5.14.11.panel.sleep and urologic disease

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  • 1. EMBARGOED FOR RELEASE UNTIL SATURDAY, MAY 14, 2011 AT 2:00 P.M. Contact: Wendy Waldsachs Isett, AUA 410-977-4770, wisett@AUAnet.org STUDIES LINK QUALITY OF SLEEP TO ERECTILE DYSFUNCTION, OTHER UROLOGIC CONDITIONSWashington, DC May 14, 2011 – Two studies that link the quality of sleep to the occurrence of erectiledysfunction (ED) and other urologic conditions will be presented to reporters during a special press conferenceat the Walter E. Washington Convention Center in Washington, DC, today, Sunday, May 14, at 2:00 p.m. duringthe 2011 Annual Meeting of the American Urological Association (AUA). The session will be moderated by KevinMcVary, MD.Erectile Dysfunction Is Independently Associated With Sleep Apnea In A Large Population Of Middle-AgedMen (#1325): In the largest study to date demonstrating the relationship between obstructive sleep apnea(OSA) and erectile dysfunction, researchers from Mount Sinai Medical Center in New York evaluated 870consecutively enrolled men in the ongoing Law Enforcement Cardiac Screening program (LECS), a subset of theWorld Trade Center Medical Monitoring and Treatment Program. Patients who scored positive on the BerlinQuestionnaire (a widely used survey for OSA) were defined to be at high risk for OSA. ED was assessed by use ofthe International Index of Erectile Function -5 (IIEF-5), and was defined as IIEF of less than 22. A multivariate,binary logistic regression was performed to adjust for age, history of cardiovascular disease, systolic bloodpressure, diabetes, smoking and body mass index (BMI).The mean age of the patients in the study population was 47.3 years, with a mean BMI of 30.2. Sixty-threepercent of the patients screened positive for OSA, 5.6 percent had a history of diabetes, and 29 percent had asmoking history. After adjusting for age and comorbidities, the patients with ED were more than twice morelikely to have OSA than their normal counterparts. The likelihood of having OSA increased as the severity oferectile dysfunction increased, suggesting that men with this condition should also be screened for OSA.Sleep Predicts The Development Of Urologic Symptoms In A Longitudinal Study (#57): Sleep is a modifiable riskfactor that precedes certain urologic conditions (urinary incontinence [UI], lower urinary tract symptoms [LUTS]and nocturia) in men and women, perhaps operating through inflammatory and other pathways, according to astudy by researchers at New England Research Institutes Inc. in Watertown, MA.In the prospective cohort analyses of 1,610 men and 2, 535 women who completed the baseline and follow-upphases of the Boston Area Community Health (BACH) survey, researchers followed the subjects for five years,assessing sleep disturbance and the development of urologic symptoms. Baseline short sleep duration (menonly) was defined as sleeping fewer than five hours per night, and sleep quality was defined as having restlesssleep in the past week. LUTS were assessed using the AUA Symptom Index, urinary incontinence was defined asweekly urine leakage, and nocturia was defined as needing to urinate more than two times per night after fallingasleep.
  • 2. Incidence of LUTS among men (8 percent) and women (13 percent) was strongly related to short sleep durationamong men and restless sleep among men and women. Incidences of UI and nocturia were associated withrestless sleep among women but not men.“We know that proper amounts of sleep and quality of sleep can impact a wide range of health conditionsincluding erectile function and lower urinary tract symptoms,” said AUA spokesperson Kevin T. McVary, MD.“These data may help us better assess how helping patients modify their sleep patterns may help improve theirhealth and overall quality of life.”NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange aninterview with an expert, please contact the AUA Communications Office at the number above or e-mailCommunications@AUAnet.org.About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the AmericanUrological Association is the pre-eminent professional organization for urologists, with more than 17,000 membersthroughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standardsof urologic care by carrying out a wide variety of programs for members and their patients. ###
