Relationships between nocturia and geriatric syndromes among community-dwelling older adults: the NOSE study

Relationships between nocturia and geriatric syndromes among community-dwelling older adults: the NOSE study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Relationships between nocturia and geriatric syndromes among community-dwelling older adults: the NOSE study Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Yuya Akagi, Hiroko Yoshida, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7884797/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objectives Nocturia and geriatric syndromes (GSs) are common and burdensome among older adults. Despite their negative effects on sleep, functioning, and quality of life (QOL), many community-dwelling older adults leave them unaddressed and the associations between nocturia and representative GSs among them remain underexplored. This study examined associations between nocturia and representative GSs, including those not intuitively related to urinary symptoms. Methods A cross-sectional analysis was conducted using data from 744 community-dwelling adults aged ≥ 65 years old in Nose Town, Osaka. Nocturia was defined as ≥ 2 voids per night. 15 GSs were assessed via questionnaire by interview. Sex-stratified multivariable logistic regression analyses were performed, adjusting for demographic and medical factors. Results Nocturia was more prevalent in males (47.1%) than females (30.8%) (p < 0.001). In males, nocturia was significantly associated with poor sleep (OR: 2.04; 95% CI: 1.18–3.54) and numbness (2.08; 1.19–3.64). In females, it was associated with poor sleep (1.93; 1.20–3.10) and leg edema (1.84; 1.11–3.07). Understanding its association with GSs may support community-based detection and integrated preventive strategies to improve QOL in aging societies, and may also help link community-based identification with appropriate clinical care. Community-dwelling older adults nocturia geriatric syndrome numbness leg edema Introduction Nocturia is a prevalent and burdensome condition among older adults, affecting approximately 70% of individuals aged ≥ 60 years [ 1 ]. It is typically defined as waking one or more times at night to void [ 2 ], and associated with a range of adverse outcomes, including disrupted sleep, reduced quality of life (QOL), risk of falls, and comorbidities [ 1 – 6 ]. Its etiologies include nocturnal polyuria (NP), bladder urine storage disorders, sleep disorders, and cardiovascular diseases (CVDs) —factors that reflect the multisystem dysregulation characteristics of aging [ 4 , 5 , 7 ]. Despite these impacts, nocturia remains underrecognized [ 2 , 4 ], particularly among relatively healthy, community-dwelling older adults. While existing researches have largely focused on clinical or care-seeking populations, and less attention has been given to older adults independently living in the community [ 7 , 8 ]. This group typically maintains better functioning level and represents a key targeted cluster for early preventions. Moreover, many community-dwelling older adults have limited health literacy regarding nocturia [ 5 , 9 – 11 ]. Consequently, nocturia often remains unaddressed until it significantly impairs functioning or QOL [ 12 ]. In parallel, geriatric syndromes (GSs)—such as frailty, cognitive decline, depression, sleep disturbance—are common and often co-occur in older adults [ 13 – 17 ]. They interact synergistically, complicate clinical management [ 13 ], and negatively affect QOL and long-term prognosis [ 14 – 16 ]. Prior studies have linked nocturia to specific GSs, including frailty, sleep problems, falls, and edema [ 7 , 9 , 13 , 18 – 20 ]. However, limited evidence exists regarding the relationship between nocturia and GSs in healthier, community-based populations. Moreover, GSs not typically associated with urinary symptoms may also play indirect roles [ 20 , 21 ]. These potential pathways suggest that community-level interventions may be effective in addressing nocturia from a more holistic standpoint. A comprehensive understanding of the associations between nocturia and GSs can provide novel insights for clinical and public health strategies on early identification of nocturia and prevention of QOL decline. The aim of this study was to examine the associations between nocturia and multiple representative GS among community-dwelling older adults in Nose Town, Osaka. Methods Study participants The study participants were selected from the 2020–2021 dataset of the NOSE study. This study is an ongoing prospective cohort study, designed to assess the impact of home BP measurements and recordings on the prevention of cognitive impairment, CVDs, frailty, and the extension of healthy lifespan among residents of Nose Town. 1151 participants were voluntarily recruited from there. 397 participants < 65 years old [ 22 ] and 10 participants with missing data for the items used in this study were excluded. 744 participants were included in the final analysis. Data was collected through venue-based surveys held at local health and welfare centers and community centers by trained physicians, nurses, and physical therapists [ 23 , 24 ]. Variables Independent Variable: Nocturia Data were collected via a standardized questionnaire administered by trained medical professionals during face-to-face interviews. The participants self-reported their current nocturia conditions by answering the question “How many times did you wake up to urinate from sleeping at night to get up in the morning?” with response options of 0 (never), 1 (once per night), 2 (twice per night), and 3 (≥ 3 times per night). Nocturia was defined as waking to urinate two or more (≥ 2) times per night in this study, given its stronger clinical significance and associations with morbidity and increased mortality than the ≥ 1 void(s) threshold [ 5 , 25 , 26 ]. Dependent Variable: GSs The participants were asked whether they had any of the following 15 GS symptoms currently by asking "Do you have this GS symptom?". For each GS item, they responded “yes” (present) or “no” (absent). GS symptoms investigated in this study comprised of loss of appetite, poor vision, poor hearing, tinnitus, dizziness and stagger, numbness, skin problems, poor sleep, general weakness, body instability, fear of falling, leg edema, shortness of breath, constipation, and physical pain [ 27 , 28 ]. Covariates Based on previous studies [ 2 – 6 , 19 ], the adjusted covariates included age, sex, educational year(s), economic status, current smoking, drinking frequency, overweight (body mass index [BMI] ≥ 25 kg/m 2 ), office systolic BP, diabetes, urologic condition(s) (any of the chronic kidney disease (CKD), chronic nephritis (CN), hyperuricemia, prostate cancer, acute nephritis, urinary calculus, cystitis, pyelonephritis, prostatic hyperplasia, other kidney/uric acid/urinary tract/prostate diseases(s), or dialysis), antihypertensive medication(s) (any of angiotensin receptor blockers [ARBs], diuretics, β-blockers, α-blockers, αβ-blockers, aldosterone antagonists, ARB-diuretic adjuvants or sodium-dependent glucose transporter 2 [SGLT2] blockers), nocturia-related medications (any of the anticholinergics, β 3 -adrenoceptor agonists, α 1 -adrenoceptor antagonists, 5α-reductase inhibitors, cholinesterase inhibitors, phytotherapeutics, phosphodiesterase type 5 inhibitors, or other nocturia-included symptom relief agents) and psychotropic medication(s) (any of sleep aids, anti-anxiety medications, antidepressants, or antipsychotics) in the models. Office BP (OBP) was measured using BP monitoring devices (HEM-7281T, OMRON HEALTHCARE Co. Ltd., Kyoto, Japan) following guidelines [ 29 ] by trained medical professionals on two arms twice per participant, and calculated into mean values. Medication data was interviewed and verified by examining the drug records within two years on the participants’ medication notebooks [ 30 ]. Statistical analysis SPSS (Version 29.0) was used for data analysis. Participants were divided into four groups by sex and nocturia status [ 19 ]. χ² tests and Mann-Whitney U tests were conducted. Univariate and multivariable logistic regression analyses were conducted to examine the associations between nocturia and GSs. Crude odds ratios (cORs) with 95% confidence intervals (c95%CIs) were estimated in the univariate analysis, and adjusted ORs (aORs) with 95% CIs (a95%CI) were calculated in the multivariable models after controlling for covariates. The significance level was set at p = 0.05. Results Among all the participants, females accounted for 58.1% (n = 432) and 37.6% participants had nocturia (≥ 2 voids/night, n = 280). The mean age overall was 73.06 ± 5.51 years old. The most prevalent GS overall was general weakness (74.2%, n = 552), followed by poor vision (68.0%, n = 506) and poor hearing (49.1%, n = 365). (Table 1 in Table_SuppInfo) Group comparisons of nocturia-related factors, and GSs Participants with nocturia had a significantly higher mean age than those without nocturia in the total sample (74.86 ± 5.87 years vs. 