Wearable sleep tracker with expanded nocturia diary provide insight into nocturia evaluation

Objectives: Nocturia is a leading cause of sleep disturbance. The etiology of nocturia is multifaceted and pathogenesis overlaps with bladder, metabolic, and environmental factors. Current nocturia investigations are limited to self-completed voiding diaries to establish etiology or guide treatment. We aim to assess feasibility of using an expanded bladder diary with additional nocturia-specific questions combined with a wearable sleep tracker to enhance the breadth and depth of data for clinical nocturia evaluation.

Methods: This pilot study is part of an IRB-approved study investigating sleep patterns and nocturia. Five participants under age 65 without bladder or sleep pathology completed a 3-day traditional bladder. A 30% fluid increase was then performed within 2 hours of bed to induce nocturia over 5 days. Nighttime voids were documented using an expanded diary, consisting of the standard bladder diary template but with additional detailed questions covering nocturnal urination domains of: “bladder urge”, “bladder pain”, “bladder leakage”, “non-bladder reason (ie noise, no sleep, etc)”. A WHOOP 4.0 activity tracker was worn throughout this 8-day protocol to assess sleep patterns and stages. End user feedback in the form of an exit survey assessed feasibility and limitations to both sleep tracker use and nocturia survey instrument.

Results: 100% of participants completed the traditional and expanded bladder diary. 100% of participants found the additional nocturia questions reflected nocturnal awakenings, with 80% responding “strongly agree”. All participants found the expanded bladder diary similar or easier to use than the standard bladder diary. Participants were overall compliant with using the WHOOP strap for sleep monitoring. 1 participant rated learning to use the WHOOP “hard”, but ultimately 100% found maintenance of it was easy or manageable. The biggest limitations to sleep monitoring was remembering to wear the device (60%), strap discomfort (20%), and device misplacement (20%). Participants completed 90% of the expected protocol days. 76% of the awakenings documented on the nocturia diary correlated with identifiable sleep disturbances on the WHOOP tracker. The WHOOP successfully uploaded 92.8% of the sleep data for the nights that it was worn by participants, making it a feasible home monitoring device when compliance is assured.

Conclusions: The combination of a wearable sleep tracker with an expanded bladder diary surveying specific questions relevant to nocturnal voiding is a feasible addition to nocturia evaluation, providing sleep behavior data and other domains currently absent from clinical evaluation of nocturia.