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Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP

Nature Reviews Urology volume 22, pages 720–721 (2025)Cite this article

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Notably, a similar vicious cycle can occur in men with benign prostatic hyperplasia (BPH). BPH-induced bladder outlet obstruction leads to increased bladder pressure, impaired bladder compliance and, ultimately, nocturia2. In such circumstances, the overlapping contributions of impaired ADH secretion and heightened ANP activity could complicate the therapeutic landscape. In clinical practice, ADH analogues (such as desmopressin) are frequently used to address ADH deficiency-associated nocturnal polyuria. These treatments are effective but often fail in a subset of patients owing to several factors, including heterogeneous pathophysiological mechanisms underlying nocturnal polyuria3.

Our hypothesis that ANP antagonizes ADH-driven water reabsorption in patients with OSA4 provides a mechanistic insight into reported treatment resistance3. Incorporating ANP measurement into clinical evaluation could refine the treatment paradigm for nocturnal polyuria.

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Fig. 1: Mechanistic interactions between obstructive sleep apnoea, atrial natriuretic peptide, antidiuretic hormone and nocturnal polyuria.

References

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Authors and Affiliations

  1. Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan

    Yu-Hsiang Lin, Kuo-Jen Lin & Chun-Te Wu

  2. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yu-Hsiang Lin, Kuo-Jen Lin & Chun-Te Wu

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  1. Yu-Hsiang Lin
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  2. Kuo-Jen Lin
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Correspondence to Yu-Hsiang Lin.

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Lin, YH., Lin, KJ. & Wu, CT. Revisiting the complex interactions in nocturnal polyuria: insights on OSA, ADH and ANP. Nat Rev Urol 22, 720–721 (2025). https://doi.org/10.1038/s41585-025-01028-4

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