Prevalence of nocturia and associated factors in women attending two urogynecology outpatient clinics in the state of Rio de Janeiro: a cross-sectional study

Silva, Ingrid Antunes da; Moraes, José Rodrigo de; Sá, Renato Augusto Moreira de; Faria, Carlos Augusto

doi:10.1590/1981-22562024027.230140.pt

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Original Articles • Rev. bras. geriatr. gerontol. 27 • 2024 • https://doi.org/10.1590/1981-22562024027.230140.en linkcopy

Prevalence of nocturia and associated factors in women attending two urogynecology outpatient clinics in the state of Rio de Janeiro: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To identify the prevalence and factors related to nocturia in women presenting lower urinary tract symptoms.

Methods Observational cross-sectional survey, individualized, hospital-based, involving women attended by the Unified Health System in urogynecology outpatient clinics in Niterói and Petrópolis, RJ, Brazil. Sociodemographic, clinical, and lifestyle data were collected. Two outcomes of nocturia were considered: one or more nocturnal voids and two or more nocturnal voids, the latter due to its greater impact on quality of life. Associations between the investigated variables and the outcomes were assessed by logistic regression models, and crude and adjusted odds ratios were obtained.

Results A total of 132 participants were included. The prevalence of nocturia was 71.2%, and of two or more voids, 56.8%. Lower education level OR 0,260 (0,106; 0,637), mixed urinary incontinence OR 2,533 (1,103; 5,817), and three or more comorbidities OR 3,105 (1,340; 7,196) were associated with a higher chance of nocturia. Lower education level OR 0,324 (0,148; 0,709), lower caffeine consumption OR 0,995 (0,990; 1,000), and overactive bladder syndrome OR 2,761 (1,189; 6,409) were associated with a higher chance of two or more voids.

Conclusions In the population attending specialized services, the prevalence of nocturia was similar to that of the general population and to that of similar services, but the prevalence of two or more voids was higher. Active screening for nocturia in women with comorbidities, especially three or more, and their adequate management, proved to be important in addressing the symptom.

Keywords Nocturia; Lower Urinary Tract Symptoms; Women's Health

Characteristics	% of patients (N=132)	Nocturia 1 (number of voids)		Nocturia 2 (number of voids)
Characteristics	or Mean ± SD	None (n=38)	One or more (n=94)	Up to one (n=57)	Two or more (n=75)
Location
Niterói	34.1	35.6	64.4	46.7	53.3
Petrópolis	65.9	25.3	74.7	41.4	58.6
Age (in years)
< 60	47.7	33.3	66.7	49.2	50.8
>60	52.3	24.6	75.4	37.7	62.3
Education
Incomplete elementary education	45.5	16.7	83.3	31.7	68.3
Complete elementary education or higher	54.5	38.9	61.1	52.8	47.2
Caffeine (mg/day)	163.1 ± 77.8	173.0 ± 86.1	159.0 ± 74.3	178.0 ± 85.7	151.0 ± 69.6
Tobacco (packs/year)	4.4 ± 13.5	5.6 ± 19.1	3.8 ± 10.6	5.4 ± 17.3	3.6 ± 9.9