71.97 ± 4.98 years, p < 0.001), in the male group (74.18 ± 5.78 years vs. 71.54 ± 4.89 years, p < 0.001), and in the female group (75.62 ± 5.89 years vs. 72.21 ± 5.02 years, p < 0.001). The prevalence of nocturia was significantly higher in males (47.1%) than in females (30.8%) (p < 0.001). In females, nocturia was significantly associated with fewer educational year(s) (p = 0.004) and more nocturia-related medications (p < 0.001). In males, nocturia was significantly associated with current smoking (p = 0.007), other urologic condition(s) (p = 0.015), spinal disease(s) (p = 0.014) and more nocturia-related medications (p < 0.001). (Table 1) Relationships between nocturia and GSs In univariate analysis, in males, nocturia was significantly associated with dizziness and stagger (cOR 1.86; c95% CI 1.07–3.26), numbness (2.03; 1.23–3.36), poor sleep (2.04; 1.25–3.31), body instability (1.71; 1.05–2.80) and leg edema (1.96; 1.02–3.76). In females, nocturia was significantly associated with poor sleep (1.97; 1.29-3.00) and leg edema (1.72; 1.09–2.71). (Table 2) In multivariable analysis, nocturia was significantly positively associated with poor sleep (aOR 2.04; a95% CI 1.18–3.54) and numbness (2.08; 1.19–3.64) in males. Whereas, nocturia was significantly positively associated with poor sleep (1.93; 1.20–3.10) and with leg edema (1.84; 1.11–3.07) in females. (Table 3) Discussions In our community-based older adults, 37.6% of participants reported nocturia—a prevalence notably lower than that reported in previous similar investigations [ 31 ]. Only 16.0% in males and 3.2% in females reported taking nocturia-related medication, suggesting that many cases may remain untreated or unrecognized. This lower prevalence and low treatment rate may reflect the relatively healthy status of our participants, who had a lower comorbidity burden compared with participants in prior studies, many of whom had poorer health status [ 3 , 32 , 33 ]. Nocturia and numbness in Older Males Nocturia was significantly associated with numbness in older males in this study, which is partially supported by prior studies [ 5 ]. Nocturia can be categorized into four subtypes: NP, general polyuria, reduced bladder capacity, and mixed-causes type [ 1 ]. Bladder control, locomotion, and lower limb sensation share spinal and central neural pathways. Accordingly, spinal dysfunction may lead to both nocturia and numbness [ 34 – 36 ]. Restless Legs Syndrome (RLS) may also be a contributing factor. It brings numbness-included discomforts [ 37 ], causing nocturnal awakenings that is misinterpreted as nocturia [ 5 , 38 ]. RLS may either directly cause this association via shared neurological spinal dysfunction with urinary tract [ 5 , 34 , 35 ], or cause sleep disruption and accordingly increase nocturnal urination [ 5 , 38 ]. The actual sex difference in RLS severity and self-reporting have inconsistent evidence [ 39 , 40 , 41 ]. In our study, spinal disease was associated with nocturia only in older males (Table 2 in Tables_SuppInfo). These results may reflect the sex differences in structural neurogenic mechanisms affecting sensation and the urinary tract, perception of mild sensory symptoms and the actions taken against them [ 42 ]. Taken together, nocturia may interact with numbness through complex mechanisms. The observed association between spinal diseases and nocturia in older males further highlights the consideration of anatomical and functional diversity and detection of age-related functional changes when assessing urinary symptoms or numbness-included diseases in older adults. Nocturia and Leg Edema in Older Females Nocturia was significantly positively associated with leg edema in older females, which is partially aligned with previous studies [ 42 – 44 ]. In older females, the significant association between nocturia and leg edema may reflect fluid redistribution associated with cardiovascular insufficiency, including heart failure [ 2 , 44 – 52 ]. In addition, declined hormone due to the older age may have contributed to our result. Declining estrogen levels in postmenopausal females might also play a role in both urinary symptoms and fluid retention [ 45 , 46 ]. These findings highlight the importance of tailoring interventions to address underlying etiologies—such as promoting appropriate physical activities to control the fluid retention-related disorders, facilitating community assessment and followed-up care including lifestyle adjustment [ 47 , 48 ]. Providing appropriate care may also reduce unnecessary anxiety or behavioral restrictions. Nocturia and Poor Sleep in Both Sexes Nocturia was significantly associated with poor sleep in both sexes, which was corroborated in existing studies suggesting a bidirectional relationship between them [ 18 , 19 , 49 , 50 ]. Sleep disruption contributes to nocturia by altering antidiuretic hormone secretion and circadian rhythms [ 51 – 53 ]. Conversely, nocturia disrupts sleep through repeated awakenings. Structured fluid intake timing, behavioral sleep interventions, and accurate diagnosis of sleep disorders may be crucial to breaking this cycle [ 54 ]. Furthermore, assessments should consider daytime lifestyle factors such as reduced social participation, irregular activity patterns, and limited outdoor exposure, which may indirectly affect both sleep quality and nocturia through disturbed circadian regulation and decreased physical or psychosocial stimulation [ 55 ]. Addressing these broader contextual elements may provide additional pathways to improve outcomes, especially in community-based, non-clinical populations. Other GSs and their relationships with nocturia While some GSs (e.g., frailty, sensory impairment) were not statistically associated with nocturia in this study, this likely reflects the relatively healthy status with lower prevalence of comorbidities among our community-based participants. Nonetheless, these symptoms could still indicate early or indirect influences on nocturia via subclinical pathways [ 20 , 21 ]. Limitations and Implications This study has several limitations. All data were self-reported, potentially introducing recall bias or deviations from actual diagnoses. The cross-sectional design prevents conclusions about causality. Detailed treatment status for nocturia and other GSs was not assessed, limiting our ability to account for potential confounding by ongoing medical care. Moreover, participants were drawn from a single rural town, which may limit generalizability to more diverse populations. Future longitudinal or interventional studies are needed. However, our findings underscore the potential value of incorporating awareness of nocturia and its related GSs into community-based strategies for GS assessment and management. Such an approach may help identify individuals silently experiencing nocturia, particularly in settings where direct nocturia assessment is limited, and could ultimately contribute to healthier aging and improved QOL in aging societies, while also helping to link community-based detection with appropriate clinical care. Conclusions Nocturia was significantly associated with numbness and poor sleep in males, and with leg edema and poor sleep in females—GSs not typically linked to urinary symptoms. These findings may value detection of unrecognized nocturia in relatively healthy older populations, earlier intervention, and improve healthier aging and QOL in aging societies. Abbreviations No. Abbreviations Full name 1 a95% CI Adjusted 95% confidence intervals 2 aOR Adjusted odd ratio 3 ARBs Angiotensin receptor blockers 4 BMI Body mass index 5 BP Blood pressure 6 c95% CI Crude 95% confidence intervals 7 CKD Chronic kidney disease 8 CN Chronic nephritis 9 cOR Crude odd ratio 10 CVDs Cardiovascular diseases 11 GSs Geriatric syndromes 12 NP Nocturnal polyuria 13 OBP Office blood pressure 14 ODBP Office diastolic blood pressure 15 OSBP Office systolic blood pressure 16 QOL Quality of life 17 RLS Restless legs syndrome 18 SGLT2 Sodium-dependent glucose transporter 2 Declarations Ethics approval and consent All research procedures were approved by the Ethics Committee of Osaka University Hospital (Approval No. 19433-4). All participants provided written informed consent for participation and publication. Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This study was supported by the Top-Z Research Grant from OMRON HEALTHCARE Co., Ltd. Kakenhi 23K24672, T24K222310. Authors’ Contributions Conceptualized and designed – Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Kei Kamide, Mai Kabayama. Data collection and curation – Yaya Li, Michiko Kido, Yuya Akagi, Hiroko Yoshida, Takeshi Kikuchi, Makiko Higashi, Arisa Wada, Kei Kamide, Mai Kabayama. Data analysis - Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Hiroko Yoshida, Kei Kamide, Mai Kabayama. Data interpretation - Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Hiroko Yoshida, Yasuharu Tabara, Gary Yu, Kei Kamide, Mai Kabayama. Original draft – Liyu Shi, Yaya Li, Marlon Maus, Kei Kamide, Mai Kabayama. Verification and critical feedback – Yaya Li, Michiko Kido, Kayo Godai, Yuya Akagi, Hiroko Yoshida, Keigo Kobayashi, Yuka Fukata, Saya Terada, Chihiro Anzai, Yurie Maeyama, Yuka Yokoyama, Takeshi Kikuchi, Makiko Higashi, Arisa Wada, Marlon Maus, Gary Yu, Yasuharu Tabara, Kei Asayama, Takayoshi Ohkubo, Hiromi Rakugi, Kei Kamide, Mai Kabayama. Funding- Kei Kamide, Mai Kabayama. All authors verified the results and revised and finalized the manuscript. Acknowledgements We gratefully acknowledge all NOSE study participants for their kind cooperation. We sincerely appreciate all relevant members of the Nose Town Office staffs, and the University of Osaka Graduate School staffs, especially Yuka Ohata, Naoko Murakami, Yuka Tachibana, Haruna Kikuchi, Tomoko Yano, Fang Wen, Toshiki Mizuno, Masaaki Isaka, Mariko Hosokawa, Werayuth Srithumsuk, Nonglak Klinpudtan, Natsumi Fujiwara, Yuri Tominaga, Mei Nishida, Satoko Iwasaku, Ayumi Sugibayashi, Anna Kodama, Ruriko Yamada, Miwa Sasaki, Mio Kubo, Minori Eguchi, Ayano Tamura, Mayuka Iguchi, Motoko Nogami, Ayaka Hiratsuka, Kaoru Hatta, Riko Kinjo, Maya Mitani, Yui Toshimitsu, Reina Yokokawa, Chisato Hori, Suzuho Arimune, Nazuno Iwai, Aina Okashita, Kayo Toyoda, and Phouvanh Chanthavong. And we are thankful to Akiko Yoshinori, Mihoko Isama and Kaoru Higa Eriko Nishikuchi, Tomoe Tsubosaka for their secretary work. Availability of data and materials The data of the NOSE study are available from the corresponding author upon reasonable request and with approval from the appropriate ethics committee. Supplementary Information Other outcome is outlined in Supplementary Material: Table_SuppInfo. References Clemens JQ, Wiseman JB, Smith AR, Amundsen CL, Yang CC, Bradley MS, Kirkali Z, Agochukwu NQ, Cameron AP; LURN Study Group. Prevalence, subtypes, and correlates of nocturia in the symptoms of Lower Urinary Tract Dysfunction Research Network cohort. Neurourol Urodyn. 2020 Apr;39(4):1098-1107. doi: 10.1002/nau.24338. Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, Wein A. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn. 2019 Feb;38(2):478-498. doi: 10.1002/nau.23939. Haddad R, Decalf V, Monaghan TF, Van Laecke E, Bower W, Goessaert AS, Petrovic M, Everaert K. Nocturia severely impairs the sleep quality of nursing home residents: results from a multi-center study. Geriatr Nurs. 2022 Nov-Dec;48:164-168. doi: 10.1016/j.gerinurse.2022.09.009. Komleva Y, Gollasch M, König M. Nocturia and frailty in older adults: a scoping review. BMC Geriatr. 2024 Jun 6;24(1):498. doi: 10.1186/s12877-024-05049-3. Japanese Urological Association, Japanese Continence Society. Clinical Guidelines for Nocturia. 2nd ed. 2020. https://www.urol.or.jp/lib/files/other/guideline/37_nocturia_v2.pdf . Accessed 30 Jun 2025. Tabara Y, Matsumoto T, Murase K, Setoh K, Kawaguchi T, Nagashima S, Funada S, Kosugi S, Hirai T, Nakayama T, Wakamura T, Chin K, Matsuda F; Nagahama study group. Lifestyle habits associated with nocturnal urination frequency: The Nagahama study. Neurourol Urodyn. 2019 Nov;38(8):2359-2367. doi: 10.1002/nau.24156. Bower WF, Lau L, Whishaw DM, Reijnierse EM, Maier AB. Characteristics of Geriatric Rehabilitation Inpatients with Nocturia: RESORT. Gerontology. 2024;70(12):1284-1293. doi: 10.1159/000542056. Luo Z, Niu C, Yuan C, Lee DY, Shin YS, Kam SC. Identification of Correlation Between Frailty and Lower Urinary Tract Symptoms in Elderly Male Using Korean-FRAIL Scale. World J Mens Health. 2024 Oct 30. doi: 10.5534/wjmh.240122. Leslie SW, Sajjad H, Singh S. Nocturia. 2023 Mar 11. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan. https://www.ncbi.nlm.nih.gov/books/NBK518987/. Accessed 30 Jun 2025. Fisch GZ, Fang AH, Miller CD, Choi C, Monaghan TF, Smith EF, Prishtina L, Weiss JP, Blaivas JG. Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology. Neurourol Urodyn. 2023 Jan;42(1):256-262. doi: 10.1002/nau.25078. Nonaka H, Suzuki S, Negoro H, Ikeda A, Chihara I, Kandori S, Nishiyama H. Association between nocturia and sleep issues, incorporating the impact of lifestyle habits perceived as promoting sleep in an internet survey. Sci Rep. 2025 May 20;15(1):17508. doi: 10.1038/s41598-025-02587-7. Weiss JP. Nocturia: focus on etiology and consequences. Rev Urol. 2012;14(3-4):48-55. doi: 10.3909/riu0576] Satake S, Toba K. Symptoms and syndromes specific to older adults: geriatric syndrome. National Center for Geriatrics and Gerontology. 2012;5:7. http://www.igaku.co.jp/pdf/1205_resident-01.pdf . Accessed 30 Jun 2025. Kimura T. Geriatric syndrome and comprehensive geriatric assessment. Journal of the Japanese Society of Internal Medicine. 2018;107(2):2420-2429. https://www.jstage.jst.go.jp/article/naika/107/12/107_2420/_pdf. Accessed 30 Jun 2025. American Geriatrics Society. A guide to geriatric syndromes: common and often related medical conditions in older adults. https://www.healthinaging.org/sites/default/files/media/pdf/HIA-TipSheet%20Geriatric%20Syndromes19.pdf. Accessed 30 Jun 2025. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780-91. doi: 10.1111/j.1532-5415.2007.01156.x. Olde Rikkert MG, Rigaud AS, van Hoeyweghen RJ, de Graaf J. Geriatric syndromes: medical misnomer or progress in geriatrics? Neth J Med. 2003 Mar;61(3):83-7. https://www.njmonline.nl/getpdf.php?id=73 Monaghan TF, Weiss JP, Wein AJ, Rahman SN, Lazar JM, Bliwise DL, Everaert K, Lemack GE, Cornu JN, Drake MJ, et al. Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications ("Sleep C.A.L.M.") in the evaluation and management of nocturia: A simple approach to a complex diagnosis. Neurourol Urodyn. 2023 Mar;42(3):562-572. doi: 10.1002/nau.25128. Bliwise DL, Wagg A, Sand PK. Nocturia: A Highly Prevalent Disorder With Multifaceted Consequences. Urology. 2019 Nov;133S:3-13. doi: 10.1016/j.urology.2019.07.005. Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA; American Geriatrics Society/National Institute on Aging Urinary Incontinence Conference Planning Committee and Faculty. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc. 2018 Apr;66(4):773-782. doi: 10.1111/jgs.15157. Asplund R. Nocturnal giddiness in relation to nocturia and other symptoms and to medication in the elderly. Arch Gerontol Geriatr. 2005 Jan-Feb;40(1):103-11. doi: 10.1016/j.archger.2004.06.002. World Health Organization. (n.d.). Preparing for population ageing in the Western Pacific Region. WHO. https://www.who.int/westernpacific/newsroom/commentaries/detail/preparing-for-population-ageing-in-the-western-pacific-region. Accessed 30 Jun 2025. Wada A, Kabayama M, Godai K, Kido M, Ohata Y, Murakami N, Nakamura Y, Yoshida H, Hashimoto S, Higashi M, et al. Factors influencing the continuation of home blood pressure measurement in community-dwelling older adults: the NOSE study. J Hypertens. 2024 Apr 1;42(4):694-700. doi: 10.1097/HJH.0000000000003628. Ohata Y, Kabayama M, Godai K, Kido M, Li Y, Akagi Y, Murakami N, Yoshida H, Hosokawa M, Tachibana Y, et al. Office and home blood pressure and their difference according to frailty status among community-dwelling older adults: the NOSE study. Hypertens Res. 2025 Apr;48(4):1389-1398. doi: 10.1038/s41440-025-02145-8. Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z. Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. Int J Clin Pract. 2015 Dec;69(12):1508-16. doi: 10.1111/ijcp.12727. Yoshida M. Geriatric management of lower urinary tract dysfunction (voiding dysfunction) based on clinical guidelines. Journal of the Japanese Geriatrics Society. 2022;59(2):115-130. https://www.jstage.jst.go.jp/article/geriatrics/59/2/59_59.115/_pdf/-char/ja. Accessed 30 Jun 2025. Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare, Japan. Manual for the Assessment of Daily Function for the Prevention of Long-term Care. 2009 May. https://www.jpn-geriat-soc.or.jp/proposal/pdf/geriatric_care_GL.pdf. Accessed Jun 30. Japan Geriatrics Society and Japan Gerontological Society. Clinical Practice Guideline for Geriatric Syndromes in Elderly Care. 2022 Mar. https://www.jpn-geriat-soc.or.jp/proposal/pdf/geriatric_care_GL.pdf. Accessed Jun 30 2025. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Research. 2019 Sep; 42(9):1235–1481. doi: 10.1038/s41440-019-0284-9. Yajima R, Matsumoto M, Iida M, Harada N, Shibuki T, Hirata A, Kuwabara K, Miyagawa N, Nakamura T, Okamura T, Takebayashi T. Validity of self-administered questionnaire on medication information compared with medication notebooks among community-dwelling older adults. Japanese Journal of Public Health. 