Autonomic neuroscience : basic & clinical · 2026
Understanding nocturnal polyuria in cardiovascular autonomic failure: Pathophysiological mechanisms and clinical implications.
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Umbertini Elisa, Calandra-Buonaura Giovanna, Carrozzo Giannicola
Аннотация
BACKGROUND: Nocturnal polyuria (NP), characterized by excessive nighttime urine production, is a common non-motor symptom in synucleinopathies, particularly in the presence of cardiovascular autonomic failure (AF). NP contributes to sleep fragmentation, increased fall risk, and exacerbation of morning orthostatic hypotension. Diagnosis requires a comprehensive assessment of lower urinary tract symptoms, comorbidities and medication use.
METHODS: We conducted a scoping review of the existing literature on PubMed up to December 2024 regarding NP associated with synucleinopathies and AF.
RESULTS: NP is frequent in patients with AF. In Multiple System Atrophy, NP is associated with hypothalamic degeneration and impaired arginine vasopressin secretion. In Pure AF, NP appears multifactorial, while Lewy body disease-related NP is influenced by hypothalamic dysfunction and fluid redistribution. Therapeutic strategies include desmopressin, antihypertensive agents (e.g., clonidine, losartan) and non-pharmacological interventions such as CPAP and head-up tilt sleeping.
CONCLUSIONS: Although NP affects disease severity and quality of life in patients with AF, several research gaps emerged concerning prevalence, pathophysiology and specific treatments.
METHODS: We conducted a scoping review of the existing literature on PubMed up to December 2024 regarding NP associated with synucleinopathies and AF.
RESULTS: NP is frequent in patients with AF. In Multiple System Atrophy, NP is associated with hypothalamic degeneration and impaired arginine vasopressin secretion. In Pure AF, NP appears multifactorial, while Lewy body disease-related NP is influenced by hypothalamic dysfunction and fluid redistribution. Therapeutic strategies include desmopressin, antihypertensive agents (e.g., clonidine, losartan) and non-pharmacological interventions such as CPAP and head-up tilt sleeping.
CONCLUSIONS: Although NP affects disease severity and quality of life in patients with AF, several research gaps emerged concerning prevalence, pathophysiology and specific treatments.