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Association of obstructive sleep apnea risk factors with nocturnal enuresis in postmenopausal women

Koo, Patrick MD; McCool, F. Dennis MD; Hale, Lauren PhD; Stone, Katie PhD; Eaton, Charles B. MD, MS

doi: 10.1097/GME.0000000000000517
Original Articles

Objective: The prevalence of obstructive sleep apnea (OSA) in women increases significantly after menopause. However, identifying at-risk women is difficult because they tend to underreport symptoms and their complaints may differ from those traditionally associated with OSA. We investigated whether OSA risk factors are associated with the presence of a “nontraditional” complaint, such as nocturnal enuresis, in postmenopausal women.

Methods: A cross-sectional study of postmenopausal women aged 50 to 79 years who participated in the Women's Health Initiative Observational Study and clinical trials (1993-2005) at 40 clinical centers in the United States was performed. Multiple variable logistic regression analysis was used to determine the association of OSA risk factors with nocturnal enuresis.

Results: A cohort of 2,789 women (1.7%) reported having nocturnal enuresis. Obesity (odds ratio [OR], 2.29; 95% CI, 2.00-2.62), snoring (OR, 2.01; 95% CI, 1.74-2.32), poor sleep quality (OR, 1.70; 95% CI, 1.52-1.91), sleep fragmentation (OR, 2.44; 95% CI, 2.14-2.79), daytime sleepiness (OR, 1.50; 95% CI, 1.33-1.68), and hypertension (OR, 1.13; 95% CI, 1.01-1.26) were associated with nocturnal enuresis. Each additional OSA risk factor in a predefined OSA score significantly increased the odds of having nocturnal enuresis in a dose-response fashion (OR of 1.38, 2.00, 2.80, 3.87, 5.10, and 7.02 for scores of 1-6, respectively) compared with no risk factors.

Conclusions: OSA risk factors are associated with nocturnal enuresis in postmenopausal women. Mechanisms relating nocturnal enuresis to OSA may include apnea-associated changes in intrathoracic pressure, leading to increased urine output. Questioning at-risk postmenopausal women presenting with nocturnal enuresis about other OSA risk factors should be considered.

1Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI

2Program in Public Health, Stony Brook Medicine, Stony Brook, NY

3California Pacific Medical Center Research Institute, University of California, San Francisco, San Francisco, CA

4Department of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, RI.

Address correspondence to: Charles B. Eaton, MD, MS, Department of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, RI. E-mail:

Received 6 March, 2015

Revised 29 May, 2015

Accepted 29 May, 2015

The funding source had no role in the study.

Funding/support: The Women's Health Initiative program was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, HHSN271201100004C, and HL094300.

Financial disclosure/conflicts of interest: None reported.

© 2016 by The North American Menopause Society.