PD29-06 WHY ONE SHOULD STOP-BANG (IN THE UROLOGY CLINIC)?

Abstract

INTRODUCTION AND OBJECTIVE: Obstructive sleep apnoea (OSA) is recognised as one of the causes of nocturia, but its prevalence among patients with nocturia is unknown. It is impractical to screen all nocturia patients with overnight polysomnography, which remains the mainstay of the OSA diagnostics. At the same time, clinical assessment alone misses the diagnosis in up to 92% of patients with moderatesevere OSA. Recently, STOP-Bang questionnaire has emerged as an easy-to-use tool for risk-stratification of patients at the risk of OSA. We decided to offer patients presenting to the urology clinic with a bothersome nocturia (with or without daytime LUTS) a routine assessment with a STOP-Bang questionnaire followed by the formal sleep study for those scoring ≥ 3 and with the evidence of cardio-vascular disease. METHODS: We retrospectively reviewed clinical outcomes in 71 consecutive patients managed in multi-disciplinary setting, according to the principles of the nocturia protocol which was recently approved for use in our region. RESULTS: The average age of patients was 73 years (range 34-88), male-to-female ratio 14:1 and median nocturia frequency 4. Patients at risk of undiagnosed sleep apnoea (35) were referred for sleep studies and 4 patients declined a sleep study. Median STOPBang score of the referred patients was 5 and those not referred was 3. Overall, 31 out of 35 sleep studies (88.6 %) demonstrated the presence of OSA; of these 23 (74.2%) confirmed moderate or severe OSA. Nine patients (39%) with moderate or severe OSA denied snoring and the same number denied daytime hypersomnolence; these patients were only diagnosed because of scoring ≥ 3 on STOP-Bang. All patients with OSA were seen and treated by the respiratory service. In the whole cohort, 18 patients underwent bladder outlet procedures and 19 were prescribed desmopressin. Overall, median nocturia frequency in our patients decreased from 4 to 1. CONCLUSIONS: At least a third of patients (32%) with bothersome nocturia have an undiagnosed clinically-significant OSA. The assessment of the nocturia patient in the urology clinic represents an opportunity to screen for OSA with a STOP-Bang questionnaire. Identification and treatment of OSA improves outcomes across the whole cohort, because nocturia in patients without OSA is more likely to respond to other therapies, such as bladder outlet procedures and desmopressin.