Overnight Urge Perception in Nocturia Is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Population

• Published in: Journal of clinical sleep medicine Vol. 15; no. 4; pp. 615 - 621
• Main Authors: Monaghan, Thomas F, Bliwise, Donald L, Suss, Nicholas R, Epstein, Matthew R, Wu, Zhan D, Michelson, Kyle P, Agudelo, Christina W, Robins, Dennis J, Wagg, Adrian, Weiss, Jeffrey P
• Format: Journal Article
• Language: English
• Published: United States American Academy of Sleep Medicine 15-04-2019
• Subjects: Aged; Anxiety - epidemiology; Anxiety - etiology; Depression - epidemiology; Depression - etiology; Humans; Male; Nocturia - complications; Nocturia - epidemiology; Scientific Investigations; Severity of Illness Index; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; United States - epidemiology; United States Department of Veterans Affairs - statistics & numerical data; Veterans - statistics & numerical data; United States; nocturnal voiding; nocturia; sleep disorders; mental health; insomnia
• ISSN: 1550-9389; 1550-9397; 1550-9397
• DOI: 10.5664/jcsm.7726

The goal of this study was to compare the urge perception associated with nocturnal voiding at the time of voiding in individuals with and without depression, posttraumatic stress disorder (PTSD), or anxiety diagnoses to test the hypothesis that patients with such diagnoses are more likely to experience insomnia-driven convenience voiding during the sleep period.
A database of voiding diaries with urge perception grades (UPGs) from 429 adult males seeking treatment for nocturia at a Veterans Affairs-based urology clinic was analyzed. The UPG categorizes perception for urinating from 0 (out of convenience) to 4 (desperate urge). Diaries completed by males age 18 years and older showing ≥ 2 nocturnal voids were included. Those included (n = 178) were divided into two cohorts based on the presence (n = 62) or absence (n = 116) of one or more previously established mental health diagnoses (depression, PTSD, or anxiety). The chi-square test was used to determine significance between groups.
Patients with a mental health diagnosis were more likely to report convenience voiding compared to those without depression, PTSD, or anxiety (14.5% versus 0.8%,
< .01). However, most voids in both groups were associated with the perception of urinary urgency. There were no differences in urinary volumes or hourly rates of urine production between the groups.
A relatively small subset of urology patients experience nocturnal voiding because they are awake for reasons other than the urge to void. Mental health factors had a substantial, albeit minimal, effect. Most nocturia reflects urgency to urinate rather than voiding by convenience.