  • 3. 1325ERECTILE DYSFUNCTION IS INDEPENDENTLY ASSOCIATED WITH SLEEP APNEA IN A LARGE POPULATION OFMIDDLE-AGED MENBoback Berookhim, Mary Ann McLaughlin, Mark Woodward, Rupa Iyengar, Simonette Sawit, Cynara MacedaJacqueline Moline, Natan Bar-Chama, New York, NYINTRODUCTION AND OBJECTIVES: Obstructive sleep apnea (OSA) is a common condition, which has beenrecently associated with erectile dysfunction (ED). A number of different mechanisms have been proposed todescribe this association, including endothelial dysfunction and nocturnal hypoxemia. The Berlin Questionnaireis the most widely used questionnaire for OSA, with published sensitivity up to 86% and specificity of 87%(Netzer NC, 1999, Ahmadi N, 2008). We aim to describe an independent association between patients with EDand those at risk for OSA as assessed by the Berlin Questionnaire.METHODS: We evaluated 870 consecutively enrolled men in the ongoing Law Enforcement Cardiac Screeningprogram (LECS), a subset of the World Trade Center Medical Monitoring and Treatment Program. Patients whoscored positive on the Berlin Questionnaire were defined to be at high risk for OSA. ED was assessed by use ofthe International Index of Erectile Function -5 (IIEF-5), and was defined as IIEF < 22. A multivariate, binary logisticregression was performed to adjust for age, history of cardiovascular disease, systolic blood pressure, diabetes,smoking and body mass index (BMI).RESULTS: The mean age of the patients in the study population was 47.3 years, with a mean BMI of 30.2. 63% ofpatients screened positive for OSA, 5.6% of patients had a history of diabetes, and 29% had a smoking history.After adjusting for age and comorbidities, patients with ED were more than twice as likely to have OSA thantheir normal counterparts (OR 2.15, 95% confidence interval 1.42 ? 3.26, p = 0.0003). The likelihood of havingOSA increased as the severity of ED increased (Wilcoxon test, p= 0.0005) (see figure 1). Normal Erectile Mild ED Mild to Moderate ED Severe ED Function (IIEF > (IIEF 17- Moderate ED (IIEF 8-11) (IIEF < 8) 22) 21) (IIEF 12-16) Percent of patients at high 59% 72% 79% 83% 88% risk for OSACONCLUSIONS: On multivariate analysis, ED is independently associated with patients at high risk for OSA, andthe risk of having OSA increased as the severity of ED increased. This is the largest study to date demonstratingthis relationship, and verifies recently published data (Budweiser, 2009). Given these findings, this studysuggests that men with ED should also be screened for OSA .Source of Funding: The New York Fraternal Order of Police through the Charity Fund of the NY Office of theAttorney General.
  • 4. 57SLEEP PREDICTS THE DEVELOPMENT OF UROLOGIC SYMPTOMS IN A LONGITUDINAL STUDYAndre B. Araujo, Rebecca S. Piccolo, John B. McKinlay, Watertown, MAINTRODUCTION AND OBJECTIVES: Current thinking regarding the association between urologic symptoms andsleep implicitly assumes that the two are linked uni-directionally, i.e., that urologic symptoms (urinaryincontinence (UI), lower urinary tract symptoms (LUTS), and nocturia) lead to sleep disturbance in men andwomen. However, it is highly plausible that sleep disturbance, which is associated with obesity and systemicinflammation, leads to the development of urologic symptoms. We tested whether sleep predicts thedevelopment of UI, LUTS, and nocturia in a longitudinal study.METHODS: Prospective cohort analyses of 1,610 men and 2,535 women who completed the baseline (2002-05)and follow-up (2006-10) phases of the Boston Area Community Health (BACH) survey, a population-basedrandom sample survey. Subjects were followed for approximately 5 years for the development of urologicsymptoms. Baseline short sleep duration (men only) was defined as sleeping < 5 h per night, and sleep qualitywas defined as having restless sleep in the past week. Moderate-to-severe LUTS was defined by AmericanUrological Association Symptom Index ?8, urinary incontinence was defined as weekly urine leakage, andnocturia was defined as 2+ urinations at night after falling asleep. Sex-specific logistic regression models ofincidence among those without UI, LUTS, and nocturia at baseline yielded odds ratios (OR) and 95% confidenceintervals (CI) that were adjusted for age, race/ethnicity, diabetes, heart disease, alcohol use, physical activityand anti-depressant use (at baseline). Further adjustments were made for baseline body mass index (BMI) andbaseline C-reactive protein (CRP) levels to test for mediation of associations.RESULTS: The mean age at baseline was 48 y. Short sleep duration was present in 18% of men, and restless sleepin 34% of men and 42% of women. Incidence of LUTS among men (8%) and women (13%) was strongly relatedto short sleep duration among men (OR: 1.97, 95% CI: 1.02, 3.78) and restless sleep among men (OR: 2.03, 95%CI: 1.26, 3.28) and women (OR: 1.66, 95% CI: 1.10, 2.49). Incident UI (OR: 1.78, 95%: 1.06, 2.96) and nocturia(OR: 1.90, 95%: 1.26-2.88) were associated with restless sleep among women but not men. Findings persistedwith adjustment for BMI and CRP, but OR estimates were considerably altered with adjustment for CRP.CONCLUSIONS: This study identified sleep as a novel and modifiable risk factor that precedes urologic symptomsin men and women, perhaps operating through inflammatory and other pathways.Source of Funding: This study was supported by award number U01DK056842 from the National Institute ofDiabetes and Digestive and Kidney Disorders.