Improving Nocturia Management Through Sleep Apnea Diagnosis and Treatment

Obstructive sleep apnea (OSA) has an established association with nocturia, but even when referred, patients presenting with nocturia may not undergo a full evaluation or begin treatment for underlying OSA. At our institution, patients with nocturia (≥ 2 episodes per night) are often referred for at-home sleep studies. This study aims to assess if patients presenting with nocturia undergo evaluation for OSA and the impact of continuous or automatic positive airway pressure (CPAP/APAP) on nocturia severity.

We conducted a retrospective chart review of patients with nocturia who completed an at-home sleep study for OSA between July 2020 and September 2023. Patients with pre-existing OSA were excluded. Statistical analysis included Wilcoxon signed-rank tests and Kruskal-Wallis tests.

Of 336 nocturia patients referred for sleep studies, 37 completed the study, and all met diagnostic criteria for OSA. Sixteen of those patients (43.2%) initiated CPAP/APAP therapy. In patients receiving nocturia medication, the mean nocturic episodes significantly decreased after CPAP/APAP initiation (p < 0.01). No significant change was observed before CPAP/APAP initiation with medical management alone (p = 0.052). Twelve of the 16 patients reported subjective improvement in lower urinary tract symptoms (LUTS).

All patients with nocturia who completed an at-home sleep study were diagnosed with OSA, yet most did not follow up, indicating potential underdiagnosis and undertreatment. As advancements in OSA treatment continue to be made, evaluation and treatment for OSA in patients presenting with nocturia may lead to improvement in both conditions.