Nocturnal overactive bladder and sleep disruption in middle-aged and older women

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PROJECT SUMMARY Overactive bladder (OAB), a syndrome defined by recurrent strong urges to urinate, frequent trips to the bathroom, and in some cases involuntary urine leakage, affects up to one in five adult women, with symptoms becoming more frequent and severe as women age. One of the principal ways in which OAB can decrease quality of life is by disrupting sleep, with up to 75% of patients reporting urges to urinate associated with waking up to urinate at night (a.k.a. nocturia). Among older women who are most likely to suffer from OAB, the relationship between nocturnal bladder symptoms and sleep disruption may be complex and bidirectional, such that nocturia may be both a cause and a consequence of poor sleep quality. However, prior studies of the impact of OAB on sleep have not used objective measures of sleep duration or disruption or examined relationships between bladder symptoms and sleep outcomes on a prospective, night-by-night basis to assess the extent to which nocturnal awakenings are precipitated by urges to urinate. To gain a deeper insight into the strength and direction of relationships between nocturnal OAB symptoms and sleep outcomes, we have arranged to administer multiple ancillary sleep measures in women aged 40 years and older enrolled in an ongoing, NIH-funded, randomized trial of a behavioral slow-paced respiration intervention for OAB. Using data from sleep diaries, questionnaires, and actigraphy, we will assess whether nocturnal bladder symptoms are associated with decreased sleep duration, greater sleep disruption, or worse sleep quality in this population. We will examine the extent to which nocturnal awakenings among women with OAB are attributable to nocturnal urges to void as opposed to other clinical and contextual factors. We will also assess for changes in sleep outcomes associated with the experimental slow-paced respiration intervention and explore whether intervention effects on sleep are mediated by changes in bladder symptoms. This ancillary research is designed to make efficient use of the R03 small grant program to achieve important scientific aims regarding relationships between nocturnal OAB symptoms and sleep disturbance in older women and evaluate the potential of paced respiration as a behavioral management strategy for poor sleep in this population, while using limited additional resources.