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The Prevalence of an Undiagnosed Sleep Disorder in Patients with Voiding Complaints
Arun Rai, BA1, Vik Uberoi, MD1, Brooke Harnisch, MD2, Lori Lerner, MD2.
1Boston University School of Medicine, Boston, MA, USA, 2VA Boston Healthcare System, Boston, MA, USA.

BACKGROUND:
Aside from adversely affecting sleep patterns, it is likely that obstructive sleep apnea (OSA) plays a role in the development of nocturnal polyuria and subsequent nocturia (Umlauf et al, 2004). While the prevalence of OSA approaches 70%, recent data from the VA Boston Healthcare System demonstrated that only 4% of patients carried a concomitant ICD-9 code for both nocturia and OSA suggesting an under diagnosis of sleep disorders within the urologic patient population. We sought to determine the prevalence of a sleep disorder in men presenting to a urology clinic, hypothesizing that undiagnosed sleep disorders may be contributing to nocturia and/or voiding complaints.
METHODS:
A case-control study was conducted on all patients who presented to the VA Boston Healthcare System urology clinic between August and October 2012. As part of routine evaluation, all patients over age 50 were administered the International Prostate Symptom Score (IPSS) and Berlin sleep questionnaires at the time of check in to the clinic. One of the components of the IPSS, the Bother Score, has been demonstrated to be a statistically valid measure of evaluating voiding symptoms (O'Leary et al, 2005). Patients completed the questionnaires voluntarily while in the waiting room, and the responses were addressed during the clinical visit.
RESULTS:
A total of 337 male patients completed the questionnaires. Preliminary results indicate that 58% of patients were found to have nocturia (> 2 voids/night). Of the patients with nocturia, 56% had a positive response on the Berlin questionnaire, suggesting a sleep disorder. Having nocturia increased the probability of a positive Berlin score (p=0.004). Additionally, patients with a positive Berlin response had a higher mean Bother Score than those with a negative Berlin response (p <0.0001) (table 1). Interestingly, a body mass index >30 was not associated with nocturia (p=1.00).
CONCLUSIONS:
Nocturia and elevated bother score were significantly associated with a positive Berlin score. In fact, current literature demonstrates that higher circulating levels of ANP are observed with OSA patients leading polyuria and nocturia. These preliminary findings suggestthat nocturia and the IPSS may be an indicator of a more serious condition, such as OSA. For patients refractory to standard urologic approaches to lower urinary tract symptoms, further investigation into other etiologies of nocturia is important and referral for evaluation of a sleep disorder may be prudent.
Degree of bother associated with positive or negative Berlin score
Degree of botherNumber of patients with positive Berlin scoreNumber of patients with negative Berlin score
011 (6.3%)24 (15%)
124 (14%)27 (17%)
217 (10%)44 (27%)
340 (23%)34 (21%)
419 (11%)11 (6.7%)
531 (18%)13 (8.0%)
632 (18%)10 (6.3%)
Mean3.45 ± 1.872.37 ± 1.68P Value: <0.0001**


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