Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland.
Department of Urology, Tampere University Hospital, Tampere, Finland.
J Urol. 2020 Mar;203(3):486-495. doi: 10.1097/JU.0000000000000463. Epub 2019 Jul 31.
Nocturia (waking from sleep at night to void) is a common cause of sleep disruption associated with increased comorbidity and impaired quality of life. However, its impact on mortality remains unclear. We performed a systematic review and meta-analysis to evaluate the association of nocturia with mortality as a prognostic factor and a causal risk factor.
We searched PubMed®, Scopus®, CINAHL® (Cumulative Index of Nursing and Allied Health Literature) and major conference abstracts up to December 31, 2018. Random effects meta-analyses were done to address the adjusted RR of mortality in people with nocturia. Meta-regression was performed to explore potential determinants of heterogeneity, including the risk of bias. We applied the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) framework to rate the quality of evidence for nocturia as a prognostic risk factor for mortality and separately as a cause of mortality.
Of the 5,230 identified reports 11 observational studies proved eligible for inclusion. To assess nocturia 10 studies used symptom questionnaires and 1 used frequency-volume charts. Nocturia was defined as 2 or more episodes per night in 6 studies (55%) and as 3 or more episodes per night in 5 (45%). Pooled estimates demonstrated a RR of 1.27 (95% CI 1.16-1.40, I=48%) with an absolute 1.6% and 4.0% 5-year mortality difference in individuals 60 and 75 years old, respectively. The pooled estimates of relative risk did not differ significantly across varying age, gender, followup, nocturia case definition, risk of bias or study region. We rated the quality of evidence for nocturia as a prognostic factor as moderate and as a cause of mortality as very low.
Nocturia is probably associated with an approximately 1.3-fold increased risk of death.
夜尿症（夜间从睡眠中醒来排尿）是睡眠中断的常见原因，与更高的合并症发病率和较差的生活质量相关。然而，其对死亡率的影响尚不清楚。我们进行了系统回顾和荟萃分析，以评估夜尿症作为预后因素和因果风险因素与死亡率的关联。
我们检索了 PubMed®、Scopus®、CINAHL®（护理与联合健康文献累积索引）和主要会议摘要，检索时间截至 2018 年 12 月 31 日。我们采用随机效应荟萃分析来评估夜尿症患者的死亡率调整后 RR。进行荟萃回归以探索异质性的潜在决定因素，包括偏倚风险。我们应用 GRADE（推荐、评估、发展和评估等级）框架来评估夜尿症作为死亡率的预后风险因素以及作为死亡率的因果因素的证据质量。
在 5230 份鉴定报告中，有 11 项观察性研究被证明符合纳入标准。为了评估夜尿症，有 10 项研究使用了症状问卷，1 项研究使用了频率-容量图表。在 6 项研究（55%）中，夜尿症定义为每晚 2 次或更多次，在 5 项研究（45%）中定义为每晚 3 次或更多次。汇总估计显示，60 岁和 75 岁个体的相对风险分别为 1.27（95%CI 1.16-1.40，I=48%），绝对 5 年死亡率差异分别为 1.6%和 4.0%。相对风险的汇总估计在不同年龄、性别、随访、夜尿症病例定义、偏倚风险或研究区域之间没有显著差异。我们将夜尿症作为预后因素的证据质量评为中等，作为死亡率的因果因素的证据质量评为非常低。
夜尿症可能与死亡风险增加约 1.3 倍相关。