2024;71(8):430–7. doi:10.11236/jph.23-110. Mitsui T, Sekido N, Masumori N, Haga N, Omae K, Saito M, Kubota Y, Sakakibara R, Yoshida M, Takahashi S. Prevalence and impact on daily life of lower urinary tract symptoms in Japan: Results of the 2023 Japan Community Health Survey (JaCS 2023). Int J Urol. 2024 Jul;31(7):747-754. doi: 10.1111/iju.15454. Yee CH, Chan CK, Teoh JYC, Chiu PKF, Wong JHM, Chan ESY, Hou SSM, Ng CF. Survey on prevalence of lower urinary tract symptoms in an Asian population. Hong Kong Med J. 2019 Feb;25(1):13-20. doi: 10.12809/hkmj187502. Shao C, Wang H, He Y, Yu B, Zhao H. Clinical phenotype of obstructive sleep apnea in older adults: a hospital-based retrospective study in China. Ir J Med Sci. 2023 Oct;192(5):2305-2312. doi: 10.1007/s11845-023-03290-0. Chancellor MB, Yoshimura N. Neurophysiology of stress urinary incontinence. Rev Urol. 2004;6 Suppl 3(Suppl 3):S19-28. https://pmc.ncbi.nlm.nih.gov/articles/PMC1472861/. Accessed 30 Jun 2025. de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015 Jan;5(1):327-96. doi: 10.1002/cphy.c130056. Kanematsu R, Hanakita J, Takahashi T, Minami M, Inoue T, Miyasaka K, Shimauchi-Ohtaki H, Ueno M, Honda F. Improvement in Neurogenic Bowel and Bladder Dysfunction Following Posterior Decompression Surgery for Cauda Equina Syndrome: A Prospective Cohort Study. Neurospine. 2021 Dec;18(4):847-853. doi: 10.14245/ns.2142252.126. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J; Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003 Mar;4(2):101-19. doi: 10.1016/s1389-9457(03)00010-8. Wolff DT, Adler KA, Weinstein CS, Weiss JP. Managing Nocturia in Frail Older Adults. Drugs Aging. 2021 Feb;38(2):95-109. doi: 10.1007/s40266-020-00815-5. Pieroni I, Cerroni G, Velluto L, Sorbi S, Guarnieri B. Sex and age differences in sleep disorders: insights from a diverse cohort referred to a sleep center. Neurol Sci. 2025 Aug;46(8):3885-3897. doi: 10.1007/s10072-025-08133-7. Kim J, Kim JR, Park HR, Joo EY. Sex-specific patterns of discomfort in patients with restless legs syndrome. J Clin Sleep Med. 2024 Feb 1;20(2):253-259. doi: 10.5664/jcsm.10848. Bentley AJ, Rosman KD, Mitchell D. Gender differences in the presentation of subjects with restless legs syndrome. Sleep Med. 2006 Jan;7(1):37-41. doi: 10.1016/j.sleep.2005.03.004. Bjorling DE, Wang ZY. Estrogen and neuroinflammation. Urology. 2001 Jun;57(6 Suppl 1):40-6. doi: 10.1016/s0090-4295(01)01124-4. Hirayama A, Torimoto K, Yamada A, Tanaka N, Fujimoto K, Yoshida K, Hirao Y. Relationship between nocturnal urine volume, leg edema, and urinary antidiuretic hormone in older men. Urology. 2011 Jun;77(6):1426-31. doi: 10.1016/j.urology.2010.12.030. Boongird S, Shah N, Nolin TD, Unruh ML. Nocturia and aging: diagnosis and treatment. Adv Chronic Kidney Dis. 2010 Jul;17(4):e27-40. doi: 10.1053/j.ackd.2010.04.004. Pauwaert K, Goessaert AS, Robinson D, Cardozo L, Bower W, Calders P, Mariman A, Abrams P, Tubaro A, Dmochowski R, Weiss JP, Hervé F, Depypere H, Everaert K. Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age. Int Urogynecol J. 2024 May;35(5):935-946. doi: 10.1007/s00192-024-05743-1. Kim SY, Bang W, Kim MS, Park B, Kim JH, Choi HG. Nocturia Is Associated with Slipping and Falling. PLoS One. 2017 Jan 6;12(1):e0169690. doi: 10.1371/journal.pone.0169690. Thangada ND, Zhang D, Zhao L, Tian L, McDermott MM. Safety and efficacy of home-based walking exercise for peripheral artery disease. J Vasc Surg. 2025 Feb;81(2):441-449.e1. doi: 10.1016/j.jvs.2024.10.013. Leong DP, Yusuf R, Iqbal R, Avezum Á, Yusufali A, Rosengren A, Chifamba J, Lanas F, Diaz ML, Miranda JJ, Davletov K, Mirrakhimov E, Yeates K, Khatib R, Alhabib KF, Gulec S, Paucar MJ, Lopez-Lopez JP, Mohan V, Gupta R, Soman B, Lakshmi PVM, Poirier P, Teo K, Zatonska K, Mat-Nasir N, Artamonova G, Hu B, Liu Z, Liu X, Dans A, Rangarajan S, Yusuf S; PURE Study Investigators. The burden of cardiovascular events according to cardiovascular risk profile in adults from high-income, middle-income, and low-income countries (PURE): a cohort study. Lancet Glob Health. 2025 Aug;13(8):e1406-e1414. doi: 10.1016/S2214-109X(25)00155-X. Tyagi S, Chancellor MB. Nocturnal polyuria and nocturia. Int Urol Nephrol. 2023 Jun;55(6):1395-1401. doi: 10.1007/s11255-023-03582-5. Luo Z, Wang J, Huang S, Hao X, Lv K, Lv C, Yang G, Yuan Q. Decadal changes in nocturia among American middle-aged and older men. Geriatr Gerontol Int. 2024 Dec;24(12):1308-1314. doi: 10.1111/ggi.15007. Tyagi S, Resnick NM, Clarkson BD, Zhang G, Krafty RT, Perera S, Subramanya AR, Buysse DJ. Impact of sleep on chronobiology of micturition among healthy older adults. Am J Physiol Renal Physiol. 2023 Oct 1;325(4):F407-F417. doi: 10.1152/ajprenal.00025.2023. Kim JH, Duffy JF. Circadian Rhythm Sleep-Wake Disorders in Older Adults. Sleep Med Clin. 2018 Mar;13(1):39-50. doi: 10.1016/j.jsmc.2017.09.004. Bower WF, Whishaw DM, Khan F. Nocturia as a marker of poor health: Causal associations to inform care. Neurourol Urodyn. 2017 Mar;36(3):697-705. doi: 10.1002/nau.23000. Jaqua EE, Hanna M, Labib W, Moore C, Matossian V. Common Sleep Disorders Affecting Older Adults. Perm J. 2023 Mar 15;27(1):122-132. doi: 10.7812/TPP/22.114. Takahashi S, Arai Y, Yoshida M. Night urination - diagnosis and latest treatment. The Journal of The Japan Medical Association. 2023 Dec 1;152(9):972. https://www.med.or.jp/cme/jjma/newmag/15209/15209.html. Accessed 30 Jun 2025. Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files MainDataTables1.xlsx MainDataTables2.xlsx MainDataTables3.xlsx TableSuppInfo.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 18 Nov, 2025 Reviewers invited by journal 13 Nov, 2025 Editor invited by journal 20 Oct, 2025 Editor assigned by journal 19 Oct, 2025 Submission checks completed at journal 19 Oct, 2025 First submitted to journal 17 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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It is typically defined as waking one or more times at night to void [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and associated with a range of adverse outcomes, including disrupted sleep, reduced quality of life (QOL), risk of falls, and comorbidities [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Its etiologies include nocturnal polyuria (NP), bladder urine storage disorders, sleep disorders, and cardiovascular diseases (CVDs) \u0026mdash;factors that reflect the multisystem dysregulation characteristics of aging [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite these impacts, nocturia remains underrecognized [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], particularly among relatively healthy, community-dwelling older adults.\u003c/p\u003e\u003cp\u003eWhile existing researches have largely focused on clinical or care-seeking populations, and less attention has been given to older adults independently living in the community [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This group typically maintains better functioning level and represents a key targeted cluster for early preventions. Moreover, many community-dwelling older adults have limited health literacy regarding nocturia [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Consequently, nocturia often remains unaddressed until it significantly impairs functioning or QOL [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn parallel, geriatric syndromes (GSs)\u0026mdash;such as frailty, cognitive decline, depression, sleep disturbance\u0026mdash;are common and often co-occur in older adults [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. They interact synergistically, complicate clinical management [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and negatively affect QOL and long-term prognosis [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Prior studies have linked nocturia to specific GSs, including frailty, sleep problems, falls, and edema [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, limited evidence exists regarding the relationship between nocturia and GSs in healthier, community-based populations. Moreover, GSs not typically associated with urinary symptoms may also play indirect roles [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These potential pathways suggest that community-level interventions may be effective in addressing nocturia from a more holistic standpoint. A comprehensive understanding of the associations between nocturia and GSs can provide novel insights for clinical and public health strategies on early identification of nocturia and prevention of QOL decline.\u003c/p\u003e\u003cp\u003eThe aim of this study was to examine the associations between nocturia and multiple representative GS among community-dwelling older adults in Nose Town, Osaka.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy participants\u003c/h2\u003e\u003cp\u003eThe study participants were selected from the 2020\u0026ndash;2021 dataset of the NOSE study. This study is an ongoing prospective cohort study, designed to assess the impact of home BP measurements and recordings on the prevention of cognitive impairment, CVDs, frailty, and the extension of healthy lifespan among residents of Nose Town. 1151 participants were voluntarily recruited from there. 397 participants\u0026thinsp;\u0026lt;\u0026thinsp;65 years old [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and 10 participants with missing data for the items used in this study were excluded. 