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Reply to ‘Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP’

Nature Reviews Urology volume 22, page 722 (2025)Cite this article

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Lin, Lin and Wu provide insightful comments regarding our article1 on the physiological mechanisms linking obstructive sleep apnoea (OSA) with nocturia (Vrooman, O. P. J. et al. Nocturia and obstructive sleep apnoea. Nat. Rev. Urol. 21, 735–753; 2024), which are thought-provoking (Lin, Y.-H., Lin, K.-J. & Wu, C.-T. Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP. Nat. Rev. Urol. https://doi.org/10.1038/s41585-025-01028-4; 2025)2. We agree that benign prostatic hyperplasia (BPH) can contribute to nocturia through bladder outlet obstruction, leading to increased intravesical pressure and impaired bladder compliance3. Indeed, these events can result in detrusor overactivity and reduced voided volumes during nocturnal urination. However, as highlighted in our Review1, nocturia is a multifactorial condition, and alternative mechanisms influencing urine production should be considered. Specifically, nocturnal polyuria, which can coexist with lower urinary tract dysfunction in BPH, is increasingly recognized as a considerable contributor to nocturia in the ageing population4.

We acknowledge the Correspondence authors’ focus on the interplay between atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) in influencing nocturnal urine production2. The antagonistic effects of ANP on ADH-driven water reabsorption in the renal collecting ducts provide valuable mechanistic insight into treatment resistance observed with ADH analogues such as desmopressin5. This process is particularly relevant in patients with OSA, in whom negative intrathoracic pressures and intermittent hypoxia promote ANP secretion, counteracting ADH-mediated water retention6. Thus, incorporating ANP measurements into clinical evaluation might improve management of nocturnal polyuria in this patient population7. Nevertheless, certain challenges should be considered. ANP levels peak at night owing to negative intrathoracic pressures, so the optimal time for measurement remains uncertain. Morning samples might not accurately reflect nocturnal surges given the short half-life of ANP8.

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References

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Authors and Affiliations

  1. Department of Urology, Hospital Rijnstate Arnhem, Arnhem, Netherlands

    Olaf P. J. Vrooman

  2. Department of Urology Nij Smellinghe Hospital, Drachten, Netherlands

    Mohammad S. Rahnama’i

  3. Society of Urological research and education (SURE), Maastricht, Netherlands

    Mohammad S. Rahnama’i

Authors
  1. Olaf P. J. Vrooman
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  2. Mohammad S. Rahnama’i
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Correspondence to Olaf P. J. Vrooman.

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Vrooman, O.P.J., Rahnama’i, M.S. Reply to ‘Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP’. Nat Rev Urol 22, 722 (2025). https://doi.org/10.1038/s41585-025-01027-5

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