5: OSA patients
Parameter of PSG	With nocturia (n=17)	Without nocturia (n=9)	p-Value	With nocturia (n=90)	Without nocturia (n=24)	p-Value^a
Age, year	40.59±3.29	29.67±4.01	0.045?	46.81±1.40	35.63±1.50	<0.001?
Height, cm	170.94±2.02	171.44±2.53	0.792	170.26±0.85	172.77±1.23	0.209
Weight, kg	73.68±3.40	82.56±4.22	0.051	83.84±1.67	86.54±3.58	0.914
BMI, kg/m²	25.18±1.01	27.97±0.89	0.025?	28.72±0.45	28.92±1.05	0.684
AHI, events/h
REM^b	5.47±0.88	9.86±2.10	0.096	31.29±2.26	26.71±3.40	0.387
NREM	1.99±0.29	1.76±0.33	0.634	25.73±2.58	18.13±3.16	0.357
TST	2.46±0.33	2.84±0.44	0.426	26.71±2.46	19.57±2.90	0.442
Sleep time, min
Time in bed	425.71±24.82	456.33±14.27	0.263	455.61±3.54	455.04±7.14	0.936
Sleep period	380.09±26.98	421.78±16.37	0.263	423.34±4.47	430.10±7.45	0.449
TST	323.50±25.77	377.94±15.50	0.241	382.21±5.35	402.58±7.93	0.062
Sleep cycle, %
Awake time	17.70±3.06	10.06±2.74	0.051	9.81±0.74	6.40±0.81	0.005?
Stage 1 sleep	22.18±2.43	19.13±2.02	0.958	16.90±0.78	11.87±1.24	0.003?
Stage 2 sleep	44.69±2.05	41.73±3.34	0.312	48.91±1.16	49.66±1.78	0.569
Stage 3 sleep	19.65±2.10	22.88±1.52	0.396	16.45±0.85	20.20±1.12	0.014?
REM	13.48±1.77	16.26±2.22	0.525	17.56±0.64	18.28±1.34	0.571
Sleep efficiency, %	72.49±4.29	82.96±2.59	0.058	83.82±0.93	88.45±0.95	0.010?
Sleep latency, min	20.82±3.94	21.44±3.53	0.634	14.85±1.65	14.38±1.80	0.426
Arousal
Total events in sleep	39.00±9.51	48.89±14.45	0.426	104.50±7.82	63.29±8.26	0.006?
Index, events/h	7.94±1.63	8.96±3.02	0.958	18.26±1.47	9.75±1.33	0.002?
SaO₂, %
Baseline	97.18±0.31	97.22±0.55	0.672	95.90±0.20	96.25±0.40	0.253
Mean	94.47±0.34	93.78±0.52	0.263	89.38±0.38	90.33±0.50	0.321
Minimum	89.47±0.78	88.89±0.73	0.458	77.54±1.21	79.17±1.44	0.772
Desaturation index, events/h	2.46±0.33	2.84±0.44	0.426	26.88±2.49	19.55±2.90	0.43
Snore
Total events in sleep	387.94±105.49	376.00±134.82	1	873.50±58.84	923.21±101.50	0.536
Index, events/h	66.98±15.79	64.29±24.30	0.634	136.29±8.78	139.08±15.96	0.773
PLM
Total events in sleep^c	13.90±4.02	27.00±18.18	0.839	21.64±3.14	12.00±1.18	0.016?
Index^c, events/h	2.67±0.68	4.53±3.11	0.839	3.46±0.57	1.82±0.21	0.011?
IPSS
Residual sensation	1.41±1.58	0.56±0.88	0.148	1.17±1.30	1.29±1.33	0.678
Urinary frequency	1.18±0.88	1.11±1.36	0.883	1.50±1.19	0.88±1.15	0.023?
Intermittent	0.88±1.11	0.22±0.44	0.102	0.72±1.20	0.33±0.57	0.126
Urinary urgency	0.53±1.07	0.33±0.71	0.626	0.52±1.12	0.04±0.20	0.040?
Weak stream	1.06±1.56	0.22±0.67	0.14	0.63±1.12	0.25±0.68	0.112
Straining	0.53±1.01	0.22±0.67	0.42	0.38±0.89	0.21±0.66	0.382
Nocturia	1.71±0.77	0.00±0.00	<0.001?	1.56±0.89	0.00±0.00	<0.001?
Total	7.29±4.44	2.67±2.29	0.008?	6.48±4.66	3.00±2.32	0.001?
Quality-of-life score due to urinary symptoms	2.59±1.62	0.78±1.09	0.006?	1.94±1.68	0.54±0.98	<0.001?

Analysis of normal and OSA patients with and without nocturia.

Analysis of mild OSA patients (5 events/h≤AHI<15 events/h) with and without nocturia.

Analysis of moderate OSA patients (15 events/h≤AHI<30 events/h) with and without nocturia.

Analysis of severe OSA patients (AHI≥30 events/h) with and without nocturia.

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