744 participants were included in the final analysis. Data was collected through venue-based surveys held at local health and welfare centers and community centers by trained physicians, nurses, and physical therapists [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eIndependent Variable: Nocturia\u003c/h2\u003e\u003cp\u003eData were collected via a standardized questionnaire administered by trained medical professionals during face-to-face interviews. The participants self-reported their current nocturia conditions by answering the question \u0026ldquo;How many times did you wake up to urinate from sleeping at night to get up in the morning?\u0026rdquo; with response options of 0 (never), 1 (once per night), 2 (twice per night), and 3 (\u0026ge;\u0026thinsp;3 times per night). Nocturia was defined as waking to urinate two or more (\u0026ge;\u0026thinsp;2) times per night in this study, given its stronger clinical significance and associations with morbidity and increased mortality than the \u0026ge;\u0026thinsp;1 void(s) threshold [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDependent Variable: GSs\u003c/h3\u003e\n\u003cp\u003eThe participants were asked whether they had any of the following 15 GS symptoms currently by asking \"Do you have this GS symptom?\". For each GS item, they responded \u0026ldquo;yes\u0026rdquo; (present) or \u0026ldquo;no\u0026rdquo; (absent). GS symptoms investigated in this study comprised of loss of appetite, poor vision, poor hearing, tinnitus, dizziness and stagger, numbness, skin problems, poor sleep, general weakness, body instability, fear of falling, leg edema, shortness of breath, constipation, and physical pain [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eBased on previous studies [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], the adjusted covariates included age, sex, educational year(s), economic status, current smoking, drinking frequency, overweight (body mass index [BMI]\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e), office systolic BP, diabetes, urologic condition(s) (any of the chronic kidney disease (CKD), chronic nephritis (CN), hyperuricemia, prostate cancer, acute nephritis, urinary calculus, cystitis, pyelonephritis, prostatic hyperplasia, other kidney/uric acid/urinary tract/prostate diseases(s), or dialysis), antihypertensive medication(s) (any of angiotensin receptor blockers [ARBs], diuretics, β-blockers, α-blockers, αβ-blockers, aldosterone antagonists, ARB-diuretic adjuvants or sodium-dependent glucose transporter 2 [SGLT2] blockers), nocturia-related medications (any of the anticholinergics, β\u003csub\u003e3\u003c/sub\u003e-adrenoceptor agonists, α\u003csub\u003e1\u003c/sub\u003e-adrenoceptor antagonists, 5α-reductase inhibitors, cholinesterase inhibitors, phytotherapeutics, phosphodiesterase type 5 inhibitors, or other nocturia-included symptom relief agents) and psychotropic medication(s) (any of sleep aids, anti-anxiety medications, antidepressants, or antipsychotics) in the models.\u003c/p\u003e\u003cp\u003eOffice BP (OBP) was measured using BP monitoring devices (HEM-7281T, OMRON HEALTHCARE Co. Ltd., Kyoto, Japan) following guidelines [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] by trained medical professionals on two arms twice per participant, and calculated into mean values. Medication data was interviewed and verified by examining the drug records within two years on the participants\u0026rsquo; medication notebooks [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eSPSS (Version 29.0) was used for data analysis. Participants were divided into four groups by sex and nocturia status [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. χ\u0026sup2; tests and Mann-Whitney U tests were conducted. Univariate and multivariable logistic regression analyses were conducted to examine the associations between nocturia and GSs. Crude odds ratios (cORs) with 95% confidence intervals (c95%CIs) were estimated in the univariate analysis, and adjusted ORs (aORs) with 95% CIs (a95%CI) were calculated in the multivariable models after controlling for covariates. The significance level was set at p\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong all the participants, females accounted for 58.1% (n\u0026thinsp;=\u0026thinsp;432) and 37.6% participants had nocturia (\u0026ge;\u0026thinsp;2 voids/night, n\u0026thinsp;=\u0026thinsp;280). The mean age overall was 73.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51 years old. The most prevalent GS overall was general weakness (74.2%, n\u0026thinsp;=\u0026thinsp;552), followed by poor vision (68.0%, n\u0026thinsp;=\u0026thinsp;506) and poor hearing (49.1%, n\u0026thinsp;=\u0026thinsp;365). (Table\u0026nbsp;1 in Table_SuppInfo)\u003c/p\u003e\n\u003ch3\u003eGroup comparisons of nocturia-related factors, and GSs\u003c/h3\u003e\n\u003cp\u003eParticipants with nocturia had a significantly higher mean age than those without nocturia in the total sample (74.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.87 years vs. 71.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98 years, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), in the male group (74.18\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78 years vs. 71.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89 years, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and in the female group (75.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89 years vs. 72.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.02 years, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The prevalence of nocturia was significantly higher in males (47.1%) than in females (30.8%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In females, nocturia was significantly associated with fewer educational year(s) (p\u0026thinsp;=\u0026thinsp;0.004) and more nocturia-related medications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In males, nocturia was significantly associated with current smoking (p\u0026thinsp;=\u0026thinsp;0.007), other urologic condition(s) (p\u0026thinsp;=\u0026thinsp;0.015), spinal disease(s) (p\u0026thinsp;=\u0026thinsp;0.014) and more nocturia-related medications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;1)\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRelationships between nocturia and GSs\u003c/h2\u003e\u003cp\u003eIn univariate analysis, in males, nocturia was significantly associated with dizziness and stagger (cOR 1.86; c95% CI 1.07\u0026ndash;3.26), numbness (2.03; 1.23\u0026ndash;3.36), poor sleep (2.04; 1.25\u0026ndash;3.31), body instability (1.71; 1.05\u0026ndash;2.80) and leg edema (1.96; 1.02\u0026ndash;3.76). In females, nocturia was significantly associated with poor sleep (1.97; 1.29-3.00) and leg edema (1.72; 1.09\u0026ndash;2.71). (Table\u0026nbsp;2)\u003c/p\u003e\u003cp\u003eIn multivariable analysis, nocturia was significantly positively associated with poor sleep (aOR 2.04; a95% CI 1.18\u0026ndash;3.54) and numbness (2.08; 1.19\u0026ndash;3.64) in males. Whereas, nocturia was significantly positively associated with poor sleep (1.93; 1.20\u0026ndash;3.10) and with leg edema (1.84; 1.11\u0026ndash;3.07) in females. (Table\u0026nbsp;3)\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eIn our community-based older adults, 37.6% of participants reported nocturia\u0026mdash;a prevalence notably lower than that reported in previous similar investigations [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Only 16.0% in males and 3.2% in females reported taking nocturia-related medication, suggesting that many cases may remain untreated or unrecognized. This lower prevalence and low treatment rate may reflect the relatively healthy status of our participants, who had a lower comorbidity burden compared with participants in prior studies, many of whom had poorer health status [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eNocturia and numbness in Older Males\u003c/h2\u003e\u003cp\u003eNocturia was significantly associated with numbness in older males in this study, which is partially supported by prior studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Nocturia can be categorized into four subtypes: NP, general polyuria, reduced bladder capacity, and mixed-causes type [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Bladder control, locomotion, and lower limb sensation share spinal and central neural pathways. Accordingly, spinal dysfunction may lead to both nocturia and numbness [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Restless Legs Syndrome (RLS) may also be a contributing factor. It brings numbness-included discomforts [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], causing nocturnal awakenings that is misinterpreted as nocturia [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. RLS may either directly cause this association via shared neurological spinal dysfunction with urinary tract [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], or cause sleep disruption and accordingly increase nocturnal urination [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The actual sex difference in RLS severity and self-reporting have inconsistent evidence [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, spinal disease was associated with nocturia only in older males (Table\u0026nbsp;2 in Tables_SuppInfo). These results may reflect the sex differences in structural neurogenic mechanisms affecting sensation and the urinary tract, perception of mild sensory symptoms and the actions taken against them [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTaken together, nocturia may interact with numbness through complex mechanisms. The observed association between spinal diseases and nocturia in older males further highlights the consideration of anatomical and functional diversity and detection of age-related functional changes when assessing urinary symptoms or numbness-included diseases in older adults.