Department of Urology, SUNY Downstate Medical School, Brooklyn, New York.
Neurourol Urodyn. 2014 Apr;33 Suppl 1:S19-24. doi: 10.1002/nau.22592.
Strategies to manage nocturia include lifestyle modifications and treatment with alpha-blockers, antimuscarinic therapies, and antidiuretics. The concept of achieving success should not be limited to reduction of nighttime voids; it should ideally include proof of improvement of conditions generally associated with nocturia, such as falls, quality of life, and overall health. Few studies have looked specifically at parameters other than nocturnal voids, such as sleep latency, first undisturbed sleep period (FUSP), and total sleep time, including their clinical relevance to patient well-being. Lifestyle modifications, such as voiding before bedtime, limiting caffeine and alcohol, and adjusting medication timing, may be initially effective in mild cases of nocturia. Statistically significant reductions in voiding have been reported with antimuscarinic agents and alpha-blockers as initial therapy, but these reductions generally are not clinically relevant. The antidiuretic therapy desmopressin acetate, a selective vasopressin receptor 2 agonist, is effective in adults with nocturia associated with nocturnal polyuria; however, hyponatremia can occur. The newest formulation-desmopressin orally disintegrating sublingual tablet (ODST)--has greater bioavailability; thus, lower doses can be used, potentially reducing hyponatremia risk. A phase 3 study demonstrated statistically significant reductions in nocturnal voids for desmopressin ODST 50 and 100 µg versus placebo (-1.18 and -1.43 vs. -0.86; P = 0.02 and P < 0.0001, respectively) in patients with nocturia. Treatment was well-tolerated, and low-dose desmopressin ODST was associated with statistically significant increases in duration of FUSP. Development of a validated composite endpoint may help clinicians identify and compare strategies for treating nocturia.
管理夜间多尿的策略包括生活方式的改变以及使用α受体阻滞剂、抗毒蕈碱药物和抗利尿药物进行治疗。取得成功的概念不应局限于减少夜间排尿次数；它应该理想地包括证明与夜间多尿相关的状况得到改善，例如跌倒、生活质量和整体健康状况。很少有研究专门关注除夜间排尿次数以外的参数，例如睡眠潜伏期、首次未受干扰的睡眠期（FUSP）和总睡眠时间，包括它们对患者福祉的临床相关性。在轻度夜间多尿的情况下，睡前排尿、限制咖啡因和酒精摄入以及调整药物使用时间等生活方式的改变可能最初是有效的。抗毒蕈碱药物和α受体阻滞剂作为初始治疗，已报道有统计学意义的排尿次数减少，但这些减少通常与临床无关。抗利尿治疗醋酸去氨加压素，一种选择性血管加压素受体 2 激动剂，对与夜间多尿相关的夜间多尿的成年人有效；然而，可能会发生低钠血症。最新的制剂——去氨加压素口腔崩解舌下片（ODST）——具有更高的生物利用度；因此，可以使用较低的剂量，潜在地降低低钠血症的风险。一项 3 期研究表明，与安慰剂相比，去氨加压素 ODST 50 和 100μg 可使夜间多尿患者的夜间排尿次数分别显著减少（-1.18 和-1.43 与-0.86；P=0.02 和 P<0.0001）。治疗耐受性良好，低剂量去氨加压素 ODST 与 FUSP 持续时间的统计学显著增加相关。开发一个经过验证的综合终点可能有助于临床医生识别和比较治疗夜间多尿的策略。
