Correlation of unilateral urolithiasis with sleep posture

PURPOSE: Recurrent stone formers commonly present with calculi on the same side and the etiology of recurrent unilateral urolithiasis is unclear. Despite comprehensive metabolic evaluations, many patients will not be readily categorized into a treatable group. Data from the literature support that sleep posture may result in alterations of renal hemodynamics. We investigate the correlation of sleep posture with unilateral urinary stone formation. MATERIALS AND METHODS: A prospective study of 110 patients with recurrent unilateral nephrolithiasis was conducted. A questionnaire was used to evaluate patient sleep posture. Right or left side down and rotisserie-like sleep postures were defined. The side of stone formation was correlated with sleep posture using chi-square test. RESULTS: Of the patients 93 slept consistently with 1 side in a dependent position and the side of stone was identical to the dependent sleep side in 76% (p = 0.008). The positive predictive values of right and left side down sleep posture for formation of ipsilateral calculi were 82% and 70%, respectively. CONCLUSIONS: Although the exact pathophysiology of the association between sleep posture and recurrent unilateral stone disease remains to be elucidated, sleep posture may alter renal hemodynamics during sleep and promote stone formation. This observation needs further investigation and should be factored into the evaluation and prevention of unilateral urinary stone disease.