Though LUTS and sleep problems often co-occur, whether sleep disturbances are linked with LUTS development and progression is unknown. We examined the relationship between sleep problems measured by the Medical Outcomes Study Sleep Scale (MOS-Sleep) 6-item survey and LUTS development and progression in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study.
REDUCE was a randomized trial testing prostate cancer chemoprevention with dustasteride in men with PSA 2.5-10ng/mL and a negative biopsy. At baseline, men completed MOS-Sleep; a scaled average was used to calculate sleep score. Men were followed for 4 years and the International Prostate Symptom Score (IPSS) was obtained at baseline and every 6 months. Asymptomatic men had IPSS<8, while symptomatic men had IPSS≥8. In the placebo arm among men not taking alpha blockers or 5-alpha reductase inhibitors at baseline (n=2,588), we tested the association between sleep problems and LUTS development and progression using Cox models.
During follow-up, 209/1452 (14%) asymptomatic men developed LUTS and 567/1136 (50%) men with LUTS demonstrated progression. On multivariable analysis, higher sleep scores were associated with increased LUTS development in asymptomatic men (HR quartile 4 vs 1=1.50, 95%CI 1.00-2.23, p=0.048) and LUTS progression in symptomatic men (HR per 10 points in sleep score=1.06, 95%CI 1.02-1.12, p=0.029).
Among men with LUTS, worse sleep scores were associated with LUTS progression. Among asymptomatic men, worse sleep scores were associated with LUTS development. If confirmed, these data suggest sleep problems may precede LUTS. Whether treating sleep problems improves LUTS requires further testing.
The Journal of urology. 2017 Sep 01 [Epub ahead of print]
Brandee L Branche, Lauren E Howard, Daniel M Moreira, Claus Roehrborn, Ramiro Castro-Santamaria, Gerald L Andriole, Martin L Hopp, Stephen J Freedland
Surgery Section, Durham Veterans Affairs Medical Center, Durham, NC, USA., Surgery Section, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA., University of Illinois at Chicago, Chicago, IL, USA., UTSouthwestern Medical Center, Dallas, TX, USA., GlaxoSmithKline Inc., Metabolic Pathways and Cardiovascular R&D Unit, King of Prussia, PA, USA., Washington University School of Medicine in St. Louis, St. Louis, MO, USA., Cedars-Sinai Medical Center, Los Angeles, CA, USA., Surgery Section, Durham Veterans Affairs Medical Center, Durham, NC, USA; Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: .