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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(04): 383-387
DOI: 10.5935/1984-0063.20220067
ORIGINAL ARTICLES

Nocturia as a clinical indicator of severe obstructive sleep apnea syndrome and its response to CPAP or surgical treatment

Alberto Labra
1   Mexican Institute of Integral Sleep Medicine, Otolaryngology - Mexico City - Mexico
,
Montserrat Roldan-Navarro
2   Mexican Institute of Integral Sleep Medicine, CPAP Clinic - Mexico City - Mexico
,
Reyes Haro-Valencia
3   Mexican Institute of Integral Sleep Medicine, Director - Mexico City - Mexico
,
Francisco Sánchez-Narvaez
4   Mexican Institute of Integral Sleep Medicine, Clinical Research - Mexico City - Mexico
,
Mauricio Ruiz-Morales
1   Mexican Institute of Integral Sleep Medicine, Otolaryngology - Mexico City - Mexico
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Introduction Obstructive sleep apnea syndrome (OSAS) is a common condition that has been associated to a number of metabolic, cardiovascular and cognitive consequences. Its diagnosis relies on a polysomnographic or polygraphic study, but clinical findings remain as an important part of the diagnostic process. Nocturia is a common symptom that may indicate severe OSAS, but it is often forgotten in the initial evaluation of these kind of patients. Positive airway pressure (CPAP) is known to reduce nocturia, but the roll of surgery is not clear about it.

Material and Methods A case series is presented. We compare 2 groups of male adults with severe OSAS, the first group treated with CPAP for 3 months, while group 2 underwent a multilevel surgical management. Apnea-hypopnea index (AHI) and the nocturia events number (NEN) were assessed before and after the treatment. Frequencies, descriptive statistics and a related sample Student’s t-test were performed for statistical analysis.

Results 97 male patients were included, age ranged from 29 to 71 years old. In group 1, treated with CPAP, AHI mean was 54.59 and nocturia mean 4.53 before treatment. With CPAP, the AHI mean was 6.63 and NEN mean 0.51. In group 2, AHI mean before surgery was 40.02, NEN mean 3.78, and after the surgical management AHI mean was 7.74 and NEN mean 0.7. Student’s t-test in groups 1 and 2 showed a p=0.000.

Conclusions AHI and NEN were clearly related in both groups, and the improvement of NEN and AHI were consistent in both groups, the CPAP and the surgical treatment. The presence of a NEN value of 4-5 may be an indicator of severe OSAS and should always be clinically evaluated.

Obstructive Sleep Apnea - Nocturia - Surgical Procedures


Publication History

Received: 07 August 2021

Accepted: 25 January 2022

Article published online:
01 December 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Labra A, Haro-Valencia R, Huerta-Delgado AD, Jumenez-Correa U, Sanchez-Narvaez F. Efficacy of submucosal sodium tetradecyl sulfate in the soft palate as a treatment of the mild obstructive sleep apnea syndrome: a pilot study. Sleep Disord. 2012;2012:ID597684.
  • 2 Labra A. Classification and surgical prognosis in a sleep disordered breathing patient. In: Lugo-Saldaña R, ed. Surgical management in snoring and sleep-disordered breathing. London: Jaypee Brothers Medical Publishers Ltd.; 2015.
  • 3 Oztura I, Kaynak D, Kaynak HC. Nocturia in sleep-disordered breathing. Sleep Med. 2006 Jun;7(4):362-7.
  • 4 Margel D, Shochat T, Getzler O, Livne PM, Pillar G. Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology. 2006 May;67(5):974-7.
  • 5 Lin CC, Tsan KW, Lin CY. Plasma levels of atrial natiuretic factor in moderate to severe obstructive sleep apnea syndrome. Sleep. 1993 Jan;16(1):37-9.
  • 6 Krieger J, Follenius M, Sforza E, Brandenberger G, Peter JD. Effects of treatment with nasal continuous positive airway pressure on atrial natriuretic peptide and arginine vasopressin release during sleep in patientes with obstructive sleep apnoea. Clin Sci (London). 1991 May;80(5):443-9.
  • 7 Baruzzi A, Riva R, Cirignotta F, Zucconi M, Cappelli M, Lugaresi E. Atrial natriuretic peptide and catecholamines in obstructive sleep apnea syndrome. Sleep. 1991 Feb;14(1):83-6.
  • 8 Ichioka M, Hirata Y, Inase N, Tojo N, Yoshizawa M, Chida M, et al. Changes of circulating atrial natriuretic peptide and antidiuretic hormone in obstructive sleep apnea syndrome. Respiration. 1992;59(3):164-8.
  • 9 Río-Vázquez V, Anaías-Calderón J. Mecanismos fisiopatológicos de las alteraciones cardiovasculares en el síndrome de apnea obstructiva del sueño. Rev Cub Invest Bioméd. 2009 Mar;28(1):1-8.
  • 10 Karakioulaki M, Grendelmeier P, Strobel W, Schmid T, Jahn K, Grize L, et al. Copeptin, pro-atrial natriuretic peptid and pro-adrenomedullin as markers of hypoxic stress in patients with obstructive sleep apnea. A prospective intervention study. Respir Res. 2021 Apr;22:114-25.