Sleep quality is a crucial aspect of well-being and its impairment is associated with adverse outcomes in older adults. While nocturia is known to disturb sleep in nursing home (NH) residents, its association with sleep quality is yet to be demonstrated. The objective of this study was thus to evaluate the association between self-reported sleep quality and nocturia in NH residents.

A cross-sectional multicentre study, approved by the local ethics committee, was deployed in 2017 in 2 Belgian NH. Residents aged over 65 years willing to participate in the validation study of the Dutch for Belgium ‘Targeting the individual’s Aetiology of Nocturia to Guide Outcomes’ (TANGO-D) questionnaire were included. The dependent variable was self-reported poor sleep quality (“I would describe my sleep quality as bad”) using the TANGO-D questionnaire. Independent variables included: age, gender, nocturia defined by at least 2 nocturnal awakenings to void (using the International Consultation on Incontinence Modular Questionnaire for Male or Female Lower Urinary Tract Symptoms), self-rated health status, insomnia symptoms (using the TANGO-D questionnaire), cognitive frailty score (using the Comprehensive Frailty Assessment Instrument) and hypnosedatives use obtained from patients' medication administration record. The association between nocturia and self-reported poor sleep quality was examined using three multivariable logistic regression analyses. The potential confounding variables included in the multivariable analysis models were selected a priori using a direct acyclic graph, based on literature data. Model 1 included age and gender. Model 2 included further self-reported health status as a proxy of comorbidities and cognitive frailty as a proxy of cognitive status. Model 3 included further drugs intake, i.e. hypnosedative and antidepressant use.

Among the study population (median age 89±7 years, 77.5% women), 23 (28.7%) had a self-reported poor sleep quality. The three most frequent sleep-related complaints were sleep-onset insomnia (33.7%), sleep-maintenance insomnia (32.5%) and sleep duration less than 5 hours per night (23.7%). Nocturia, the lower urinary tract symptom most frequently by all participants, was identified in in 56.2% of the study population. It was significantly more frequent among those with versus without self-reported poor sleep quality (78.3% vs 47.4%, p=0.01), with a mean number of nocturia episodes per night of 2.3±1.2 in this group. In multivariable analysis, nocturia was statistically significantly associated with self-reported poor sleep quality after adjustment for age and gender (Model 1, p=0.01). This relationship persisted upon adjustment for comorbidities, considered using the self-rated health status and the cognitive frailty score (Model 2, p=0.007). Nocturia and self-rated health status were the only factors independently associated with self-reported poor sleep quality when antidepressant and hypnosedative utilization were added to the model, with an OR (95%CI) of 6.06 (1.83-25.36) and 7.38 (1.20-57.44) respectively.

This study identified a significant association between nocturia and self-reported poor sleep quality which persisted after controlling for age, gender, self-rated health, cognitive frailty, hypnosedative and antidepressant use. Effect size was substantial, with a 6-fold increased risk of self-reported poor sleep quality for nocturia, which is similar to the increase in risk found for self-rated health status.

Nocturia, along with self-rated health status, are independently associated with subjective poor sleep quality in NH residents. These results are important for clinical practice and suggest that optimization of concomitant nocturia may be an indispensable component of the evaluation and management of poor sleep in this population.