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We present a 55-year-old woman has progressive multiple sclerosis (MS). She is paraparetic, unable to walk, and she presents with a transurethral catheter placed 1 year ago to manage her urinary incontinence. She has a history of recurrent urinary tract infections and recalcitrant detrusor overactivity with urgency urinary incontinence. Several anticholinergic drugs have been previously administered to control her urinary incontinence, without any substantial benefit and with intolerable anticholinergic side effects. She has a normal renal function with a creatinine of 0.4 mg/dl. Her BMI is 23 Kg/m2...
By Professor Donald Bliwise
Sleep researchers interested in both observational and interventional studies have long made use of the sleep diary (sometimes called a “sleep log”) to gather systematically self-report data regarding an individual’s sleep. Although sleep diaries can never replace the quality and richness of data on human sleep that can be collected with instrumented electrophysiological recordings (e.g., polysomnography), they do provide a surprising amount of data, gathered nightly, on issues related to bedtime, wake up time, time to fall asleep, number of awakenings, timing and duration of awakenings, and amount of sleep obtained at night, as well as sleep-related issues occurring during the daytime (e.g., sleepiness, napping). Although many different versions of sleep diaries have been proposed, the 2012 “Consensus Sleep Diary” (Carney et al, 2012) captures the many aspects of nocturnal sleep that have been incorporated into many previous versions of sleep diaries. This publication provides an invaluable resource for those interested in constructing and using a sleep diary in their current work.
Unfortunately, for researchers whose focus is nocturia, the vast majority of these sleep diaries fail to record information on bathroom trips that are essential to understand the extent to which nocturnal voiding may interrupt sleep. One of the few attempts to incorporate data on nocturnal voiding into an otherwise typical sleep diary noted that slightly over half of all nighttime awakenings in a group of 119 elderly persons with insomnia were associated with bathroom trips (Bliwise et al 2014). These data suggest that any researcher interested in adequately characterizing nighttime behavior, whether that interest emanates from an interest in nocturia per se or from an interest in disrupted sleep generally, should use a diary that encompasses all types of data.
Bliwise DL, Friedman L, Hernandez B, Zeitzer JM, Kushida CA, Yesavage JA. Nocturia reported in nightly sleep diaries: common occurrence with significant implications? Health Psychology 2014; 33: 1362-5.
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM. The Consensus Sleep Diary: standardizing prospective sleep self-monitoring. Sleep 2012; 35: 287-302.
The Nocturia-Quality of Life Questionnaire: a specific instrument to assess nocturia
Commented by Prof. Antonella Giannantoni
Outcome measures for nocturia should not only measure symptom frequency, but also evaluate patients’ perception of their condition and associated impacts. The Nocturia-Quality of Life Questionnaire (N-QOL) is a validated, disease-specific instrument that examines the impact of nocturia as a symptom on quality of life in patients affected by the condition. It was developed with input from men experiencing nocturia who came from different cultures. (1) The pilot N-QOL consisted of 31 items with a 5-point Likert-like response scale. Items covered different areas such as concentration, energy, interference with habits and productivity, limitations on activities, sleep difficulties. Items were scored from 0 to 4, with a greater score indicating better QOL. Scores were then summed and transformed into a standardized scale from 0 to 100. The original questionnaire was then reduced substantially from 31 to 13 items. In the current version of the N-QOL questionnaire, 12 items relate directly to nocturia and are used to calculate the score for N-QOL. The 13th item is a global QOL item, which should be scored separately. The N-QOL overall score and subscales are also able to discriminate among men experiencing one, two, three or more episodes of nocturia. The N-QOL questionnaire has also been tested in women and appears to have strong content validity for the experiences of both men and women with nocturia. (2) The N-QOL, which the average patient can complete within a few minutes, can easily be self-administered and as easily be used in the clinical setting, together with other measures, such as the voiding diary and validated questionnaires specifically addressing sleep.
Abraham L, Hareendran A, Mills IW, Martin ML, Abrams P, Drake MJ, MacDonagh RP, Noble JG. Development and validation of a quality-of-life measure for men with nocturia. Urology 2004; 63: 481–6.
Lauren L. Mock, Patricia A. Parmelee, Nancy Kutner, Jane Scott, Theodore M. Johnson II. Content Validation of Symptom-Specific Nocturia Quality-of-Life Instrument Developed in Men: Issues Expressed by Women, as Well as Men. Urology 2008; 72: 736–42.
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