Sleep quality and duration are associated with the development of urologic symptoms like erectile dysfunction and lower urinary tract symptoms. Two studies presented at the American Urological Association meeting link sleep and urologic health: 1) A study of 870 men found those with erectile dysfunction were over twice as likely to be at high risk for obstructive sleep apnea. Risk increased with erectile dysfunction severity. 2) A longitudinal study of over 3,000 men and women found short sleep duration and poor sleep quality predicted later development of lower urinary tract symptoms, urinary incontinence, and nocturia. Improving sleep may benefit urologic health.

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 CONDITIONS
Washington, DC May 14, 2011 – Two studies that link the quality of sleep to the occurrence of erectile
dysfunction (ED) and other urologic conditions will be presented to reporters during a special press conference
at the Walter E. Washington Convention Center in Washington, DC, today, Sunday, May 14, at 2:00 p.m. during
the 2011 Annual Meeting of the American Urological Association (AUA). The session will be moderated by Kevin
McVary, MD.
Erectile Dysfunction Is Independently Associated With Sleep Apnea In A Large Population Of Middle-Aged
Men (#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 870
consecutively enrolled men in the ongoing Law Enforcement Cardiac Screening program (LECS), a subset of the
World Trade Center Medical Monitoring and Treatment Program. Patients who scored positive on the Berlin
Questionnaire (a widely used survey for OSA) were defined to be at high risk for OSA. ED was assessed by use of
the 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 blood
pressure, 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-three
percent of the patients screened positive for OSA, 5.6 percent had a history of diabetes, and 29 percent had a
smoking history. After adjusting for age and comorbidities, the patients with ED were more than twice more
likely to have OSA than their normal counterparts. The likelihood of having OSA increased as the severity of
erectile 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 risk
factor 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 a
study 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-up
phases 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 (men
only) was defined as sleeping fewer than five hours per night, and sleep quality was defined as having restless
sleep in the past week. LUTS were assessed using the AUA Symptom Index, urinary incontinence was defined as
weekly urine leakage, and nocturia was defined as needing to urinate more than two times per night after falling
asleep.

2. Incidence of LUTS among men (8 percent) and women (13 percent) was strongly related to short sleep duration
among men and restless sleep among men and women. Incidences of UI and nocturia were associated with
restless sleep among women but not men.
“We know that proper amounts of sleep and quality of sleep can impact a wide range of health conditions
including 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 their
health and overall quality of life.”
NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange an
interview with an expert, please contact the AUA Communications Office at the number above or e-mail
Communications@AUAnet.org.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American
Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 members
throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards
of urologic care by carrying out a wide variety of programs for members and their patients.
###

3. 1325
ERECTILE DYSFUNCTION IS INDEPENDENTLY ASSOCIATED WITH SLEEP APNEA IN A LARGE POPULATION OF
MIDDLE-AGED MEN
Boback Berookhim, Mary Ann McLaughlin, Mark Woodward, Rupa Iyengar, Simonette Sawit, Cynara Maceda
Jacqueline Moline, Natan Bar-Chama, New York, NY
INTRODUCTION AND OBJECTIVES: Obstructive sleep apnea (OSA) is a common condition, which has been
recently associated with erectile dysfunction (ED). A number of different mechanisms have been proposed to
describe this association, including endothelial dysfunction and nocturnal hypoxemia. The Berlin Questionnaire
is 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 ED
and those at risk for OSA as assessed by the Berlin Questionnaire.
METHODS: We evaluated 870 consecutively enrolled men in the ongoing Law Enforcement Cardiac Screening
program (LECS), a subset of the World Trade Center Medical Monitoring and Treatment Program. Patients who
scored positive on the Berlin Questionnaire were defined to be at high risk for OSA. ED was assessed by use of
the International Index of Erectile Function -5 (IIEF-5), and was defined as IIEF < 22. A multivariate, binary logistic
regression 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% of
patients 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 than
their normal counterparts (OR 2.15, 95% confidence interval 1.42 ? 3.26, p = 0.0003). The likelihood of having
OSA 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 OSA
CONCLUSIONS: On multivariate analysis, ED is independently associated with patients at high risk for OSA, and
the risk of having OSA increased as the severity of ED increased. This is the largest study to date demonstrating
this relationship, and verifies recently published data (Budweiser, 2009). Given these findings, this study
suggests 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 the
Attorney General.

4. 57
SLEEP PREDICTS THE DEVELOPMENT OF UROLOGIC SYMPTOMS IN A LONGITUDINAL STUDY
Andre B. Araujo, Rebecca S. Piccolo, John B. McKinlay, Watertown, MA
INTRODUCTION AND OBJECTIVES: Current thinking regarding the association between urologic symptoms and
sleep implicitly assumes that the two are linked uni-directionally, i.e., that urologic symptoms (urinary
incontinence (UI), lower urinary tract symptoms (LUTS), and nocturia) lead to sleep disturbance in men and
women. However, it is highly plausible that sleep disturbance, which is associated with obesity and systemic
inflammation, leads to the development of urologic symptoms. We tested whether sleep predicts the
development 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-based
random sample survey. Subjects were followed for approximately 5 years for the development of urologic
symptoms. Baseline short sleep duration (men only) was defined as sleeping < 5 h per night, and sleep quality
was defined as having restless sleep in the past week. Moderate-to-severe LUTS was defined by American
Urological Association Symptom Index ?8, urinary incontinence was defined as weekly urine leakage, and
nocturia was defined as 2+ urinations at night after falling asleep. Sex-specific logistic regression models of
incidence among those without UI, LUTS, and nocturia at baseline yielded odds ratios (OR) and 95% confidence
intervals (CI) that were adjusted for age, race/ethnicity, diabetes, heart disease, alcohol use, physical activity
and anti-depressant use (at baseline). Further adjustments were made for baseline body mass index (BMI) and
baseline 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 sleep
in 34% of men and 42% of women. Incidence of LUTS among men (8%) and women (13%) was strongly related
to 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 persisted
with 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 symptoms
in 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 of
Diabetes and Digestive and Kidney Disorders.