Improvement in Nocturia with MAD and Changes in Polysomnographic Values

Abstract Nocturia refers to waking up at least two times for voiding and occurs in at least ten percent of the population. Although nocturia has been classically associated with urological disease and diabetes, studies support a relationship with obstructive sleep apnea (OSA). Management with continuous positive airway pressure therapy significantly reduces nocturia. Mechanisms linking OSA and nocturia are not fully understood, improvement in apneic events and/or oxygen saturation contributes to the improvement in nocturia. To the best of our knowledge, no studies have investigated the effect of a mandibular advancement device (MAD) on nocturia, especially its association with apnea hypopnea index (AHI). Therefore, our aims are to (1) test if MAD is associated with reductions in nocturia (2) investigate if significant improvements in nocturia are associated with improvement in AHI. We hypothesized that using MAD will improve nocturia and that improvement in nocturia will result in improvement in AHI. Patients referred for management of OSA with MAD will provide nightly nocturia data for one-month preceding delivery of the appliance and continue until titration is completed. Titration will be performed until nocturia improves (less than 2 nocturia episodes for 2 weeks) or until maximum anatomical protrusive movement is reached, time at which second home sleep study will be performed to evaluate changes in AHI.