deamino-arginine-vasopressin and Sleep-Apnea-Syndromes

Nocturnal enuresis is a prevalent and challenging problem in children and young adults with sickle cell disease (SCD). Limited progress has been made in elucidating etiology and pathophysiology of nocturnal enuresis in individuals with SCD. Among adults with SCD ages 18-20 years, approximately 9% report nocturnal enuresis. Nocturnal enuresis contributes to decreased health related quality of life in people with SCD, resulting in low self-esteem and sometimes social isolation. Postulated non-mutually exclusive causes of nocturnal enuresis in individuals with SCD include hyposthenuria leading to nocturnal polyuria, decreased bladder capacity or nocturnal bladder overactivity, increased arousal thresholds, and sleep disordered breathing. No evidence-based therapy for nocturnal enuresis in SCD exists. This review is focused on describing the natural history, postulated causes and a rational approach to the evaluation and management of nocturnal enuresis in children and adults with SCD.

Topics: Anemia, Sickle Cell; Antidiuretic Agents; Brain; Cholinergic Antagonists; Deamino Arginine Vasopressin; Humans; Nocturnal Enuresis; Quality of Life; Sleep Apnea Syndromes; Urinary Bladder

Nocturia is common in the elderly population and, aside from being a nuisance, it is associated with morbidity and mortality. Nocturia results from the complex interactions of several factors: changes in the urinary system and renal function with aging, the effects of sleep on renal function, changes in sleeping patterns associated with aging, and the presence of concurrent diseases and medications. Nocturia in the elderly can be caused by many conditions; a common cause is the syndrome of nocturnal polyuria. Although the pathophysiology of nocturnal polyuria remains obscure, some investigators believe that low night-time levels of antidiuretic hormone are involved. Proper management of nocturia requires identification of the specific underlying causes. This Review provides an overview of the mechanisms, evaluation and treatment of nocturia for the practicing nephrologist.

Topics: Aged; Aging; Antidiuretic Agents; Circadian Rhythm; Comorbidity; Deamino Arginine Vasopressin; Depression; Glomerular Filtration Rate; Humans; Kidney; Nocturia; Polyuria; Sleep; Sleep Apnea Syndromes; Sleep, REM; Syndrome; Urinary Bladder; Urination; Urodynamics