Understanding nocturnal polyuria in cardiovascular autonomic failure: Pathophysiological mechanisms and clinical implications.

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.