Impact of Sleep Disturbance, Physical Function, Depression and Anxiety on Male Lower Urinary Tract Symptoms: Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)

Abstract

Purpose: The impact of nonurological factors on male lower urinary tract symptoms (LUTS) remains unclear. We investigated cross-sectional and longitudinal associations among anxiety, depression, physical function, sleep quality and urinary symptom subdomains.

Materials and methods: Data from 518 men in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) study were analyzed to identify associations between Patient-Reported Outcomes Measurement Information System® (PROMIS®) depression, anxiety, sleep disturbance and physical function measures and LUTS subdomains, as derived from the American Urological Association Symptom Index and LUTS Tool. Multivariable linear regression was used to assess the relationships between PROMIS measures and LUTS subdomains at baseline and at 3- and 12-month followup.

Results: Baseline depression and anxiety were associated with urinary incontinence (p <0.001), voiding symptoms (p <0.001) and quality of life (p=0.002), whereas baseline sleep disturbance was associated with voiding and storage symptoms and quality of life (p <0.001 for all). Urinary symptom severity improved in all subdomains at 3 and 12 months. Similar associations between PROMIS measures and LUTS subdomains were observed at all time points, but baseline depression, anxiety, sleep disturbance and physical function measures were not associated with longitudinal trajectories of LUTS.

Conclusions: Urinary symptom subdomains are independently associated with modifiable clinical variables including sleep quality and depression at all time points, but these variables do not predict the degree of improvement in LUTS following urological evaluation and treatment over the medium term. Bidirectional assessment and randomized experiments may improve our understanding of these relationships.

Keywords: anxiety; depression; lower urinary tract symptoms; patient reported outcome measures; quality of life.

Conflict of interest statement

Conflict of Interest Statement:

Anne P. Cameron reports the following conflicts: Speaker Wellspect; Investigator Medtronic; Guideline committee travel payment Aua; SUFU board member. Michelle Taddeo works in Dr. Griffith’s lab at Northwestern University which received funding in the form of a research grant (U01 DK097779) from the National Institute of Diabetes and Digestive and Kidney Diseases. (NIDDK from a U01 research grant for this work). All other authors have no conflicts to report.

Figures

Figure 1.. Baseline multivariable linear regression model assessing the relationships between baseline PROMIS measures, participant characteristics, and LUTS sub-domains.

Statistically significant covariate point estimates and corresponding 95% confidence intervals depicted as diamonds and horizontal bars, respectively. Final covariates included in each model are shown, grey shading indicates that covariate was not included in the model depicted in that column. For example, all else equal, for each 10 point increase in the baseline PROMIS depression score, the LUTS UI score increased (i.e. more severe UI) by 6.3 units, on average, where each unit represents 1% of the total scale. Full model results are provided in Supplementary Table 1.

Figure 2.. LUTS sub-domains over time.

Sub-domains are displayed using the raw scores on the y-axes. Higher UI, voiding, and storage scores represent worse symptom severity, while higher QOL scores represent worse quality of life. The box represents the first to third quartiles (Q1 to Q3, respectively) of scores, with the median depicted by a horizontal line. Mean measures are shown as plus signs. The whiskers extend down from the box to the most extreme observation that is less than or equal Q1 minus 1.5 times the IQR and up from the box to the most extreme observation that is less than or equal to Q3 plus 1.5 times the IQR. Measures that are below or above this cut off, respectively, are graphed as dots.

Figure 3.. Repeated measures linear regression model assessing the relationships between baseline PROMIS measures, participant characteristics, and LUTS sub-domains at follow-up timepoints.

Statistically significant covariate point estimates and corresponding 95% confidence intervals depicted as diamonds and horizontal bars, respectively. Final covariates included in each model are shown, grey shading indicates that covariate was not included in the model depicted in that column. For example, all else equal, for each 10 point increase in the baseline PROMIS depression score, the LUTS UI score increased (i.e. more severe UI) by 4.9 units, on average, where each unit represents 1% of the total scale.