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Linkage of Lower Urinary Tract Symptoms to Sleep Quality in Elderly Men with Nocturia: A Community Based Study Using Home Measured Electroencephalogram Data

Chie Matsushita, Kazumasa Torimoto, Daisuke Goto, Yosuke Morizawa, Keisuke Kiba, Masatake Shinohara, Akihide Hirayama, Norio Kurumatani, Kiyohide Fujimoto

The Journal of Urology, Volume 197, Issue 1, January 2017, Pages 204–209

Commentary by Philip Van Kerrebroeck

These authors investigated the relationship between sleep quality/efficiency and factors associated with micturition using at-home electroencephalogram assessment. They recruited the participants fort his study from individuals that were enrolled in another study, the Fujiwara-kyo Study. This is a community based longitudinal evaluation that started in 2007 in Nara Prefecture, Japan. For inclusion in this study, they used the following criteria: men of at least 65 years old with nocturia defined as waking up at least 3 times per week with the urge to void. Lower urinary tract symptoms were evaluated with I-PSS, and uroflowmetry and 3-day frequency volume charting measurements were also obtained.  Subjective sleep quality was studied using the Pittsburgh Sleep Quality Index. Furthermore electroencephalogram recordings were obtained during sleep to evaluate objective sleep quality. The final analysis as presented in this article, consists of data obtained from 47 participants.

Based on the collected data the authors conclude that I-PSS-quality of life score and slow wave sleep time were independent predictors of good subjective sleep quality as determined by Pittsburgh Sleep Quality Index scores. Furthermore nocturnal urinary volume was an independent predictor of greater sleep efficiency. Maximum flow rate was an independent predictor of longer slow wave sleep time.

The authors conclude, and we could not agree more also based on other data, that in elderly men with nocturia, sleep quality is associated with lower urinary tract function. The additional information in this cohort also indicates that higher subjective sleep quality is associated with longer slow wave sleep time and less severe lower urinary tract symptoms. Higher objective sleep quality is further associated with a higher urinary flow rate and lower nocturnal urinary volume.

This study confirms the strong correlation between sleep quality and lower urinary tract dysfunction especially nocturia. However it still remains an intriguing question if this is a unidirectional or a bidirectional correlation. My guess would be that both are present!