Nocturia is independently associated with self-reported poor sleep quality in nursing home residents

Haddad R1, Decalf V2, Monaghan T3, Van Laecke E1, Bower W4, Petrovic M5, Everaert K1

Research Type

Clinical

Abstract Category

Nocturia

Abstract 296
ePoster 5
Scientific Open Discussion Session 21
On-Demand
Nocturia Gerontology Questionnaire
1. Department of Urology, Ghent University Hospital, Ghent, Belgium, 2. Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium, 3. Department of Urology, SUNY Downstate Health Sciences University, Brooklyn NY, USA, 4. Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia, 5. Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
Presenter
Links

Abstract

Hypothesis / aims of study
Sleep quality is a crucial aspect of well-being and its impairment is associated with adverse outcomes in older adults. While nocturia is known to disturb sleep in nursing home (NH) residents, its association with sleep quality is yet to be demonstrated. The objective of this study was thus to evaluate the association between self-reported sleep quality and nocturia in NH residents.
Study design, materials and methods
A cross-sectional multicentre study, approved by the local ethics committee, was deployed in 2017 in 2 Belgian NH. Residents aged over 65 years willing to participate in the validation study of the Dutch for Belgium ‘Targeting the individual’s Aetiology of Nocturia to Guide Outcomes’ (TANGO-D) questionnaire were included. The dependent variable was self-reported poor sleep quality (“I would describe my sleep quality as bad”) using the TANGO-D questionnaire. Independent variables included: age, gender, nocturia defined by at least 2 nocturnal awakenings to void (using the International Consultation on Incontinence Modular Questionnaire for Male or Female Lower Urinary Tract Symptoms), self-rated health status, insomnia symptoms (using the TANGO-D questionnaire), cognitive frailty score (using the Comprehensive Frailty Assessment Instrument) and hypnosedatives use obtained from patients' medication administration record. The association between nocturia and self-reported poor sleep quality was examined using three multivariable logistic regression analyses. The potential confounding variables included in the multivariable analysis models were selected a priori using a direct acyclic graph, based on literature data. Model 1 included age and gender. Model 2 included further self-reported health status as a proxy of comorbidities and cognitive frailty as a proxy of cognitive status. Model 3 included further drugs intake, i.e. hypnosedative and antidepressant use.
Results
Among the study population (median age 89±7 years, 77.5% women), 23 (28.7%) had a self-reported poor sleep quality. The three most frequent sleep-related complaints were sleep-onset insomnia (33.7%), sleep-maintenance insomnia (32.5%) and sleep duration less than 5 hours per night (23.7%). Nocturia, the lower urinary tract symptom most frequently by all participants, was identified in in 56.2% of the study population. It was significantly more frequent among those with versus without self-reported poor sleep quality (78.3% vs 47.4%, p=0.01), with a mean number of nocturia episodes per night of 2.3±1.2 in this group. In multivariable analysis, nocturia was statistically significantly associated with self-reported poor sleep quality after adjustment for age and gender (Model 1, p=0.01). This relationship persisted upon adjustment for comorbidities, considered using the self-rated health status and the cognitive frailty score (Model 2, p=0.007). Nocturia and self-rated health status were the only factors independently associated with self-reported poor sleep quality when antidepressant and hypnosedative utilization were added to the model, with an OR (95%CI) of 6.06 (1.83-25.36) and 7.38 (1.20-57.44) respectively.
Interpretation of results
This study identified a significant association between nocturia and self-reported poor sleep quality which persisted after controlling for age, gender, self-rated health, cognitive frailty, hypnosedative and antidepressant use. Effect size was substantial, with a 6-fold increased risk of self-reported poor sleep quality for nocturia, which is similar to the increase in risk found for self-rated health status.
Concluding message
Nocturia, along with self-rated health status, are independently associated with subjective poor sleep quality in NH residents. These results are important for clinical practice and suggest that optimization of concomitant nocturia may be an indispensable component of the evaluation and management of poor sleep in this population.
Disclosures
Funding This work was supported by the Fonds de dotation Renaitre (Grant number not provided); the Société Française de Médecine Physique et de Réadaptation with the institutional support of Merz Pharma France (Grant number not provided); and the Société Interdisciplinaire Francophone d'UroDynamique et de Pelvi Périnéologie (Grant number not provided). Clinical Trial No Subjects Human Ethics Committee EC/2017/0704 Helsinki Yes Informed Consent Yes
23/11/2024 01:23:44