Abstract 4358: Nocturia Is Associated With Objective And Subjective Sleep Characteristics, Symptoms, And Functional Performance In Stable Heart Failure
Purpose: To examine the prevalence and correlates of nocturia and its associations with objective and subjective characteristics of sleep, daytime symptoms, and functional performance in people with stable heart failure (HF).
Methods: The sample included 177 community-residing patients with stable HF (M age =60.2 + 16.4 years; n =63/35% female; n =159/90% NYHA Class II/III; EF M =32.3 + 14.8%). Participants completed one night of unattended ambulatory polysomnography (PSG) in their homes, six minute walk test (6 MWT), a sleep/symptom diary, the MOS SF-36, Multidimensional Assessment of Fatigue Scale, Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. PSG data were scored with standard sleep staging and cardiorespiratory criteria.
Results: Participants reported 0 – 8 voidings/night (median =2), classified as none (Group 1) (n =31/17.5%); 1–2 times (Group II) (n =90/50.6%); and 3+ times (Group III) (n =56/32.6%). Sixty four percent (n =113) reported that nocturia often or always disrupted their sleep during the past year. Nocturia was not associated with age, gender, ejection fraction, NY class, diuretics, comorbidity, or diabetes. Group III had twice as much wake after sleep onset (WASO%) (30% vs. 15%, p<.001), half as much Stage 3– 4 sleep (4% vs. 8%, p <.001), and 1.5 times more respiratory events (M =26.75 vs. 17.37, p <.05) than Group I. Nocturia was associated with REM%, time at oxygen saturation <90%, sleep duration, and self-reported sleep efficiency (all p <.05). Group III had poorer 6 MWT performance (279.37 vs.354.48 meters, p <.05) and were more likely to be excessively sleepy (45% vs. 12.92 %, p <.01) than Group I. Nocturia was also associated with self-reported physical function and fatigue ( p <.05). WASO% mediated the effect of voiding frequency on 6 MWT, after controlling for clinical and demographic variables. The associations between voiding frequency and sleepiness and fatigue were not explained by decrements in sleep.
Conclusions: Nocturia is common and chronic in HF and is associated with significant decrements in sleep, symptoms, and function. Its contribution to objective functional performance appears to be secondary to its impact on sleep. Sleep does not explain the relationships between nocturia, fatigue, and EDS.