How frequent night-time bathroom visits can negatively impact sleep, well-being and productivity

Examining the associations between nocturia, well-being and economic outcomes in a working-age population

by Marco Hafner, Jack Pollard, Wendy M. Troxel, Erez Yerushalmi, Clement Fays, Michael Whitmore, Christian Van Stolk

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Research Questions

  1. What are the factors associated with nocturia in a working-age population?
  2. Is nocturia associated with subjective well-being and workplace engagement and productivity?
  3. What are the economic implications of nocturia?

Nocturia is a condition caused by reduced nocturnal bladder capacity and/or a large urine volume produced during the night. It is also relatively common, with up to 20 per cent of the overall population being affected, and its prevalence increases with age. Given its sleep-interrupting nature, nocturia is regarded to have negative implications for individuals' daytime functioning and is potentially associated with lower life satisfaction and reduced levels of workplace productivity. This study is one of the first to comprehensively examine of the associations between nocturia and a range of health, wellbeing, demographic and economic variables in a working-age population.

Our results show a set of associations between nocturia and a range of conditions, outcomes and factors. On the one hand, it confirms in the working-age population what has been seen in other studies that focused more specifically on the older populations. We find that a range of chronic conditions are associated with nocturia, though our surveys do not capture all relevant chronic conditions. Not surprisingly, we see a strong association between nocturia and other sleep quality indicators such as the first interrupted period of sleep. On the other hand, our study can be more expansive about the economic and wellbeing effects of the condition given the range of data points that were collected in recent workplace surveys. Respondents who report two or more voids have lower work engagement, life satisfaction and lower work productivity resulting in lower individual wellbeing and costs to society and employers.

Key Findings

Nocturia is a common and 'bothersome' condition, with two voids per night a critical threshold.

  • Estimates on the prevalence of nocturia suggest that, even though its prevalence is increasing with age, it is a condition that also affects approximately up to one in ten individuals aged 45 or younger.

A variety of demographic, lifestyle and health factors — which differ by age and gender — are associated with nocturia.

  • The research findings confirm previous research based on older study populations that some of the examined demographic factors associated with nocturia are also relevant for the working-age population, including age, gender or ethnicity. Furthermore, we find that chronic health conditions — such as kidney disease, diabetes, cardiovascular disease, cancer and hypertension — are associated with more frequent night time voids.

Nocturia is associated with higher levels of sleep disturbance and daytime fatigue.

  • Across three sleep quality measures we find that the prevalence of nocturia is associated with self-reported poor sleep quality, higher levels of sleep interruption and higher levels of daytime fatigue, independent of age and gender of the respondent.

Nocturia is significantly associated with lower life satisfaction, work engagement and productivity.

  • The empirical analysis presented in this study suggests that nocturia is associated with lower life satisfaction, work engagement and productivity in the working-age population, even after adjusting for many other factors that could determine these outcome variables, including sleep quality and duration.

Nocturia is associated with up to $79 billion of lost economic output per year across six countries, including the United Kingdom, United States, Japan, Germany, Spain and Australia.

Recommendation

  • Given the substantial economic implications of untreated nocturia, this should be a 'wake-up' call to diverse stakeholders — including patients, health-care providers and employers — of the importance of identifying and treating nocturia.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    The prevalence of nocturia, factors associated with the condition and possible consequences — a glance at the literature

  • Chapter Three

    Quantifying factors associated with nocturia and corresponding outcomes — data and methods

  • Chapter Four

    Factors associated with nocturia in the working-age population — demographics, lifestyle, co-morbidities and sleep

  • Chapter Five

    Nocturia and the associations with life satisfaction, work engagement and impairment

  • Chapter Six

    Quantifying the macroeconomic implications associated with nocturia

  • Chapter Seven

    Summary and conclusion

  • Appendix A

    Factors associated with nocturia in the working-age population: demographics, lifestyle, co-morbidities and sleep — corresponding regression output tables

  • Appendix B

    Nocturia and the associations with life satisfaction, workplace engagement and productivity — corresponding regression output tables

  • Appendix C

    The BHW and AIA surveys

  • Appendix D

    Description of the CGE model

Research conducted by

This research was prepared for Ferring Pharmaceuticals and conducted by RAND Europe.

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