deamino-arginine-vasopressin and Sleep-Wake-Disorders

Nocturia is a bothersome urologic symptom and is defined as awakening from sleep once or more times to void. The condition is highly prevalent in men and women and increases in prevalence with age. Impact on quality of life is substantial as is the associated morbidity and mortality.. A PubMed literature search was undertaken to identify evidence for the currently available and utilized pharmacotherapy options for the treatment of nocturia. Available pharmacologic treatments include desmopressin, α-blockers, antimuscarinics, and other less commonly utilized therapies. Desmopressin is generally found to have high-level evidence to support its use for the indication of nocturnal polyuria, a form of nocturia caused by excessive nighttime urine production. α-blockers and antimuscarinics are generally recommended in the setting of benign prostatic hypertrophy in men and overactive bladder in both men and women.. Clinical trials addressing nocturia often report statistically significant results that do not translate to clinically significant reductions in nighttime voids. As a result, the clinical utility of these agents has been called into question. Further drug development and clinical trials specifically focused on nocturia are needed. Furthermore, improved patient-focused assessment tools to measure the impact on symptom reduction, improvement in sleep quality, and improvement in quality of life are important in understanding what matters most to patients and what outcomes translate to patient satisfaction with care.

Topics: Adrenergic alpha-Antagonists; Age Factors; Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Muscarinic Antagonists; Nocturia; Prevalence; Quality of Life; Sleep Wake Disorders; Urination Disorders

Nocturia is a bothersome and highly prevalent urological condition characterised by the need to wake to void at night. Contrary to popular misconception, nocturia is equally common in men and women, and although its prevalence increases with age, a significant proportion of younger people are also affected. Nocturia leads to repeated fragmentation of sleep and consequently to a serious decline in daytime functioning and in overall quality of life and health. As such, its impact should not be underestimated by clinicians. Traditionally, nocturia has been regarded as a symptom of benign prostatic enlargement and/or overactive bladder syndrome, with treatment therefore directed towards increasing the capacity of the bladder to hold urine. Such treatments have proven largely ineffective in many patients, likely because nocturnal polyuria (NP), a condition that results in overproduction of urine at night, has been found to be present in the majority of nocturia patients. As such, the traditional belief that nocturia is attributable to some other underlying pathological factors, is now being replaced by the acknowledgment that it can be a distinct clinical entity with specific pathogenesis. Frequency-volume charts are an invaluable tool, recommended for routine use in clinical practice, to determine whether nocturia is a result of excessive urine production at night, or of small voided volumes (indicating bladder storage problems), or indeed a combination of these factors. Given the specific antidiuretic action of desmopressin, a synthetic analogue of the body's own antidiuretic hormone, it should be considered as first-line therapy for patients with nocturia where NP is present.

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Female; Humans; Male; Nocturia; Sex Factors; Sleep Wake Disorders; Urinary Bladder, Overactive

Nocturia may be attributable to nocturnal polyuria (nocturnal urine overproduction), a diminished nocturnal bladder capacity or a combination of the two conditions.A disorder of the vasopressin (antidiuretic hormone) system with very low or undetectable levels of vasopressin at night, affecting some elderly people, may cause an increase in the nocturnal urine output, which in the most extreme cases accounts for 85% of the 24-hour diuresis. The increased urine output can be treated with desmopressin orally at bedtime, generally using low doses. Self-imposed fluid restrictions before bedtime are not effective in reducing the nocturnal urine output in this condition. Nocturia is also more prevalent in association with a reduced bladder capacity. Antimuscarinic drugs are used in attempts to depress involuntary bladder contractions. Decreased nocturnal voided volumes in men and consequent increased nocturia may suggest difficulty in emptying the bladder or detrusor overactivity. alpha(1)-Adrenoceptor antagonists and 5alpha-reductase inhibitors are often used in men with symptoms indicative of benign prostatic hyperplasia, and one of their effects is reduction of nocturia. In women, estrogen deficiency, a common consequence of the menopausal transition, causes atrophic changes within the urogenital tract. Consequently, such women are more disposed to having urogenital symptoms, among them nocturia. This review emphasises the importance of correctly diagnosing and treating nocturia in elderly patients. This will improve patients' sleep and, in turn, reduce their risk of fall injuries and the associated detrimental consequences, thereby improving patients' health and quality of life.

