Association of Pharmacologic Treatment of Urgency Urinary Incontinence With Sleep Quality and Daytime Sleepiness EDITORIAL COMMENT

作者：Warsi Qurratul A^*; Huang Alison J^*; Hess Rachel; Arya Lily A; Richter Holly E; Bradley Catherine S; Rogers Rebecca G; Myers Deborah L; Johnson Karen C; Winkelman William D; Gregory W Thomas; Kraus Stephen R; Schembri Michael; Brown Jeanette S; Stone Katie L; Subak Leslee L

来源：Obstetrical and Gynecological Survey, 2018, 73(5): 273-274.

DOI：10.1097/OGX.0000000000000556

Both incontinence and sleep disturbance are common and bothersome conditions in middle-aged and older women. Any treatment that improves both conditions may provide clinical value. More disturbance of sleep is reported by women experiencing urgency urinary incontinence (UUI) compared with those in the general population who do not have UUI. Very limited data are available on whether interventions specifically directed at improving UUI are effective in improving sleep outcomes. It is not known whether improvements in sleep among women undergoing treatment for UUI are mediated by improvement in their symptoms of incontinence.
The aimof this study was to evaluate the association between pharmacologic therapy for UUI and sleep quality. The authors performed a planned secondary analysis of sleep outcomes using data from a previously published multicenter, double-blind, 12-week randomized trial, which evaluated pharmacologic therapy for urgency-predominant incontinence among communitydwelling women self-diagnosed using the 3-Incontinence Questions questionnaire. A total of 645 women were randomly assigned to either 4 to 8 mg antimuscarinic therapy daily or placebo: 322 to medication and 323 to placebo. Participants completed a validated voiding diary at baseline and 12 weeks to evaluate incontinence and voiding symptoms. The primary study outcome was the 12-week change in the quality of sleep assessed by the Pittsburgh Sleep Quality Index and daytime sleepiness assessed by Epworth Sleepiness Scale.
The mean (SD) age of participants was 56 (+/- 14) years, 66% were white, and 57% reported poor sleep quality (Pittsburgh Sleep Quality Index score >5). The mean frequency of UI was 4.6 (+/- 3.4)/d, and UUI episodes was 3.9 (+/- 3.0)/d. Compared with the placebo group, women in the antimuscarinic group reported a greater decrease at 12 weeks in UUI frequency (0.9 episodes/d; P < 0.001) and diurnal and nocturnal voiding frequency (P < 0.05). The antimuscarinic group also reported greater improvement in sleep quality (Pittsburgh Sleep Quality Index score 0.48; P = 0.02) and greater improvement in sleep duration and sleep efficiency subscales (P < 0.05) than the placebo group. There was no significant difference between groups in daytime sleepiness as measured by the Epworth Sleepiness Scale.
These data show that pharmacologic treatment of UUI in ambulatory women is associated with decreased incontinence frequency and nocturia and improvement in overall sleep quality, sleep duration, and sleep efficiency. Another benefit to treatment of UUI for women may be improved sleep quality.

• 出版日期2018-5