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eNocturia and Leg Edema in Older Females\u003c/h2\u003e\u003cp\u003eNocturia was significantly positively associated with leg edema in older females, which is partially aligned with previous studies [\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In older females, the significant association between nocturia and leg edema may reflect fluid redistribution associated with cardiovascular insufficiency, including heart failure [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45 CR46 CR47 CR48 CR49 CR50 CR51\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In addition, declined hormone due to the older age may have contributed to our result. Declining estrogen levels in postmenopausal females might also play a role in both urinary symptoms and fluid retention [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese findings highlight the importance of tailoring interventions to address underlying etiologies\u0026mdash;such as promoting appropriate physical activities to control the fluid retention-related disorders, facilitating community assessment and followed-up care including lifestyle adjustment [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Providing appropriate care may also reduce unnecessary anxiety or behavioral restrictions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eNocturia and Poor Sleep in Both Sexes\u003c/h2\u003e\u003cp\u003eNocturia was significantly associated with poor sleep in both sexes, which was corroborated in existing studies suggesting a bidirectional relationship between them [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Sleep disruption contributes to nocturia by altering antidiuretic hormone secretion and circadian rhythms [\u003cspan additionalcitationids=\"CR52\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Conversely, nocturia disrupts sleep through repeated awakenings. Structured fluid intake timing, behavioral sleep interventions, and accurate diagnosis of sleep disorders may be crucial to breaking this cycle [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, assessments should consider daytime lifestyle factors such as reduced social participation, irregular activity patterns, and limited outdoor exposure, which may indirectly affect both sleep quality and nocturia through disturbed circadian regulation and decreased physical or psychosocial stimulation [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Addressing these broader contextual elements may provide additional pathways to improve outcomes, especially in community-based, non-clinical populations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eOther GSs and their relationships with nocturia\u003c/h2\u003e\u003cp\u003eWhile some GSs (e.g., frailty, sensory impairment) were not statistically associated with nocturia in this study, this likely reflects the relatively healthy status with lower prevalence of comorbidities among our community-based participants. Nonetheless, these symptoms could still indicate early or indirect influences on nocturia via subclinical pathways [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and Implications\u003c/h2\u003e\u003cp\u003eThis study has several limitations. All data were self-reported, potentially introducing recall bias or deviations from actual diagnoses. The cross-sectional design prevents conclusions about causality. Detailed treatment status for nocturia and other GSs was not assessed, limiting our ability to account for potential confounding by ongoing medical care. Moreover, participants were drawn from a single rural town, which may limit generalizability to more diverse populations. Future longitudinal or interventional studies are needed.\u003c/p\u003e\u003cp\u003eHowever, our findings underscore the potential value of incorporating awareness of nocturia and its related GSs into community-based strategies for GS assessment and management. Such an approach may help identify individuals silently experiencing nocturia, particularly in settings where direct nocturia assessment is limited, and could ultimately contribute to healthier aging and improved QOL in aging societies, while also helping to link community-based detection with appropriate clinical care.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eNocturia was significantly associated with numbness and poor sleep in males, and with leg edema and poor sleep in females\u0026mdash;GSs not typically linked to urinary symptoms. These findings may value detection of unrecognized nocturia in relatively healthy older populations, earlier intervention, and improve healthier aging and QOL in aging societies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"464\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ea95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eAdjusted 95% confidence intervals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eaOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eAdjusted odd ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eARBs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eAngiotensin receptor blockers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eBody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eBlood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ec95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eCrude 95% confidence intervals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eCKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eCN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eChronic nephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ecOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eCrude odd ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eCVDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eCardiovascular diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eGSs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eGeriatric syndromes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eNP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eNocturnal polyuria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eOBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eOffice blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eODBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eOffice diastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eOSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eOffice systolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eQOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eQuality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eRLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eRestless legs syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eSGLT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 303px;\"\u003e\n \u003cp\u003eSodium-dependent glucose transporter 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll research procedures were approved by the Ethics Committee of Osaka University Hospital (Approval No. 19433-4). All participants provided written informed consent for participation and publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Top-Z Research Grant from OMRON HEALTHCARE Co., Ltd. Kakenhi 23K24672, T24K222310.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualized and designed \u0026ndash; Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Kei Kamide, Mai Kabayama. Data collection and curation \u0026ndash; Yaya Li, Michiko Kido, Yuya Akagi, Hiroko Yoshida, Takeshi Kikuchi, Makiko Higashi, Arisa Wada, Kei Kamide, Mai Kabayama. Data analysis - Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Hiroko Yoshida, Kei Kamide, Mai Kabayama. Data interpretation - Liyu Shi, Yaya Li, Michiko Kido, Kayo Godai, Hiroko Yoshida, Yasuharu Tabara, Gary Yu, Kei Kamide, Mai Kabayama. Original draft \u0026ndash; Liyu Shi, Yaya Li, Marlon Maus, Kei Kamide, Mai Kabayama. Verification and critical feedback \u0026ndash; Yaya Li, Michiko Kido, Kayo Godai, Yuya Akagi, Hiroko Yoshida, Keigo Kobayashi, Yuka Fukata, Saya Terada, Chihiro Anzai, Yurie Maeyama, Yuka Yokoyama, Takeshi Kikuchi, Makiko Higashi, Arisa Wada, Marlon Maus, Gary Yu, Yasuharu Tabara, Kei Asayama, Takayoshi Ohkubo, Hiromi Rakugi, Kei Kamide, Mai Kabayama. Funding-\u0026nbsp;Kei Kamide, Mai Kabayama. All authors verified the results and revised and finalized the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge all NOSE study participants for their kind cooperation. We sincerely appreciate all relevant members of the Nose Town Office staffs, and the University of Osaka Graduate School staffs, especially Yuka Ohata, Naoko Murakami, Yuka Tachibana, Haruna Kikuchi, Tomoko Yano, Fang Wen, Toshiki Mizuno, Masaaki Isaka, Mariko Hosokawa, Werayuth Srithumsuk, Nonglak Klinpudtan, Natsumi Fujiwara, Yuri Tominaga, Mei Nishida, Satoko Iwasaku, Ayumi Sugibayashi, Anna Kodama, Ruriko Yamada, Miwa Sasaki, Mio Kubo, Minori Eguchi, Ayano Tamura, Mayuka Iguchi, Motoko Nogami, Ayaka Hiratsuka, Kaoru Hatta, Riko Kinjo, Maya Mitani, Yui Toshimitsu, Reina Yokokawa, Chisato Hori, Suzuho Arimune, Nazuno Iwai, Aina Okashita, Kayo Toyoda, and Phouvanh Chanthavong. And we are thankful to Akiko Yoshinori, Mihoko Isama and Kaoru Higa Eriko Nishikuchi, Tomoe Tsubosaka for their secretary work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of the NOSE study are available from the corresponding author upon reasonable request and with approval from the appropriate ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOther outcome is outlined in Supplementary Material: Table_SuppInfo.