Topics: Accidental Falls; Aged; Aged, 80 and over; Antidiuretic Agents; Deamino Arginine Vasopressin; Diuretics; Female; Humans; Male; Muscarinic Antagonists; Nocturia; Prevalence; Sleep Wake Disorders; Urinary Bladder; Urinary Bladder, Overactive

Nocturia is a common condition in the elderly that profoundly influences general health and quality of life. It appears to predict a higher risk of death. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g. falls, are increased both at night and during the day in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, reduced voided volumes, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, e.g. diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. A disorder of the vasopressin system, with very low or undetectable vasopressin levels at night, is manifested as an increased nocturnal urine output, which in the most extreme cases reaches 85% of the 24-h diuresis: the prevalence of low or undetectable vasopressin levels at night has been estimated to be 3-4% in those aged >or= 65 years. Treatment of nocturia may include avoiding excessive fluid intake and use of diuretic medication in the afternoon rather than the morning, oral desmopressin at bedtime in cases of nocturnal polyuria, and antimuscarinic agents in the case of overactive bladder or impaired storage capacity of the bladder.

Topics: Age Factors; Aged; Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Health Status; Humans; Life Style; Polyuria; Renal Agents; Sleep Wake Disorders; Syndrome; Urination Disorders

Adequate sleep is a basic requirement for good health. Adults generally require 7 to 8 hours of sleep per night. Sleep deprivation is associated with a decreased ability to perform tasks controlled by the frontal lobe, such as planning, concentration, motor performance, and high-level intellectual skills. Constant poor-quality sleep can also cause excessive daytime sleepiness, depression, and immune function compromise. In addition, continued sleep disruption has been associated with an increased risk for mortality.

Topics: Behavior Therapy; Deamino Arginine Vasopressin; Female; Humans; Male; Mandelic Acids; Quality of Life; Renal Agents; Rest; Sleep; Sleep Wake Disorders; Urination Disorders; Urine

Topics: Activities of Daily Living; Deamino Arginine Vasopressin; Humans; Polyuria; Renal Agents; Sleep Wake Disorders; Urination Disorders

Sleep disorders and disturbances are common problems in children and adolescents and frequently occur concurrently with psychiatric symptomatology. There appears to be a complex relationship between the regulation of sleep and emotional and behavioral problems in children and adolescents. This article focuses on appropriate use of medications in the treatment of these common disorders through a comprehensive approach of careful evaluation, diagnosis, and the use of behavioral and other nonpharmacologic treatments.

Topics: Adolescent; Antidepressive Agents, Tricyclic; Child; Child, Preschool; Deamino Arginine Vasopressin; Female; Humans; Male; Methylphenidate; Sleep Wake Disorders; Sleep, REM; Tourette Syndrome

An update of the pathogenesis and treatment of monosymptomatic bedwetting is presented. This frequently occurring entity seems to have a multifactorial pathogenesis incorporating arousal disturbances and disturbances to the circadian rhythm of diuresis modulating hormones. It has recently been substantiated that the bladder reservoir function in monosymptomatic bedwetting is normal. This is further underlined by the fact that treatment of instability of the bladder has proven futile. In a substantial part of the monosymptomatic bedwetters the changes in circadian rhythm of antidiuretic hormone can be counteracted by desmopressin diacetate (DDAVP), which abolishes the symptom in more than 2/3 of the patients. Monitoring circadian rhythms of arginine vasopressin (AVP) and treatment with DDAVP have led to increased understanding of the pathogenesis of monosymptomatic bedwetting and opened new fields of investigation.

Topics: Arginine Vasopressin; Child; Circadian Rhythm; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Male; Mental Disorders; Polyuria; Sleep Wake Disorders; Urinary Bladder Diseases

Patients with Parkinson's disease (PD) are known to experience autonomic nervous system dysfunction: this disruptive symptomatology includes urinary urgency, frequency, and nocturnal polyuria. Anticholinergic and tricyclic medications can be beneficial in controlling these urinary symptoms, but have unpleasant side effects in some patients. Desmopressin has been used to treat nocturnal polyuria successfully in a number of conditions, such as central diabetes insipidus, enuresis, and autonomic failure. The purpose of the present study was to assess the efficacy of desmopressin in patients with PD with significant nocturia. Eight patients were recruited into the study. They were first asked to establish a baseline of number of nocturnal voids; the patients were then prescribed the intranasal form of desmopressin and asked to continue to record the number of nocturnal voids. The five patients who completed the trial demonstrated clinically and statistically significant reductions in the frequency of nocturnal voids. One patient became hyponatremic and confused during desmopressin administration; his symptoms resolved soon after the desmopressin was discontinued. Two patients failed to complete the trial due to compliance problems. Thus, desmopressin appears to be a safe and effective medication for nocturnal polyuria in PD.

Topics: Administration, Intranasal; Aged; Aged, 80 and over; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Parkinson Disease; Polyuria; Sleep Wake Disorders; Urodynamics