Nocturia

Nocturia and the less prevalent nocturnal enuresis are bothersome conditions that interfere with sleep quality and, ultimately, with health-related quality of life. Both can be a symptom of a particular underlying disease or due to an interaction of several pathogenetic mechanisms and co-existing disease entities. Sleep disturbances such as insomnia and obstructive sleep apnea may provoke or worsen nocturia. Insomnia and nocturia have reciprocal effects. The causal direction of this relationship remains unclear. Several factors may play a role in the pathogenesis of nocturia. Overproduction of urine, nocturnal polyuria, appears the most prevailing mechanism. Diuresis is controlled by circadian rhythms including vasopressin release and downregulation of blood pressure by which nocturnal urine formation is reduced. The diurnal variation of diuresis decreases with age, resulting in more urine production and hence voiding at night. Disorders of bladder capacity and continence, commonly leading to lower urinary tract symptoms (LUTS), are also important. The differential diagnosis relies substantially on appropriate history taking and on results from a voiding diary. The treatment of nocturia should target underlying or aggravating disorders in the first place. In particular, symptomatic treatment with desmopressin, an arginine vasopressin analogue, may be safe and effective in patients with polyuria due to impaired water reabsorption by the kidney.

ISBN:9781119789017

Publication year:2021

Accessibility:Closed