Objective: To assess sleep efficiency in patients presenting with nocturia and symptomatic benign prostatic hypertrophy (BPH).
Material and methods: This prospective observational survey was carried out in France by 113 urologists. A total of 1376 patients (mean+/-SD age: 68.8+/-9.0 years) consulting for BPH with greater than two nocturia episodes per 24 hours were assessed with a mean I-PSS score of 15.5+/-6.4 (symptoms greater than 19 [severe] in 26.9% of cases). Patients used a sleep diary to record the previous night's total; sleep efficiency is expressed as percentage ratio, representing the total amount of actual sleep between initial sleep onset and final awakening. Sleep disorders were assessed using HD-43 questionnaire based on International classification of sleep disorders.
Results: 29.2% of the patients suffered from chronic insomnia, considered as primary insomnia (in 29.5% of cases) or related to either BPH (63.0%); snoring/sleep apnoea in 12.5% of cases. The mean sleep efficiency index was 87.2+/-13.7% and appeared to be significantly lower in BPH-related insomnia. Significantly lower sleep efficiency index values were observed as the severity (I-PSS score) of the BPH symptoms increased (89.5+/-12.1% for mildly symptomatic BPH vs. 84.0+/-15.6% for severely symptomatic BPH, P<0.001). Sleep efficiency index lowered with nocturia frequency (89.8+/-11.3% for two nocturia episodes vs. 80.4+/-17.3% for five nocturia episodes or more, P<0.001) and chronic insomnia frequency increased with nocturia frequency (21.4% for two nocturia episodes vs. 45.2% for five nocturia episodes or more, P<0.001).
Conclusions: Insomnia is frequent in patients presenting with BPH-related lower urinary tract symptoms (LUTS) and is mainly secondary to these LUTS. There is a significant correlation between the frequency of nocturia and the severity of insomnia.