Characteristics	% of patients (N=132)	Nocturia 1 (number of voids)		Nocturia 2 (number of voids)
Characteristics	or Mean ± SD	None (n=38)	One or more (n=94)	Up to one (n=57)	Two or more (n=75)
Nocturia 1
No voids	28.8
One or more	71.2
Nocturia 2
Up to one void	43.2
Two or more voids	56.8
Stress urinary incontinence
Absent	82.6	26.6	73.4	40.4	59.6
Present	17.4	39.1	60.9	56.5	43.5
Urgency urinary incontinence
Absent	87.1	30.4	69.6	44.3	55.7
Present	12.9	17.6	82.4	35.3	64.7
Mixed urinary incontinence
Absent	43.9	37.9	62.1	55.2	44.8
Present	56.1	21.6	78.4	33.8	66.2
Overactive bladder syndrome
Absent	26.5	42.9	57.1	62.9	37.1
Present	73.5	23.7	76.3	36.1	63.9
Hesitancy
Absent	88.6	28.2	71.8	42.7	57.3
Present	11.4	33.3	66.7	46.7	53.3
Slow stream
Absent	82.6	30.3	69.7	44.0	56.0
Present	17.4	21.7	78.3	39.1	60.9
Feeling of incomplete bladder emptying
Absent	44.7	32.2	67.8	52.5	47.5
Present	55.3	26.0	74.0	35.6	64.4
Post-voiding incontinence
Absent	68.2	28.9	71.1	45.6	54.4
Present	31.8	28.6	71.4	38.1	61.9
Pelvic organ prolapse (symptom)
Absent	68.2	30.0	70.0	40.0	60.0
Present	31.8	26.2	73.8	50.0	50.0
Anterior vaginal wall prolapse
Up to stage II	89.4	28.8	71.2	42.4	57.6
Stage III or IV	10.6	28.6	71.4	50.0	50.0
Posterior vaginal wall prolapse
Up to stage II	97.7	29.5	70.5	43.4	56.6
Stage III or IV	2.3	0	100	33.3	66.7
Apical prolapse
Up to stage II	97.7	29.5	70.5	43.4	56.6
Stage III or IV	2.3	0	100	33.3	66.7
Fecal incontinence
Absent	93.2	30.9	69.1	45.5	54.5
Present	6.8	0	100	11.1	88.9
Constipation (Bristol stool scale)
Absent	80.3	32.1	67.9	46.2	53.8
Present	19.7	15.4	84.6	30.8	69.2
Constipation (frequency)
Absent	78.8	27.9	72.1	44.2	55.8
Present	21.2	32.1	67.9	39.3	60.7
Recurrent UTI
Absent	87.1	31.3	68.7	45.2	54.8
Present	12.9	11.8	88.2	29.4	70.6
Systemic arterial hypertension
Absent	40.9	31.5	68.5	48.1	51.9
Present	59.1	26.9	73.1	39.7	60.3
Diabetes mellitus
Absent	69.7	32.6	67.4	47.8	52.2
Present	30.3	20.0	80.0	32.5	67.5
Heart failure
Absent	98.5	29.2	70.8	43.1	56.9
Present	1.5	0	100	50.0	50.0
Chronic kidney disease
Absent	97.7	29.5	70.5	44.2	55.8
Present	2.3	0	100	0	100
Chronic venous insufficiency
Absent	67.4	28.1	71.9	42.7	57.3
Present	32.6	30.2	69.8	44.2	55.8
Depression/Anxiety
Absent	86.4	27.2	72.8	43.0	57.0
Present	13.6	38.9	61.1	44.4	55.6
Body mass index
Underweight or Eutrophic	21.2	28.6	71.4	42.9	57.1
Overweight	56.8	30.7	69.3	40.0	60.0
Obesity	22.0	24.1	75.9	51.7	48.3
OSA risk
Low	40.9	35.2	64.8	50.0	50.0
Moderate or high	59.1	24.4	75.6	38.5	61.5
Number of comorbidities
Up to 2 comorbidities	33.3	43.2	56.8	54.5	45.5
3 or more	66.7	21.6	78.4	37.5	62.5
Antidepressant
Absent	80.3	29.2	70.8	46.2	53.8
Present	19.7	26.9	73.1	30.8	69.2
Diuretic
Absent	70.5	30.1	69.9	44.1	55.9
Present	29.5	25.6	74.4	41.0	59.0
Calcium channel blocker
Absent	82.6	28.4	71.6	44.0	56.0
Present	17.4	30.4	69.6	39.1	60.9
Benzodiazepine
Absent	89.4	28.8	71.2	44.1	55.9
Present	10.6	28.6	71.4	35.7	64.3
ARBs
Absent	55.3	31.5	68.5	43.8	56.2
Present	44.7	25.4	74.6	42.4	57.6
Beta-blocker
Absent	83.3	29.1	70.9	43.6	56.4
Present	16.7	27.3	72.7	40.9	59.1
Hypoglycemic agent
Absent	70.5	32.3	67.7	47.3	52.7
Present	29.5	20.5	79.5	33.3	66.7
Insulin
Absent	94.7	30.4	69.6	44.8	55.2
Present	5.3	0	100	14.3	85.7
ACEI
Absent	94.7	30.4	69.6	45.6	54.4
Present	5.3	0	100	0	100
Polypharmacy
Less than 4 medications	68.2	28.9	71.1	46.7	53.3
5 or more	31.8	28.6	71.4	35.7	64.3

