Nocturia and associated mortality: observational data from the REDUCE trial

Importance: Nocturia (voids arising from sleep) is a ubiquitous phenomenon reflecting many diverse conditions, but whether it has significance in its own right remains uncertain. Objective: To determine whether nocturia is an independent risk factor for mortality Design: Observational study Setting: Global study with most sites in North America and Europe Participants: 7,343 men, ages 50-75 at Baseline from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial Exposures: Nocturia Main Outcome and Measures: Cox proportional hazards models were used to test the association between nocturia (voiding 3 more times per night) and all-cause mortality. Potential confounding variables included: age, race, region of origin, treatment group, self-reported coronary artery disease, diabetes mellitus, hypertension, and peripheral vascular disease, smoking, alcohol use, prostate volume, and diuretics. Self-reported sleep quality, as measured with the Medical Outcomes Study sleep scale, was entered as a final step in the model. Results: Nocturia was associated with increased risk for mortality (Hazard Ratio [HR] = 1.72; 95% CI 1.15-2.55) independent from all demographics and medical comorbidities. Inclusion of disturbed sleep in the model reduced the magnitude of the association (HR = 1.43; 95% CI 0.93-2.19). Conclusions and Relevance: The interruption of sleep by nocturia may have long-term impact on health and may warrant targeted intervention

Multivariable analysis of the relationship between the Apnea-Hypopnea Index (AHI), both as a dichotomous variable (AHI ≥15) and as a continuous variable, and total severity score ≥100, in the overall sample with twins treated as individuals.

Multivariable analysis of the relationship between the Apnea-Hypopnea Index (AHI), both as a dichotomous variable (AHI ≥15) and as a continuous variable, and total severity score ≥100, in the overall sample with twins treated as individuals.</p

Sociodemographic factors, military service, lifestyle, and cardiovascular disease risk factors in twins with and without obstructive sleep apnea.

Sociodemographic factors, military service, lifestyle, and cardiovascular disease risk factors in twins with and without obstructive sleep apnea.</p

Within-pair and between-pair relationships between the Apnea-Hypopnea Index (AHI) as a continuous variable and total severity score ≥100, in twins discordant for AHI (at least 5-point difference).

The pairwise analysis is also shown for AHI status as a categorical variable.</p

Myocardial perfusion imaging data in twins with and without obstructive sleep apnea.

Myocardial perfusion imaging data in twins with and without obstructive sleep apnea.</p

Participant flow diagram and construction of the analytical sample.

Participant flow diagram and construction of the analytical sample.</p

Association of a total severity score ≥100, a measure of abnormal myocardial perfusion obtained using positron emission tomography myocardial perfusion imaging, with indicators of obstructive sleep apnea classified in tertiles of their distribution, including the Apnea/Hypopnea Index (AHI), the Respiratory Disturbance Index (RDI), the oxygen desaturation index (ODI), and the cumulative proportion (%) of sleep spent with oxygen saturation (SaO2) < 90%.

P values test the difference between first and third tertile.</p