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClemens JQ, Wiseman JB, Smith AR, Amundsen CL, Yang CC, Bradley MS, Kirkali Z, Agochukwu NQ, Cameron AP; LURN Study Group. Prevalence, subtypes, and correlates of nocturia in the symptoms of Lower Urinary Tract Dysfunction Research Network cohort. Neurourol Urodyn. 2020 Apr;39(4):1098-1107. doi: 10.1002/nau.24338.\u003c/li\u003e\n\u003cli\u003eEveraert K, Herv\u0026eacute; F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, Wein A. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn. 2019 Feb;38(2):478-498. doi: 10.1002/nau.23939.\u003c/li\u003e\n\u003cli\u003eHaddad R, Decalf V, Monaghan TF, Van Laecke E, Bower W, Goessaert AS, Petrovic M, Everaert K. Nocturia severely impairs the sleep quality of nursing home residents: results from a multi-center study. Geriatr Nurs. 2022 Nov-Dec;48:164-168. doi: 10.1016/j.gerinurse.2022.09.009.\u003c/li\u003e\n\u003cli\u003eKomleva Y, Gollasch M, K\u0026ouml;nig M. Nocturia and frailty in older adults: a scoping review. BMC Geriatr. 2024 Jun 6;24(1):498. doi: 10.1186/s12877-024-05049-3.\u003c/li\u003e\n\u003cli\u003eJapanese Urological Association, Japanese Continence Society. Clinical Guidelines for Nocturia. 2nd ed. 2020. https://www.urol.or.jp/lib/files/other/guideline/37_nocturia_v2.pdf\u003cu\u003e.\u003c/u\u003e Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eTabara Y, Matsumoto T, Murase K, Setoh K, Kawaguchi T, Nagashima S, Funada S, Kosugi S, Hirai T, Nakayama T, Wakamura T, Chin K, Matsuda F; Nagahama study group. Lifestyle habits associated with nocturnal urination frequency: The Nagahama study. Neurourol Urodyn. 2019 Nov;38(8):2359-2367. doi: 10.1002/nau.24156.\u003c/li\u003e\n\u003cli\u003eBower WF, Lau L, Whishaw DM, Reijnierse EM, Maier AB. Characteristics of Geriatric Rehabilitation Inpatients with Nocturia: RESORT. Gerontology. 2024;70(12):1284-1293. doi: 10.1159/000542056.\u003c/li\u003e\n\u003cli\u003eLuo Z, Niu C, Yuan C, Lee DY, Shin YS, Kam SC. Identification of Correlation Between Frailty and Lower Urinary Tract Symptoms in Elderly Male Using Korean-FRAIL Scale. World J Mens Health. 2024 Oct 30. doi: 10.5534/wjmh.240122.\u003c/li\u003e\n\u003cli\u003eLeslie SW, Sajjad H, Singh S. Nocturia. 2023 Mar 11. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan. https://www.ncbi.nlm.nih.gov/books/NBK518987/. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eFisch GZ, Fang AH, Miller CD, Choi C, Monaghan TF, Smith EF, Prishtina L, Weiss JP, Blaivas JG. Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology. Neurourol Urodyn. 2023 Jan;42(1):256-262. doi: 10.1002/nau.25078.\u003c/li\u003e\n\u003cli\u003eNonaka H, Suzuki S, Negoro H, Ikeda A, Chihara I, Kandori S, Nishiyama H. Association between nocturia and sleep issues, incorporating the impact of lifestyle habits perceived as promoting sleep in an internet survey. Sci Rep. 2025 May 20;15(1):17508. doi: 10.1038/s41598-025-02587-7.\u003c/li\u003e\n\u003cli\u003eWeiss JP. Nocturia: focus on etiology and consequences. Rev Urol. 2012;14(3-4):48-55. \u0026thinsp;doi:\u0026thinsp;10.3909/riu0576]\u003c/li\u003e\n\u003cli\u003eSatake S, Toba K. Symptoms and syndromes specific to older adults: geriatric syndrome. National Center for Geriatrics and Gerontology. 2012;5:7. http://www.igaku.co.jp/pdf/1205_resident-01.pdf\u003cu\u003e.\u003c/u\u003e Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eKimura T. Geriatric syndrome and comprehensive geriatric assessment. Journal of the Japanese Society of Internal Medicine. 2018;107(2):2420-2429. https://www.jstage.jst.go.jp/article/naika/107/12/107_2420/_pdf. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eAmerican Geriatrics Society. A guide to geriatric syndromes: common and often related medical conditions in older adults. https://www.healthinaging.org/sites/default/files/media/pdf/HIA-TipSheet%20Geriatric%20Syndromes19.pdf. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eInouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780-91. doi: 10.1111/j.1532-5415.2007.01156.x.\u003c/li\u003e\n\u003cli\u003eOlde Rikkert MG, Rigaud AS, van Hoeyweghen RJ, de Graaf J. Geriatric syndromes: medical misnomer or progress in geriatrics? Neth J Med. 2003 Mar;61(3):83-7. https://www.njmonline.nl/getpdf.php?id=73\u003c/li\u003e\n\u003cli\u003eMonaghan TF, Weiss JP, Wein AJ, Rahman SN, Lazar JM, Bliwise DL, Everaert K, Lemack GE, Cornu JN, Drake MJ, et al. Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (\u0026quot;Sleep C.A.L.M.\u0026quot;) in the evaluation and management of nocturia: A simple approach to a complex diagnosis. Neurourol Urodyn. 2023 Mar;42(3):562-572. doi: 10.1002/nau.25128.\u003c/li\u003e\n\u003cli\u003eBliwise DL, Wagg A, Sand PK. Nocturia: A Highly Prevalent Disorder With Multifaceted Consequences. Urology. 2019 Nov;133S:3-13. doi: 10.1016/j.urology.2019.07.005.\u003c/li\u003e\n\u003cli\u003eVaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA; American Geriatrics Society/National Institute on Aging Urinary Incontinence Conference Planning Committee and Faculty. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc. 2018 Apr;66(4):773-782. doi: 10.1111/jgs.15157.\u003c/li\u003e\n\u003cli\u003eAsplund R. Nocturnal giddiness in relation to nocturia and other symptoms and to medication in the elderly. Arch Gerontol Geriatr. 2005 Jan-Feb;40(1):103-11. doi: 10.1016/j.archger.2004.06.002.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (n.d.). Preparing for population ageing in the Western Pacific Region. WHO. https://www.who.int/westernpacific/newsroom/commentaries/detail/preparing-for-population-ageing-in-the-western-pacific-region. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eWada A, Kabayama M, Godai K, Kido M, Ohata Y, Murakami N, Nakamura Y, Yoshida H, Hashimoto S, Higashi M, et al. Factors influencing the continuation of home blood pressure measurement in community-dwelling older adults: the NOSE study. J Hypertens. 2024 Apr 1;42(4):694-700. doi: 10.1097/HJH.0000000000003628.\u003c/li\u003e\n\u003cli\u003eOhata Y, Kabayama M, Godai K, Kido M, Li Y, Akagi Y, Murakami N, Yoshida H, Hosokawa M, Tachibana Y, et al. Office and home blood pressure and their difference according to frailty status among community-dwelling older adults: the NOSE study. Hypertens Res. 2025 Apr;48(4):1389-1398. doi: 10.1038/s41440-025-02145-8.\u003c/li\u003e\n\u003cli\u003eMadhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z. Nocturia: risk factors and associated comorbidities; findings from the EpiLUTS study. Int J Clin Pract. 2015 Dec;69(12):1508-16. doi: 10.1111/ijcp.12727.\u003c/li\u003e\n\u003cli\u003eYoshida M. Geriatric management of lower urinary tract dysfunction (voiding dysfunction) based on clinical guidelines. Journal of the Japanese Geriatrics Society. 2022;59(2):115-130. https://www.jstage.jst.go.jp/article/geriatrics/59/2/59_59.115/_pdf/-char/ja. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003eHealth and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare, Japan. Manual for the Assessment of Daily Function for the Prevention of Long-term Care. 2009 May. https://www.jpn-geriat-soc.or.jp/proposal/pdf/geriatric_care_GL.pdf. Accessed Jun 30.\u003c/li\u003e\n\u003cli\u003eJapan Geriatrics Society and Japan Gerontological Society. Clinical Practice Guideline for Geriatric Syndromes in Elderly Care. 2022 Mar. https://www.jpn-geriat-soc.or.jp/proposal/pdf/geriatric_care_GL.pdf. Accessed Jun 30 2025.\u003c/li\u003e\n\u003cli\u003eUmemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Research. 2019 Sep; 42(9):1235\u0026ndash;1481. doi: 10.1038/s41440-019-0284-9.\u003c/li\u003e\n\u003cli\u003eYajima R, Matsumoto M, Iida M, Harada N, Shibuki T, Hirata A, Kuwabara K, Miyagawa N, Nakamura T, Okamura T, Takebayashi T. Validity of self-administered questionnaire on medication information compared with medication notebooks among community-dwelling older adults. Japanese Journal of Public Health. 2024;71(8):430\u0026ndash;7. doi:10.11236/jph.23-110.