Incidence and Remission of Nocturia: A Systematic Review and Meta-analysis

Abstract

Context

Although vital for decision-making about management, the natural history of nocturia remains uncertain. A systematic review would clarify the issue, but because natural history reviews are uncommon it would require methodological innovations.

Objective

To estimate the incidence and remission of nocturia, and refine methods for meta-analyses assessing natural history.

Evidence acquisition

We conducted a comprehensive search of PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature databases and abstracts of major urologic meetings as far as August 31, 2015. Random effects meta-analyses addressed incidence/remission rates of nocturia; meta-regression explored potential determinants of heterogeneity. Studies were categorized as either low or high risk of bias using a novel instrument specifically designed for longitudinal symptom studies aimed at the general population.

Evidence synthesis

Of 4165 potentially relevant reports, 16 proved eligible. Pooled estimates from 13 studies (114 964 person-years of follow-up) demonstrated that annual incidence was strongly associated with age: 0.4% (0–0.8%) for adults aged < 40 yr; 2.8% (1.9–3.7%) for adults aged 40–59 yr; and 11.5% (9.1–14.0%) for adults aged ≥ 60 yr. Of those with nocturia, each year 12.1% (9.5–14.7%) experienced remission.

Conclusions

The available evidence suggests that nocturia onset is strongly associated with age, with much higher rates in those over 60 yr; remission occurs in approximately 12% each year. These estimates can aid with management decisions and counseling related to nocturia.

Patient summary

We reviewed all previous studies of progression of night-time urination (nocturia). We found that in any given year 0.4% of adults aged < 40 yr, 3% of adults aged 40–59 yr, and 12% of adults aged ≥ 60 yr will develop nocturia, while overall 12% of those with nocturia will improve. These findings may be helpful in making decisions about coping with or treating nocturia.

Introduction

Nocturia (waking from sleep at night to void) [1] is one of the most common and bothersome urinary symptoms [2]. Nocturia is associated with impaired quality of life, and is a significant cause of sleep disruption. Nocturia may increase fracture and mortality risk [3], [4]. Cross-sectional studies suggest that older age increases the risk of nocturia [5], and studies have identified additional risk factors, suggesting a multifactorial etiology [6]. Little is known, however, about patterns of progression and remission of nocturia over time, knowledge of which would facilitate shared decision-making about the initiation and continuation of therapeutic options between patients and healthcare providers [7].

Conventional systematic reviews that compare one treatment against another or against a nontreatment control are common and the methods are well established [8]. However, systematic reviews and meta-analyses addressing natural history or prognosis of symptoms are rare, and require methodological innovation. Although investigators have conducted longitudinal studies addressing nocturia, summarizing the data is challenging, with variation between assessment tools, case definitions, and analytic strategies [6]. The primary aim of this systematic review was to explore and compare, using different analytical methods and definitions, the average annual cumulative incidence and remission of nocturia. We also aimed to examine progression of nocturia, and further develop methods for systematic reviews and meta-analyses assessing natural history and prognosis of symptoms.