Nocturnal Urinary Symptoms as Screening Tools for Obstructive Sleep Apnea

Abstract

Importance Nocturnal lower urinary tract symptoms are part of obstructive sleep apnea (OSA), and urogynecology clinics may serve as OSA screening sites. Objective This study’s aim was to determine the accuracy of nocturia and nocturnal enuresis (NE) as screening tools for OSA in new patients at a urogynecology clinic. Study Design Using a retrospective study design, we gathered information regarding diagnostic OSA testing, continuous positive airflow pressure use, and lower urinary tract symptoms improvement from women in a urogynecology clinic who were previously screened for OSA using validated questionnaires. Nocturia and NE were tested for sensitivity and specificity using positive OSA diagnosis by polysomnography as the gold standard. Results Nocturia with a cutoff of ≥2 episodes per night had the best test characteristics—86.4% sensitivity (95% confidence interval [CI], 65.1–97.1) and 58.5% specificity (95% CI, 44.1–71.9) for an overall accuracy of 78.4% (95% CI, 67.0–89.8). Nocturnal enuresis with a cutoff of ≥1 episode per week had the best NE characteristics with 31.8% sensitivity (95% CI, 13.9–54.9) and 79.3% specificity (95% CI, 65.9–89.2) for an overall accuracy of 56.1% (95% CI, 41.2–71). Conclusions Lower urinary tract symptoms such as nocturia and NE are routinely assessed in urogynecology clinics, making them useful for OSA screening and referral. The present study found nocturia symptoms with ≥2 episodes per night to retain acceptable test characteristics in screening for OSA, whereas NE was found to have less acceptable test characteristics for OSA screening. Urogynecology clinics may utilize nocturia symptoms in clinical decision making for OSA referral.