目的:这篇综述的目的是讨论绝经与夜尿症之间的联系,并概述患病率的增加,危险因素,致病因素,围绝经期妇女夜尿症的治疗需求和选择。
方法:本文是基于各种关键意见领袖的专业知识和共识的叙述性回顾,结合广泛的文献综述。该文献检索包括对PubMed数据库和WebofScience上的潜在出版物的全面分析,并于2022年11月至2022年12月进行。使用以下关键词“夜尿症”和“更年期”或“夜间频率和更年期”。\"此外,关键词包括“发病率”,“\”患病率,\"\"失眠,“\”雌激素疗法,代谢综合征,“”和“潮热”与上述关键词结合使用。最后,对所获得的参考文献列表进行了筛选,以获得其他相关文献.
结果:围绝经期可能是诱发夜尿症的触发因素。通常,肥胖,体重指数(BMI),腰围是围绝经期夜尿症的危险因素。据推测,围绝经期夜尿症的发展是多因素的,膀胱之间的相互作用,睡眠,以及更年期后雌激素耗尽导致的肾脏问题。首先,泌尿生殖区域雌激素受体刺激受损导致阴道萎缩和膀胱容量降低。此外,绝经与膀胱过度活动症的发病率增加有关.第二,雌激素缺乏可通过抗利尿激素分泌和肾素-血管紧张素-醛固酮系统激活的昼夜节律减弱,引起盐和水利尿。此外,睡眠障碍的发病率增加,包括血管舒缩症状和阻塞性睡眠呼吸暂停症状,被观察到。口腔干燥和随之而来的更高的液体摄入量是围绝经期常见的症状。较高的胰岛素抵抗和较高的心血管疾病风险可能会引起夜尿症。考虑到夜尿症对一般健康和生活质量的影响,讨厌的夜尿症应该治疗。最初,应建议进行行为治疗。如果这些修改不充分,应提出具体的处理方法。发现全身性激素替代对夜尿症有有益作用,不影响夜间多尿患者的钠和水清除率。据推测,激素治疗引起的夜尿症的改善是由于睡眠障碍的改善。
OBJECTIVE: The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women.
METHODS: This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review. This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022. The following key words were used \"nocturia\" and \"menopause\" or \"nocturnal frequency and menopause.\" Moreover, key words including \"incidence,\" \"prevalence,\" \"insomnia,\" \"estrogen therapy,\" \"metabolic syndrome,\" and \"hot flushes\" were used in combination with the aforementioned key words. Last, the reference lists of articles obtained were screened for other relevant literature.
RESULTS: The perimenopause can be a trigger for inducing nocturia. Typically, obesity, body mass index (BMI), and waist circumference are risk factors for developing peri-menopausal nocturia. Presumably the development of peri-menopausal nocturia is multifactorial, with interplay among bladder, sleep, and kidney problems due to estrogen depletion after the menopause. First, impaired stimulation of estrogen receptors in the urogenital region leads to vaginal atrophy and reduced bladder capacity. Moreover, menopause is associated with an increased incidence of overactive bladder syndrome. Second, estrogen deficiency can induce salt and water diuresis through blunted circadian rhythms for the secretion of antidiuretic hormone and the activation of the renin-angiotensin-aldosterone system. Additionally, an increased incidence of sleep disorders, including vasomotor symptoms and obstructive sleep apnea signs, is observed. Oral dryness and a consequent higher fluid intake are common peri-menopausal symptoms. Higher insulin resistance and a higher risk of cardiovascular diseases may provoke nocturia. Given the impact of nocturia on general health and quality of life, bothersome nocturia should be treated. Initially, behavioral therapy should be advised. If these modifications are inadequate, specific treatment should be proposed. Systemic hormone replacement is found to have a beneficial effect on nocturia, without influencing sodium and water clearance in patients with nocturnal polyuria. It is presumed that the improvement in nocturia from hormonal treatment is due to an improvement in sleep disorders.