Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
Am J Physiol Renal Physiol. 2023 Oct 1;325(4):F407-F417. doi: 10.1152/ajprenal.00025.2023. Epub 2023 Aug 10.
Nocturia (waking to void) is prevalent among older adults. Disruption of the well-described circadian rhythm in urine production with higher nighttime urine output is its most common cause. In young adults, their circadian rhythm is modulated by the 24-h secretory pattern of hormones that regulate salt and water excretion, including antidiuretic hormone (ADH), renin, angiotensin, aldosterone, and atrial natriuretic peptide (ANP). The pattern of hormone secretion is less clear in older adults. We investigated the effect of sleep on the 24-h secretion of these hormones in healthy older adults. Thirteen participants aged ≥65 yr old underwent two 24-h protocols at a clinical research center 6 wk apart. The first used a habitual wake-sleep protocol, and the second used a constant routine protocol that removed the influence of sleep, posture, and diet. To assess hormonal rhythms, plasma was collected at 8:00 am, 12:00 pm, 4:00 pm, and every 30 min from 7:00 pm to 7:00 am. A mixed-effects regression model was used to compare subject-specific and mean trajectories of hormone secretion under the two conditions. ADH, aldosterone, and ANP showed a diurnal rhythm that peaked during sleep in the wake-sleep protocol. These nighttime elevations were significantly attenuated within subjects during the constant routine. We conclude that sleep has a masking effect on circadian rhythm amplitude of ADH, aldosterone, and ANP: the amplitude of each is increased in the presence of sleep and reduced in the absence of sleep. Disrupted sleep could potentially alter nighttime urine output in healthy older adults via this mechanism. Nocturia (waking to void) is the most common cause of sleep interruption among older adults, and increased nighttime urine production is its primary etiology. We showed that in healthy older adults sleep affects the 24-h secretory rhythm of hormones that regulate salt-water balance, which potentially alters nighttime urine output. Further studies are needed to elucidate the impact of chronic insomnia on the secretory rhythms of these hormones.
夜尿症（醒来排尿）在老年人中很常见。其最常见的原因是尿液产生的昼夜节律受到破坏，导致夜间尿量增加。在年轻人中，他们的昼夜节律受调节盐和水排泄的激素 24 小时分泌模式的调节，包括抗利尿激素（ADH）、肾素、血管紧张素、醛固酮和心钠肽（ANP）。老年人的激素分泌模式不太清楚。我们研究了睡眠对健康老年人这些激素 24 小时分泌的影响。13 名年龄≥65 岁的参与者在临床研究中心相隔 6 周进行了两次 24 小时的方案。第一次使用习惯的清醒-睡眠方案，第二次使用固定程序方案，消除了睡眠、姿势和饮食的影响。为了评估激素节律，在上午 8：00、中午 12：00、下午 4：00 和晚上 7：00 至早上 7：00 每 30 分钟采集一次血浆。使用混合效应回归模型比较两种情况下个体特异性和平均激素分泌轨迹。ADH、醛固酮和 ANP 在清醒-睡眠方案中显示出昼夜节律，在睡眠期间达到峰值。在固定程序中，这些夜间升高在个体内明显减弱。我们得出结论，睡眠对 ADH、醛固酮和 ANP 的昼夜节律幅度有掩蔽作用：在睡眠存在的情况下，每个幅度增加，在睡眠不存在的情况下减少。睡眠中断可能通过这种机制改变健康老年人的夜间尿量。夜尿症（醒来排尿）是老年人睡眠中断最常见的原因，夜间尿量增加是其主要病因。我们表明，在健康的老年人中，睡眠会影响调节水盐平衡的激素的 24 小时分泌节律，这可能会改变夜间尿量。需要进一步的研究来阐明慢性失眠对这些激素分泌节律的影响。
