30 Nov 2015
[Original article by MNCS reporter Toni Rizzo]
Higher Risk of Falling Among Older Adults with Sleep Disturbance Associated With Nocturnal Voiding
Clinical Newswire – Older adults with arousal during sleep associated with nocturnal voiding have a higher risk of falling, according to the results of a study presented at the 2015 Annual Meeting of the International Continence Society (ICS).*
Sleep disturbance is common among older adults and is associated with a high risk of falling. Sleep disturbance is also strongly associated with nocturia. Few studies have compared the incidence of falls between subjects with arousal during sleep accompanied with nocturnal voiding and subjects with sleep disturbance without nocturnal voiding. The aim of this study, presented by Rika Imanishi, MD, Niigata University of Health and Welfare, Niigata, Japan, was to clarify the relationship between the frequency of arousals during sleep, the number of nocturnal voiding episodes, and the incidence of falls in community dwelling older adults.
A comprehensive geriatric health survey was conducted among all residents aged 65 years or older in Kariwa village in northern Japan. Older adults who required some care or were admitted to the hospital were excluded. Trained interviewers performed face-to-face interviews using the Mini-Mental State Examination (MMSE) in the subjects’ homes. Among 1200 available subjects, 1103 (86.4%) participated in the survey. Older adults with ≥23 points on the MMSE were excluded, leaving 850 subjects for the analysis. The subjects were 74.3±6.7 (63-99) years of age; 459 (54%) were female and 391 (46%) were male.
The patients were assessed for lower urinary tract symptoms with the International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and Overactive Bladder Symptom Score (OABSS). Other assessments included the frequency of arousals per night, the number of nocturnal voiding episodes per night, and the incidence of falls over the previous year. Subjects who fell more than once during that time were classified as fallers.
The survey showed that 787 (92.6%) of the subjects had at least 1 incident of arousal during sleep and 731 (86.0%) had at least 1 episode of nocturnal voiding each night. A total of 63 (7.4%) subjects experienced neither arousal during sleep nor nocturnal voiding. A significant correlation between the frequency of nocturnal voiding and frequency of arousal during sleep was observed (r=0.8047l; P <0.0001). The frequency of nocturnal voiding matched that of arousal during sleep in 590 subjects (69.4%). There was no association between nocturnal voiding and arousal during sleep among the remaining 260 subjects (30.6%). The incidence of falls in the matched group was 18.0% compared with 12.3% in the mismatched group (P <0.05). The frequency of arousals each night in the matched group was once in 234 subjects (39.7%), twice in 194 subjects (32.9%), three times in 78 subjects (13.2%), and four or more times in 21 subjects (3.6%). The frequency of arousals in the mismatched group was once in 35 subjects (13.5%), twice in 122 subjects (46.9%), three times in 70 subjects (26.9%), and four or more times in 33 subjects (12.7%). The IPSS score was significantly higher in the matched group versus the mismatched group in each frequency subgroup. The proportion of subjects with overactive bladder was significantly higher in the matched versus the mismatched group in the twice and three times subgroups. The incidence of falls was higher in the matched group than in the mismatched group at each frequency of arousal during sleep. The incidence of falls was significantly higher in the matched group compared with the mismatched group in the subgroup with three arousals per night (P <0.01). These results demonstrated that the frequency of arousals during sleep was strongly associated with the frequency of nocturnal voiding. Older adults with arousal during sleep associated with nocturnal voiding had a higher risk of falling. The authors concluded that older adults with the same frequency of nocturnal voiding and arousal during sleep should be treated for nocturia to prevent falls. *Imanishi R, Matsumoto K, Ishihara M, et al. Association between nocturnal voiding, arousal during sleep and the incidence rate of falls: a community-based study with home-visit interview. ICS 2015, Abstract #12.