Presentation Authors: Matthew Epstein, Thomas Monaghan*, Kyle Michaelson, Zhan Wu, Nicholas Suss, Arturo Holmes, Brooklyn, NY, Donald Bliwise, Atlanta, GA, Jason Lazar, Jeffrey Weiss, Brooklyn, NY
Introduction: In this study, we investigate how nocturnal diuresis rates differ at different portions of sleep for 5 different etiologies of nocturnal polyuria (NP) to aid in identifying optimal management strategies for the distinct clinical entities of NP.
Methods: We retrospectively analyzed a database of voiding diaries from patients managed for nocturia at a Veterans Affairs urology clinic from 2007-2018. The first complete entries were included for males aged â‰¥18 with clinically-significant nocturia (â‰¥2 nocturnal voids) owing to NP using the two most common definitions of NP: nocturnal urine production [NUP] â‰¥90 mL/h and nocturnal polyuria index [NPi] â‰¥0.33. Patients meeting criteria were divided into 5 sub-groups with a single diagnosis of either Nocturnal Polyuria Syndrome (NPS), diabetes insipidus (DI), obstructive sleep apnea (OSA), congestive heart failure (CHF), and chronic kidney disease (CKD). NPS was defined as NP in the absence of all aforementioned diagnoses. Early nocturnal diuresis rate (ENDR), defined as first nocturnal voided volume/first uninterrupted sleep period, late nocturnal diuresis rate (LNDR), defined as remaining nocturnal urine volume/remaining hours of sleep, and diurnal diuresis rate (DDR), defined as daytime urine volume/hours awake, were calculated and displayed with Wilcoxon confidence intervals in Figure 1.
Results: At both NUP â‰¥90 mL/h and NPi â‰¥0.33, patients with NPS demonstrated an increase in diuresis rate during the early portion of sleep, followed by a decline in the latter portion of sleep, which followed the same pattern for patients with DI with NP defined as NUP â‰¥90 mL/h. Only 1 patient was identified with DI and NP defined as NPi â‰¥0.33 following inclusion and exclusion criteria. At both NUP â‰¥90mL/h and NPi â‰¥0.33, patients with OSA, CHF, and CKD were observed to have a gradual increase in diuresis rate from early nocturnal to the late nocturnal period.
Conclusions: Patients with NPS and DI exhibited an early nocturnal surge in diuresis rate, followed by a decline in the latter portion of sleep. In contrast, patients with NP of cardiogenic and renal etiology displayed a gradual increase in diuresis rate from the early to latter portion of sleep. Nocturia interventions may vary according to the differing underlying mechanisms in these subtypes of nocturnal polyuria.