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< Waking to void at least once during sleep >

- Increases with Age
 ¤ý1 in 2 adults over 50

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- Etiology: Prostate? OAB?
 ¤ýAlpha blockers reduce Nocturia by 0.2 episodes per night, 5ARIs less effective
 ¤ýAnticholinergics reduce Nocturia by 0.7 per night
 ¤ýMost resistant to treatment among BPH symptoms
 ¤ýPrevalent equally among Men and Women

¡Ü Sleep homeostasis for endocrine regulation

¢º Which occurs first?

- nocturia-induced stress decreases testosterone levels
- decreased testosterone by aging causes nocturia

¡Ü Mechanism : T & Sleep disturbance

¢º Disruption of Circadian hormones by Nocturia

- Psychological and physical stress such as deprivation of sleep significantly decrease testosterone levels
- Frequent awakening can also decrease the testosterone level.

¡Ü Aging Changes of Circadian Rhythms

¢º A central mechanistic issue in human male reproductive aging is whether low-amplitude and disorderly pulsatile LH secretion in older men is an intrinsic neuroregulatory anomaly or a secondary neuroendocrine response to partial androgen deficiency. >

¢º The process of aging commonly affects sleep architecture

- increasingly fragmented by arousals and awakening episodes
- poor sleep maintenance and consolidation
- shorter overall sleep time

¢º These effects are similar to those observed with lower T conc.

- decrease in sleep efficiency,
- lower number of REM sleep episodes
- altered REM sleep latency

¡Ü Testosterone changes after sleep deprivation (SD)/sleep restriction

¢º Sleep loss is considered to be a health risk factor

- several disease processes, reduces longevity, behavioral and hormonal alterations

¢º Increasingly common Chronic sleep loss in industrialized societies and it affects about 45% of adults.

¢º Normal average sleep duration : 8.0- 8.9 h/night in 1960; 6.9-7.0 h in 2000-2002

¢º SD induces changes in the endocrine axis.

- reduction in circulating androgens in healthy men
- decreased estrone levels and increased levels of progesterone, PRL,
   corticosterone, and catecholamines after 4 days of SD in male rats

ÀáÀ» ¾ÈÀç¿ì¸é ³²¼ºÈ£¸£¸ó levelÀÌ 10-15% °¨¼ÒÇÏ°í Á¤»óÀûÀ¸·Î ³ªÀÌ¿¡ µû¶ó
Çظ¶´Ù 1~2%°¨¼ÒÇϸç stress HÀÎ cortisÀÌ Áõ°¡ÇØ gonadal ±â´É °¨¼Ò½ÃŲ´Ù.

¡Ü Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men

¢º 10 young healthy men, 1 wk of SR to 5 hours per night, a condition experienced by at least 15% of the US working population

- Daytime T levels were decreased by 10% to 15%
- Normal aging ass. T decrease levels by 1-2% per year
- T decline was associated with lower vigor scores but not with increased levels of cortisol, a stress-responsive hormone that can inhibit gonadal function.

¡Ü Take Home Messages

¢º In aging male, increasing incidence of nocturia with lack of sleep are important issue in QOL for consequent decrease of testosterone.

¢º Still debating, nocturia showed a negative correlation with serum T levels and sleep loss by nocturia decrease T and treatment of nocturia can restore testosterone in selected populations of severe nocturia and lower serum T.

¢º But identification of definite cut-off value of T related to nocturia is not so simple for multifactorial pathophysiology, circadian rhythm, sleep and no established accurate T level assay.

¢º Further studies are requested to elucidate the causal relationship of nocturia and testosterone.

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