Characteristics	Univariate logistic models			Multivariate logistic model			Selected logistic model
Characteristics	OR	95% CI	*p-value	OR	95% CI	*p-value	OR	95% CI	*p-value
Location: Petrópolis vs Niterói	1.630	0.748;3.551	0.219
Age: >60 years vs <60	1.529	0.717;3.263	0.272
Education: Complete elementary education or higher vs. Incomplete elementary education	0.314	0.137;0.719	0.006	0.275	0.107;0.706	0.007	0.260	0.106;0.637	0.003
Hesitancy: Present vs Absent	0.786	0.250;2.473	0.680
Slow stream: Present vs Absent	1.563	0.535;4.565	0.414
Feeling of incomplete bladder emptying: Present vs Absent	1.350	0.634;2.875	0.437
Post-voiding incontinence: Present vs Absent	1.016	0.452;2.283	0.970
Pelvic organ prolapse (symptom): Present vs Absent	1.208	0.531;2.749	0.653
AVP: Stage III or IV vs. Up to stage II	1.012	0.297;3.448	0.985
Constipation (Bristol): Present vs Absent	2.597	0.830;8.127	0.101	1.552	0.444;5.424	0.491
Constipation (frequency): Present vs Absent	0.816	0.331;2.011	0.659
Recurrent UTI: Present vs Absent	3.418	0.742;15.738	0.115	3.266	0.648;16.456	0.151
SAH: Present vs Absent	1.247	0.582;2.671	0.570
DM: Present vs Absent	1.935	0.796;4.708	0.145	1.220	0.086;17.327	0.883
CVI: Present vs Absent	0.901	0.406;2.003	0.799
Depression/Anxiety: Present vs Absent	0.587	0.209;1.650	0.312
Number of comorbidities: 3 or more vs. Up to 2	2.760	1.261;6.041	0.011	2.808	1.043;7.562	0.041	3.105	1.340;7.196	0.008
Antidepressant: Present vs Absent	1.122	0.429;2.937	0.815
Diuretic: Present vs Absent	1.249	0.537;2.906	0.605
Calcium channel blocker: Present vs Absent	0.908	0.341;2.422	0.848
Benzodiazepine: Present vs Absent	1.012	0.297;3.448	0.985
ARB: Present vs Absent	1.349	0.627;2.904	0.444
Beta-blocker: Present vs Absent	1.094	0.393;3.048	0.864
Hypoglycemic agent: Present vs Absent	1.845	0.757;4.496	0.178	0.860	0.060;12.254	0.911
Polypharmacy: 5 or more vs. Up to 4 medications	1.016	0.452;2.283	0.970
BMI			0.805
BMI: Overweight vs. Low weight/Normal weigh	0.904	0.348;2.351	0.837
BMI: Obesity vs. Low weight/Normal weight	1.257	0.386;4.097	0.704
OSA (Obstructive sleep apnea) risk: Moderate/high vs Low	1.686	0.788;3.608	0.179	0.946	0.375;2.386	0.906
SUI: Present vs Absent	0.564	0.220;1.442	0.232
UUI: Present vs Absent	2.042	0.552;7.557	0.285
MUI: Present vs Absent	2.215	1.029;4.768	0.042	1.906	0.612;5.932	0.266	2.533	1.103;5.817	0.028
OAB: Present vs Absent	2.413	1.066;5.461	0.035	1.534	0.444;5.305	0.499
Caffeine (mg/day)	0.998	0.993;1.003	0.338
Tobacco (packs/year)	0.991	0.966;1.017	0.493