\u003c/li\u003e\n\u003cli\u003eMitsui T, Sekido N, Masumori N, Haga N, Omae K, Saito M, Kubota Y, Sakakibara R, Yoshida M, Takahashi S. Prevalence and impact on daily life of lower urinary tract symptoms in Japan: Results of the 2023 Japan Community Health Survey (JaCS 2023). Int J Urol. 2024 Jul;31(7):747-754. doi: 10.1111/iju.15454.\u003c/li\u003e\n\u003cli\u003eYee CH, Chan CK, Teoh JYC, Chiu PKF, Wong JHM, Chan ESY, Hou SSM, Ng CF. Survey on prevalence of lower urinary tract symptoms in an Asian population. Hong Kong Med J. 2019 Feb;25(1):13-20. doi: 10.12809/hkmj187502.\u003c/li\u003e\n\u003cli\u003eShao C, Wang H, He Y, Yu B, Zhao H. Clinical phenotype of obstructive sleep apnea in older adults: a hospital-based retrospective study in China. Ir J Med Sci. 2023 Oct;192(5):2305-2312. doi: 10.1007/s11845-023-03290-0.\u003c/li\u003e\n\u003cli\u003eChancellor MB, Yoshimura N. Neurophysiology of stress urinary incontinence. Rev Urol. 2004;6 Suppl 3(Suppl 3):S19-28. https://pmc.ncbi.nlm.nih.gov/articles/PMC1472861/. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003cli\u003ede Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015 Jan;5(1):327-96. doi: 10.1002/cphy.c130056.\u003c/li\u003e\n\u003cli\u003eKanematsu R, Hanakita J, Takahashi T, Minami M, Inoue T, Miyasaka K, Shimauchi-Ohtaki H, Ueno M, Honda F. Improvement in Neurogenic Bowel and Bladder Dysfunction Following Posterior Decompression Surgery for Cauda Equina Syndrome: A Prospective Cohort Study. Neurospine. 2021 Dec;18(4):847-853. doi: 10.14245/ns.2142252.126.\u003c/li\u003e\n\u003cli\u003eAllen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J; Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003 Mar;4(2):101-19. doi: 10.1016/s1389-9457(03)00010-8.\u003c/li\u003e\n\u003cli\u003eWolff DT, Adler KA, Weinstein CS, Weiss JP. Managing Nocturia in Frail Older Adults. Drugs Aging. 2021 Feb;38(2):95-109. doi: 10.1007/s40266-020-00815-5.\u003c/li\u003e\n\u003cli\u003ePieroni I, Cerroni G, Velluto L, Sorbi S, Guarnieri B. Sex and age differences in sleep disorders: insights from a diverse cohort referred to a sleep center. Neurol Sci. 2025 Aug;46(8):3885-3897. doi: 10.1007/s10072-025-08133-7.\u003c/li\u003e\n\u003cli\u003eKim J, Kim JR, Park HR, Joo EY. Sex-specific patterns of discomfort in patients with restless legs syndrome. J Clin Sleep Med. 2024 Feb 1;20(2):253-259. doi: 10.5664/jcsm.10848.\u003c/li\u003e\n\u003cli\u003eBentley AJ, Rosman KD, Mitchell D. Gender differences in the presentation of subjects with restless legs syndrome. Sleep Med. 2006 Jan;7(1):37-41. doi: 10.1016/j.sleep.2005.03.004.\u003c/li\u003e\n\u003cli\u003eBjorling DE, Wang ZY. Estrogen and neuroinflammation. Urology. 2001 Jun;57(6 Suppl 1):40-6. doi: 10.1016/s0090-4295(01)01124-4.\u003c/li\u003e\n\u003cli\u003eHirayama A, Torimoto K, Yamada A, Tanaka N, Fujimoto K, Yoshida K, Hirao Y. Relationship between nocturnal urine volume, leg edema, and urinary antidiuretic hormone in older men. Urology. 2011 Jun;77(6):1426-31. doi: 10.1016/j.urology.2010.12.030.\u003c/li\u003e\n\u003cli\u003eBoongird S, Shah N, Nolin TD, Unruh ML. Nocturia and aging: diagnosis and treatment. Adv Chronic Kidney Dis. 2010 Jul;17(4):e27-40. doi: 10.1053/j.ackd.2010.04.004.\u003c/li\u003e\n\u003cli\u003ePauwaert K, Goessaert AS, Robinson D, Cardozo L, Bower W, Calders P, Mariman A, Abrams P, Tubaro A, Dmochowski R, Weiss JP, Herv\u0026eacute; F, Depypere H, Everaert K. Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age. Int Urogynecol J. 2024 May;35(5):935-946. doi: 10.1007/s00192-024-05743-1.\u003c/li\u003e\n\u003cli\u003eKim SY, Bang W, Kim MS, Park B, Kim JH, Choi HG. Nocturia Is Associated with Slipping and Falling. PLoS One. 2017 Jan 6;12(1):e0169690. doi: 10.1371/journal.pone.0169690.\u003c/li\u003e\n\u003cli\u003eThangada ND, Zhang D, Zhao L, Tian L, McDermott MM. Safety and efficacy of home-based walking exercise for peripheral artery disease. J Vasc Surg. 2025 Feb;81(2):441-449.e1. doi: 10.1016/j.jvs.2024.10.013.\u003c/li\u003e\n\u003cli\u003eLeong DP, Yusuf R, Iqbal R, Avezum \u0026Aacute;, Yusufali A, Rosengren A, Chifamba J, Lanas F, Diaz ML, Miranda JJ, Davletov K, Mirrakhimov E, Yeates K, Khatib R, Alhabib KF, Gulec S, Paucar MJ, Lopez-Lopez JP, Mohan V, Gupta R, Soman B, Lakshmi PVM, Poirier P, Teo K, Zatonska K, Mat-Nasir N, Artamonova G, Hu B, Liu Z, Liu X, Dans A, Rangarajan S, Yusuf S; PURE Study Investigators. The burden of cardiovascular events according to cardiovascular risk profile in adults from high-income, middle-income, and low-income countries (PURE): a cohort study. Lancet Glob Health. 2025 Aug;13(8):e1406-e1414. doi: 10.1016/S2214-109X(25)00155-X.\u003c/li\u003e\n\u003cli\u003eTyagi S, Chancellor MB. Nocturnal polyuria and nocturia. Int Urol Nephrol. 2023 Jun;55(6):1395-1401. doi: 10.1007/s11255-023-03582-5.\u003c/li\u003e\n\u003cli\u003eLuo Z, Wang J, Huang S, Hao X, Lv K, Lv C, Yang G, Yuan Q. Decadal changes in nocturia among American middle-aged and older men. Geriatr Gerontol Int. 2024 Dec;24(12):1308-1314. doi: 10.1111/ggi.15007.\u003c/li\u003e\n\u003cli\u003eTyagi S, Resnick NM, Clarkson BD, Zhang G, Krafty RT, Perera S, Subramanya AR, Buysse DJ. Impact of sleep on chronobiology of micturition among healthy older adults. Am J Physiol Renal Physiol. 2023 Oct 1;325(4):F407-F417. doi: 10.1152/ajprenal.00025.2023.\u003c/li\u003e\n\u003cli\u003eKim JH, Duffy JF. Circadian Rhythm Sleep-Wake Disorders in Older Adults. Sleep Med Clin. 2018 Mar;13(1):39-50. doi: 10.1016/j.jsmc.2017.09.004.\u003c/li\u003e\n\u003cli\u003eBower WF, Whishaw DM, Khan F. Nocturia as a marker of poor health: Causal associations to inform care. Neurourol Urodyn. 2017 Mar;36(3):697-705. doi: 10.1002/nau.23000.\u003c/li\u003e\n\u003cli\u003eJaqua EE, Hanna M, Labib W, Moore C, Matossian V. Common Sleep Disorders Affecting Older Adults. Perm J. 2023 Mar 15;27(1):122-132. doi: 10.7812/TPP/22.114.\u003c/li\u003e\n\u003cli\u003eTakahashi S, Arai Y, Yoshida M. Night urination - diagnosis and latest treatment. The Journal of The Japan Medical Association. 2023 Dec 1;152(9):972. https://www.med.or.jp/cme/jjma/newmag/15209/15209.html. Accessed 30 Jun 2025.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Community-dwelling older adults, nocturia, geriatric syndrome, numbness, leg edema","lastPublishedDoi":"10.21203/rs.3.rs-7884797/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7884797/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eNocturia and geriatric syndromes (GSs) are common and burdensome among older adults. Despite their negative effects on sleep, functioning, and quality of life (QOL), many community-dwelling older adults leave them unaddressed and the associations between nocturia and representative GSs among them remain underexplored. This study examined associations between nocturia and representative GSs, including those not intuitively related to urinary symptoms.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional analysis was conducted using data from 744 community-dwelling adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years old in Nose Town, Osaka. Nocturia was defined as \u0026ge;\u0026thinsp;2 voids per night. 15 GSs were assessed via questionnaire by interview. Sex-stratified multivariable logistic regression analyses were performed, adjusting for demographic and medical factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNocturia was more prevalent in males (47.1%) than females (30.8%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In males, nocturia was significantly associated with poor sleep (OR: 2.04; 95% CI: 1.18\u0026ndash;3.54) and numbness (2.08; 1.19\u0026ndash;3.64). In females, it was associated with poor sleep (1.93; 1.20\u0026ndash;3.10) and leg edema (1.84; 1.11\u0026ndash;3.07). Understanding its association with GSs may support community-based detection and integrated preventive strategies to improve QOL in aging societies, and may also help link community-based identification with appropriate clinical care.\u003c/p\u003e","manuscriptTitle":"Relationships between nocturia and geriatric syndromes among community-dwelling older adults: the NOSE study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 16:15:36","doi":"10.21203/rs.3.rs-7884797/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"254188384440529793865175795261057585901","date":"2025-11-18T16:04:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-13T14:57:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-20T10:32:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-20T00:51:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-20T00:50:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-10-17T08:55:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b85cbd7c-3a70-4c6e-b493-946e08da5e77","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T16:15:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 16:15:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7884797","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7884797","identity":"rs-7884797","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}