Frequent voiding at night ups risk of death

Nocturia, or waking from sleep two or more times at night to void, appears to slightly increase the risk of mortality, results of a systematic review and meta-analysis have shown.

“Moderate quality evidence suggests that nocturia … is associated with a 1.3-fold increased risk of death,” the researchers said.

Databases including PubMed, Scopus, CINAHL and major conference abstracts were searched up to 31 December 2018. The adjusted relative risk (RR) of mortality in people with nocturia was estimated through random effects meta-analyses. Meta-regression was also conducted to explore potential determinants of heterogeneity, including risk of bias.

The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework was applied to rate the quality of evidence for nocturia as a prognostic risk factor for mortality and separately as a cause of mortality.

A total of 5,230 reports were identified, from which 11 observational studies met the eligibility criteria. Nocturia was evaluated in 10 studies using symptom questionnaires and one study using frequency-volume charts. Nocturia was defined as ≥2 episodes per night in six studies (55 percent) and as ≥3 episodes per night in five (45 percent).

The pooled estimate of RR was 1.27 (95 percent confidence interval [CI], 1.16–1.40; I², 48 percent), with an absolute 1.6-percent 5-year mortality difference in individuals aged 60 years and 4.0 percent in those aged 75 years. The pooled RR estimates were not significantly different across varying age, gender, follow-up, nocturia case definition, bias risk or study region. [J Urol 2020;203:486-495]

There was moderate quality of evidence for nocturia as a prognostic factor and very low quality for nocturia as a cause of mortality.

Only one study examining the association between nocturia and mortality was found to have been published in the past. [Int J Cardiol 2015;doi:10.1016/j.ijcard.2015.03.168]

 “Clinicians and patients should be aware that nocturia at least twice per night may be a marker of ill health,” the researchers said.

“Although urological treatments have the potential to improve quality of life in patients with nocturia, clinicians should focus not only on treating the symptom but also on exploring patient general health, considering the relevant risk factors in each individual,” they added. [Int J Clin Pract 2016;70:940-949; Eur Urol 2017;72:757-769]

Furthermore, nocturia could potentially be in the causal pathway leading to premature death, as nocturia-induced sleep impairment could mar physiological night-time blood pressure dipping and increase sympathetic activity, which increases cardiovascular death. [J Am Geriatr Soc 2015;63:733-738]

“In addition, fractures and other injuries may result from falls or other accidents related to frequent night-time toileting and daytime fatigue, and complications of these events could result in premature death,” the researchers said. [J Urol 2019;doi:10.1097/JU.0000000000000459]

“Future investigations should address the impact of nocturia treatment on mortality,” they added.