Characteristics	Univariate logistic models			Multivariate logistic model			Selected logistic model
Characteristics	OR	95% CI	*p-value	OR	95% CI	*p-value	OR	95% CI	*p-value
Location: Petrópolis vs Niterói	1.240	0.601;2.558	0.561
Age: >60 years vs <60	1.602	0.801;3.206	0.183	1.367	0.517;3.614	0.528
Education: Complete elementary education or higher vs. Incomplete elementary education	0.415	0.203;0.847	0.016	0.288	0.114;0.727	0.008	0.324	0.148;0.709	0.005
Hesitancy: Present vs Absent	0.853	0.290;2.508	0.772
Slow stream: Present vs Absent	1.224	0.488;3.068	0.666
Feeling of incomplete bladder emptying: Present vs Absent	2.001	0.993;4.032	0.052	2.130	0.919;4.936	0.078
Post-voiding incontinence: Present vs Absent	1.360	0.643;2.874	0.421
POP (symptom): Present vs Absent	0.667	0.319;1.394	0.281
AVP: Stage III or IV vs. Up to stage II	0.735	0.242;2.230	0.587
PPP: Stage III or IV vs. Up to stage II	1.534	0.136;17.350	0.729
Apical prolapse: Stage III or IV vs. Up to stage II	1.534	0.136;17.350	0.729
Fecal incontinence: Present vs Absent	6.687	0.812;55.091	0.077	6.405	0.535;76.750	0.143
Constipation (Bristol): Present vs Absent	1.934	0.774;4.835	0.158	1.304	0.438;3.877	0.633
Constipation (frequency): Present vs Absent	1.226	0.523;2.872	0.639
Recurrent UTI: Present vs Absent	1.981	0.655;5.987	0.226
SAH: Present vs Absent	1.408	0.699;2.836	0.338
DM: Present vs Absent	1.904	0.875;4.144	0.105	1.322	0.111;15.767	0.825
Heart failure: Present vs Absent	0.757	0.046;12.363	0.845
CVI: Present vs Absent	0.941	0.452;1.961	0.871
Depression/Anxiety: Present vs Absent	0.942	0.346;2.564	0.907
Number of comorbidities: 3 or more vs. Up to 2	2.000	0.960;4.166	0.064	1.549	0.546;4.400	0.411
Antidepressant: Present vs Absent	1.934	0.774;4.835	0.158	1.923	0.614;6.019	0.262
Diuretic: Present vs Absent	1.133	0.531;2.419	0.746
Calcium channel blocker: Present vs Absent	1.224	0.488;3.068	0.666
Benzodiazepine: Present vs Absent	1.418	0.448;4.488	0.552
ARB: Present vs Absent	1.061	0.531;2.123	0.866
Beta-blocker: Present vs Absent	1.118	0.441;2.833	0.814
Hypoglycemic agent: Present vs Absent	1.796	0.823;3.919	0.141	0.981	0.082;11.763	0.988
Insulin: Present vs Absent	4.870	0.570;41.612	0.148	1.210	0.106;13.850	0.878
Polifarmácia: 5 or more vs. Less than 4	1.575	0.740;3.351	0.238
BMI			0.559
BMI: Overweight vs. Low weight/Normal weight	1.125	0.467;2.711	0.793
BMI: Obesity vs. Low weight/Normal weight	0.700	0.246;1.989	0.503
OSA risk: Moderate/high vs Low	1.600	0.793;3.228	0.189	0.641	0.256;1.607	0.343
SUI: Present vs Absent	0.521	0.210;1.292	0.159	1.783	0.461;6.895	0.402
UUI: Present vs Absent	1.461	0.506;4.219	0.484
MUI: Present vs Absent	2.412	1.190;4.892	0.015	1.762	0.582;5.333	0.316
OAB: Present vs Absent	2.998	1.345;6.679	0.007	2.715	0.695;10.609	0.151	2.761	1.189;6.409	0.018
Caffeine (mg/day)	0.995	0.991;1.000	0.051	0.994	0.988;0.999	0.025	0.995	0.990;1.000	0.041
Tobacco (packs/year)	0.990	0.965;1.017	0.465

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[tfne2] UTI: Urinary tract infection. OSA: Obstructive sleep apnea. ARBs: Angiotensin II receptor blocker. ACEI: Angiotensin-converting enzyme inhibitor.