Sleep Disturbance Worsens Lower Urinary Tract Symptoms: The Nagahama Study

Purpose: Multiple factors are associated with lower urinary tract symptoms and sleep disturbance is well known to be associated with nocturia. The association between sleep disturbance and lower urinary tract symptoms has not been sufficiently elucidated. We evaluated the impact of sleep disturbance on lower urinary tract symptoms, especially voiding symptoms, in the Nagahama Study. Materials and Methods: The Nagahama Study is a prospective cohort study of healthy individuals. Among them study participants 50 years old or older who completed the I-PSS (International Prostate Symptom Score) questionnaire and a sleep problem questionnaire were included in this analysis and followed for 5 years. Sleep disturbance was stratified into poor sleep quality, sleep restriction and sleep medication use. We analyzed the association between sleep disturbance and worsening of lower urinary tract symptoms adjusted by various clinical factors on multivariate logistic regression analysis. Results: Among the 5,297 participants the prevalence of lower urinary tract symptoms at baseline was 23% and the prevalence rates of poor sleep quality, sleep restriction and sleep medication were 20%, 6% and 7%, respectively. Participants with poor sleep quality, sleep restriction or sleep medication use had a significantly greater incidence of lower urinary tract symptoms and voiding symptoms than those without such characteristics (p < 0.01). Poor sleep quality and sleep medication use were significantly associated with worsening lower urinary tract symptoms as defined by an I-PSS score increase of 4 or greater (OR 1.23, p = 0.03, and 1.67, p < 0.01), and with worsening voiding symptoms, defined as an increase of 3 or greater (OR 1.35, p < 0.005, and 1.85, p < 0.001, respectively). Conclusions: Sleep disturbance was significantly associated with the presence of lower urinary tract symptoms in a cross-sectional manner and with worsening lower urinary tract symptoms longitudinally.