Nighttime urinary incontinence and sleep disruption among nursing home residents

OBJECTIVE: To examine the relationship of urinary incontinence episodes to sleep disruption in a sample of nursing home residents. DESIGN: Descriptive, case series. SETTING: Three community nursing homes. PARTICIPANTS: Seventy-three incontinent residents of three nursing homes participating in a trial of a behavioral intervention for nighttime urinary incontinence. MEASUREMENTS: Data were collected during a baseline and repeat baseline period about 2 months later in nursing homes serving as controls for the intervention homes. Incontinence episodes were identified by incontinence pads, which were wired to detect wetness of 10 mL or more. Sleep was monitored by wireless wrist actigraphs. Noise and light changes were monitored by bedside recording devices. MAIN RESULTS: Recordings covered 403 nights, during which 1715 awakenings from 10 consecutive minutes of sleep were detected as were 1168 incontinent episodes. Only 4% of the awakenings were associated with an incontinence episode, and only 23 % of the incontinence episodes occurred during periods of at least 10 consecutive minutes of sleep. Of the latter episodes, only 12% appeared to awaken the resident. CONCLUSIONS: Our data raise questions about the relevance of incontinence episodes to sleep disruption among chronically incontinent nursing home residents. Our findings must be interpreted cautiously because of limitations in the technologies and definitions we used to identify sleep, awakenings, and incontinence episodes. Although logistically and technically difficult to perform, studies using polysomnographic recordings of sleep are needed to examine further these important associations.