Nocturia Improvement With Surgical Correction of Sleep Apnea

INJ INTERNATIONAL NEUROUROLOGY JOURNAL pISSN 2093-4777 eISSN 2093-6931 Original Article Volume 19 | Number 2 | June 2015 pages 131-210 INTERNATIONAL NEUROUROLOGY JOURNAL Int Neurourol J 2016;20:329-334 https://doi.org/10.5213/inj.1632624.312 pISSN 2093-4777 · eISSN 2093-6931 Official Journal of Korean Continence Society / Korean Society of Urological Research / The Korean Children’s Continence and Enuresis Society / The Korean Association of Urogenital Tract Infection and Inflammation einj.org Mobile Web Nocturia Improvement With Surgical Correction of Sleep Apnea Hyoung Keun Park1, Sung Hyun Paick1, Hyeong Gon Kim1, Doo-Heum Park2, Jae Hoon Cho3, Seok-Chan Hong3, Woo Suk Choi1 Department of Urology, Konkuk University School of Medicine, Seoul, Korea Department of Neuropsychiatry, Konkuk University School of Medicine, Seoul, Korea 3 Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea 1 2 Purpose: To evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA). Methods: A total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient’s subjective judgment. Results: The response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters. Conclusions: OSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA. Keywords: Sleep Apnea Syndrome; Surgical Procedure; Nocturia; Lower Urinary Tract Symptoms • Grant Support: This work was supported by Konkuk University Medical Center Research Grant 2015. • Research Ethics: All patients provided informed consent, and the study protocol was approved by the ethics committee of Konkuk University Hospital (approval number: KUH1130050). • Conflict of Interest: No potential conflict of interest relevant to this article was reported. INTRODUCTION Nocturia is common lower urinary tract symptoms (LUTS). The Boston Area Community Health study showed that nocturia affected 25% of men and 31% of women [1]. In the Epidemiology of Urinary Incontinence and Comorbidities study, the prevalence of nocturia was 49% in men and 55% in women [2]. Corresponding author: Woo Suk Choi http://orcid.org/0000-0002-8352-578X Department of Urology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea E-mail: / Tel: +82-2-2030-7676 / Fax: +82-2-2030-5319 Submitted: May 5, 2016 / Accepted: July 25, 2016 Nocturia is not only a common voiding problem but also reduces the quality of life (QoL) and is associated with sleep disruption and daytime fatigue [3,4]. Nocturia is also reported to be associated with a twofold increase in the risk of falls in a 24hour day [5]. Therefore, nocturia is an important concern for physicians who treat LUTS patients, but is not easily treatable. Except in the This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2016 Korean Continence Society www.einj.org INJ Park, et al. • Nocturia Improvement Following Sleep Apnea Correction case of nocturnal polyuria, nocturia has usually been managed as an isolated symptom, with therapy based on LUTS, including alpha blockers and anticholinergic drugs. Recent research suggests, however, that the etiology of nocturia differs from that of other LUTS, and that nocturia should be evaluated as a separate condition, as well as a component of a systemic disease [6]. Among systemic diseases, obstructive sleep apnea (OSA) syndrome has shown an association with nocturia in several studies. Oztura et al. [7] reported that the prevalence of nocturia increased with an increase in OSA severity. Communitybased elderly populations with higher rates of sleep-disordered breathing ( >25 breathing events/hr) have nearly double the number of nocturia episodes, compared with those with low rates of OSA [8]. Therefore, the correction of OSA would be expected to reduce the severity of nocturia. One study showed that continuous positive airway pressure (CPAP) treatment of OSA significantly reduced the frequency of nocturia [9]. However, to our knowledge, there is no report on nocturia improvement with surgical correction of sleep apnea. Although CPAP is recommended for primary treatment of OSA, its effectiveness is often limited by poor compliance and acceptance [10]. Furthermore, CPAP treatment has several adverse effects including nasal obstruction, mask leak, skin breakdown, pressure intolerance, and claustrophobia [11,12]. Therefore, some patients select surgical therapy [13]. Among numerous OSA surgical procedures according to the obstructive level, uvulopalatopharyngoplasty (UPPP) is one of the most popular for treating oropharyngeal obstruction [14]. In this study, we evaluated changes in nocturia episodes after UPPP, to determine whether nocturia is decreased after correction of OSA. We also investigated the effect of surgical treatment on other LUTS and related QoL. MATERIALS AND METHODS Study Subjects Between 2012 and 2014, 256 patients who consulted for a sleep problem were diagnosed with OSA by polysomnography. Of these, 66 who planned to undergo UPPP surgery for correction of OSA were included in this study. Subjects eligible for UPPP surgery were adults (age ≥18 years) who (1) complained of clinical symptoms suggestive of OSA without nasal obstruction; (2) had an apnea-hypopnea index (AHI) ≥ 5 per hour of total sleep time on diagnostic polysomnography; and (3) refused 330 www.einj.org medical treatment such as CPAP or an oral appliance. Study inclusion criteria were clinically proven OSA, nocturia episodes ≥1, age >20, and planning to undergo UPPP. Exclusion criteria were a (...truncated)