Nocturia: consequences for sleep and daytime activities and associated risks

The aetiology of nocturia (nocturnal voiding) includes several factors such as somatic disease, age-related endocrine alterations, sleep apnoea, detrusor overactivity, and benign prostatic obstruction with a significant postvoid residual. These conditions are mainly prevalent in the elderly. Indeed, nocturia is such a common condition in the older population that it is often regarded as a normal consequence of ageing and treated accordingly, i.e. left untreated. However, nocturia has a profoundly negative impact on life quality and well-being for many. The sleep disruption associated with frequent nocturnal awakenings may induce excessive daytime fatigue, cognitive impairment, mood alterations, and increased susceptibility to disease. Nocturia is also associated with depression and an increased mortality rate. In addition, nocturnal voiding episodes increase the risk for falls and fractures during the trips to the toilet and back, especially in older, frail people with a decreased cognitive and motoric functioning. Nocturia imposes not only a significant burden on many nocturics and their partners, its costs for society may also be considerable. Nocturics tend to have a lower productivity at work compared to healthy people and have an increased use of healthcare services. The fatigue due to sleep deprivation further augments the risk for accidents on the road and at the workplace. Clearly, nocturia is not just another annoying condition associated with the ageing process. Rather, it is a serious disorder that, if not treated appropriately, may have far-reaching consequences, both for the patient and for society. (C) 2005 Elsevier B.V. All rights reserved.