title: Sleep related problems and urological symptoms: testing the hypothesis of bidirectionality in a longitudinal, population based study.
abstract: OBJECTIVE
  We evaluate the bidirectional association between urological symptoms (urinary incontinence, lower urinary tract symptoms and nocturia) and sleep related variables.
  
  
  METHODS
  Data were obtained from a prospective cohort study of 1,610 men and 2,535 women who completed baseline (2002 to 2005) and followup (2006 to 2010) phases of the BACH (Boston Area Community Health) Survey, a population based random sample survey. Sleep restriction (5 hours or less per night), restless sleep, sleep medication use and urological symptoms were assessed by self-report. Urinary incontinence was defined as weekly leakage or moderate/severe leakage, lower urinary tract symptoms (overall, obstructive, irritative) were defined by the AUA-SI (American Urological Association symptom index) and nocturia was defined as urinary frequency 2 or more times per night.
  
  
  RESULTS
  At the 5-year followup 10.0%, 8.5% and 16.0% of subjects newly reported lower urinary tract symptoms, urinary incontinence and nocturia, respectively, and 24.2%, 13.3% and 11.6% newly reported poor sleep quality, sleep restriction and use of sleep medication, respectively. Controlling for confounders, the odds of urological symptoms developing were consistently increased for subjects who reported poor sleep quality and sleep restriction at baseline, but only baseline nocturia was positively associated with incident sleep related problems at followup. Body mass index, a potential mediator, reduced selected associations between sleep and incident urinary incontinence and irritative symptoms, but C-reactive protein did not.
  
  
  CONCLUSIONS
  These data suggest that self-reported sleep related problems and urological symptoms are linked bidirectionally, and that body mass index may be a factor in the relationship between sleep and the development of urological symptoms.
authors.affiliation: New England Research Institutes, Inc., Watertown, Massachusetts. Electronic address: aaraujo@neriscience.com.
authors.forename: Andre B
authors.initials: AB
authors.lastname: Araujo
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: H Klar
authors.initials: HK
authors.lastname: Yaggi
authors.affiliation: New England Research Institutes, Inc., Watertown, Massachusetts.
authors.forename: May
authors.initials: M
authors.lastname: Yang
authors.affiliation: Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
authors.affiliation: New England Research Institutes, Inc., Watertown, Massachusetts; Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Shona C
authors.initials: SC
authors.lastname: Fang
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Bliwise
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D057566:Self Report; D012893:Sleep Wake Disorders / Q000453:epidemiology*
keywords: BMI; BPH; C-reactive protein; CRP; LUTS; SES; UI; benign prostatic hyperplasia; body mass index; cohort studies; epidemiology; lower urinary tract symptoms; sleep; socioeconomic status; urinary incontinence; urologic diseases