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AUA2023 BEST POSTERS Personalized Bedtime Determined by a Wearable Device Improves Nocturia: A Prospective Interventional Crossover Study

By: Yoshinaga Okumura, MD, University of Fukui, Japan; Sou Nobukawa, PhD, Chiba Institute of Technology, Japan; Tomoaki Ishibashi, MD, University of Fukui, Japan; Tetsuya Takahashi, MD, PhD, University of Fukui, Japan; Takao Nishikawa, MD, University of Fukui, Japan; Keisuke Ueki, MD, University of Fukui, Japan; Mayu Katsuki, MD, University of Fukui, Japan; Wonseok Seo, MD, University of Fukui, Japan; Tadashi Kakitsuba, MD, University of Fukui, Japan; Nobuki Tanaka, MD, University of Fukui, Japan; Yusuke Fukiage, MD, University of Fukui, Japan; Hisato Kobayashi, MD, PhD, University of Fukui, Japan; Manami Tsutsumiuchi, MD, PhD, University of Fukui, Japan; Masaya Seki, MD, PhD, University of Fukui, Japan; Sou Inamura, MD, PhD, University of Fukui, Japan; Minekatsu Taga, MD, PhD, University of Fukui, Japan; Masato Fukushima, MD, PhD, University of Fukui, Japan; Hirotaka Kosaka, MD, PhD, University of Fukui, Japan; Osamu Yokoyama, MD, PhD, University of Fukui, Japan; Naoki Terada, MD, PhD, University of Fukui, Japan | Posted on: 30 Aug 2023

Background

Nocturia is a major health problem, especially in older adults. It is associated with an increased risk of all-cause morbidity and mortality1 and an increased risk of falls and hip fracture in older adults.2,3 Sleep disturbance is one of the major causes of nocturia and gradually increases by age.4,5 Several studies revealed that age-related changes in sleep depth and age-related changes in circadian rhythm amplitude may contribute to nocturia. A common feature of aging is the advance of the timing of sleep to earlier hours,6 often earlier than desired.7 With respect to treatment for sleep-wake phase disorder, chronotherapy8 is thought to be effective, however there is little evidence, moreover, no prospective study. To prove this hypothesis, in this study we examined whether going to bed at a personalized appropriate time and adopting regular sleeping habits improves nocturia by using data obtained from a wearable device that measures sleep-wake activity.

Participants

Patients with nocturia who visited our hospital and affiliated institutes with nocturia as a chief complaint and who still had nocturia after medical treatment or for which medication was not indicated were included in this study. The power calculation is based on improvements in nocturnal urinary frequency.

Methods

The study adopted an open-label, multicenter, quasi-randomized, crossover design, with alternate 4-week intervention and nonintervention periods with a 2-week washout period. Participants were assigned to sequences A (nonintervention period → washout period → intervention period) and B (intervention period → washout period → nonintervention period) alternately in the order of entry. During both periods, participants wore Actiwatch in the first and the last week. In the nonintervention period, they went to bed at the usual bedtime. In the intervention periods, personalized bedtime was determined by the data obtained from Actiwatch in the first week and they went to bed at the determined time in the remaining 3 weeks.

Subjects were asked to (1) go to bed on a specified bedtime as possible, at least within 15 minutes, (2) turn off the TV and any lights, and (3) not operate devices that emit light in bed, such as smartphones. Frequency volume charts of at least 3 days were administered before and after the intervention and nonintervention periods. The PSQI (Pittsburgh Sleep Quality Index), Overactive Bladder Symptom Score, IPSS (International Prostate Symptom Score), and IPSS-Quality of Life were administered before and after both periods.

Results

Thirty-three participants were enrolled in this study; a total of 7 patients withdrew. Thereafter, the analyses were performed in 24 subjects. The subjects included 17 males and 7 females. The mean±SD age was 79.8±5.7 years. The mean±SD body weight and BMI were 61.7±7.9 kg and 23.8±2.6 kg/m2, respectively. The average personalized bedtime was significantly later than usual bedtime (22:11:53 vs 21:30:50; P = .002). In 22 out of 24 (91.7%) of the study subjects, the determined bedtime was later than the usual bedtime, while only 2 participants were found to be better going to bed earlier than usual bedtime.

The mean changes in nocturnal urinary frequency were −0.9 times during the intervention period, whereas it was +0.01 times during the nonintervention period (P < .001, see Figure). Moreover, the change in nocturnal urinary volume was −105.6 mL in the intervention period, while it was +47.3 mL in the nonintervention period (P = .033), and the change in PSQI value was −2.4 in the intervention period while it was +1.2 in the nonintervention period (P = .008).

image
Figure. Comparison of nocturnal urinary frequency (NUF) between pre- and post-nonintervention and intervention periods.

Interpretation

Patients with severe nocturia were observed to go to sleep inappropriately early. Correcting the bedtime may significantly reduce the frequency of nocturia and significantly improve the sleep quality of such patients.

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