Nocturia, Sleep-Disordered Breathing, and Cardiovascular Morbid in a Community-Based Cohort

Background: Nocturia has been independently associated with cardiovascular morbidity and all-cause mortality, but such studies did not adjust for sleep-disordered breathing (SDB), which may have mediated such a relationship. Our aims were to determine whether an association between nocturia and cardiovascular morbidity exists that is independent of SDB. We also determined whether nocturia is independently associated with SDB. Methodology/Principal Findings: In order to accomplish these aims we performed a cross-sectional analysis of the Sleep Heart Health Study that contained information regarding SDB, nocturia, and cardiovascular morbidity in a middle-age to elderly community-based population. In 6342 participants (age 63611 [SD] years, 53% women), after adjusting for known confounders such as age, body mass index, diuretic use, diabetes mellitus, alpha-blocker use, nocturia was independently associated with SDB (measured as Apnea Hypopnea index .15 per hour; OR 1.3; 95%CI, 1.2–1.5). After adjusting for SDB and other known confounders, nocturia was independently associated with prevalent hypertension (OR 1.23; 95%CI 1.08– 1.40; P = 0.002), cardiovascular disease (OR 1.26; 95%CI 1.05–1.52; P = 0.02) and stroke (OR 1.62; 95%CI 1.14–2.30; P = 0.007). Moreover, nocturia was also associated with adverse objective alterations of sleep as measured by polysomnography and self-reported excessive daytime sleepiness (P,0.05). Conclusions/Significance: Nocturia is independently associated with sleep-disordered breathing. After adjusting for SDB, there remained an association between nocturia and cardiovascular morbidity. Such results support screening for SDB in patients with nocturia, but the mechanisms underlying the relationship between nocturia and cardiovascular morbidity requires further study. MeSH terms: Nocturia, sleep-disordered breathing, obstructive sleep apnea, sleep apnea, polysomnography, hypertension. Citation: Parthasarathy S, Fitzgerald M, Goodwin JL, Unruh M, Guerra S, et al. (2012) Nocturia, Sleep-Disordered Breathing, and Cardiovascular Morbidity in a Community-Based Cohort. PLoS ONE 7(2): e30969. doi:10.1371/journal.pone.0030969 Editor: Antony Bayer, Cardiff University, United Kingdom Received September 15, 2011; Accepted December 29, 2011; Published February , 2012 This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Funding: The study was funded by the National Institutes of Health (National Heart, Lung and Blood Institute [NHLBI]). The sponsor was involved in oversight of human subject safety through an independent Data Safety Monitoring Board (DSMB), and had non-voting representation in the steering committee that approved this manuscript submission. This work was supported by National Heart, Lung and Blood Institute cooperative agreements U01HL53940 (University of Washington), U01HL53941 (Boston University), U01HL53938 (University of Arizona), U01HL53916 (University of California, Davis), U01HL53934 (University of Minnesota), U01HL53931 (New York University), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL63463 (Case Western Reserve University), U01HL63429 (Missouri Breaks Research). Investigators were funded through the following grants during the data analysis and manuscript preparation 1R01HL095748 (S.P), 5R01DK077785 (M.U.), DK075967-03 (M.F). This is not an industry-funded study. SP, MF, JLG, MU, SG, and SFQ have no relevant financial interest in this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: [email protected]