The relationship between obstructive sleep apnea syndrome and lower urinary tract symptoms

Objective: Lower Urinary Tract Symptoms (LUTS) usually occur in older men andestablish a major public health problem. Obstructive Sleep Apnea Syndrome (OSAS) as asignificant health problem is also associated with various systemic diseases. The aim of thisprospective study was to investigate the relationship between LUTS and OSAS as twoCommon disorders.Materials and Methods: Between January 2007 and April 2010, the men over the ageof 50 admitted to the outpatient department of Pulmonary Diseases, Düzce Medical School,Düzce University with suspected obstructive sleep apnea were selected. All patients hadpolysomniography analysis. A total of 29 patients having moderate and severe OSAS withapnea-hypopnea index (AHI)=15-30 (11 patients) and AHI>30 (18 patients), respectivelywere included in the first group. OSAS negative 21 patients with AHI<5 constituted thecontrol group. The ones with any disorder that could cause LUTS were excluded from thestudy. Voiding symptoms were evaluated by using International Prostate Symptom Score(IPSS), uroflowmetry, and prostate volume. Erectile dysfunction (ED) was investigated byAdministering International Index of Erectile Function (IIEF).Results: Both groups were comparable with regard to age, PSA, prostate volume, andprostate size by digital rectal examination. IPSS values and uroflovmetry results were alsosimilar in these two groups of patients. The mean total IPSS value was 10.58 and the meanmaximal flow rate (Qmax) was 17.51 ml/sec in the OSAS group; while these parameters were16.95 and 9.19 ml/sec in the control group, respectively (p> 0.05). On the other hand, nocturiaand IIEF results were remarkably different between two groups. The average number ofnocturia was 1.47, and the mean score of IIEF was 15.48 in patients with OSAS. On the otherhand,mean nocturia and IIEF values were 0.88 and 19.90 in the control group, respectively(p<0.05).Conclusions: In this study, IPSS and uroflovmetry values showed no differencebetween patients with and without OSAS. On the other hand, nocturia and IIEF results wereboth remarkably different in OSAS patients. The results of this study suggested that OSASwas not a risk factor for LUTS except for nocturia. However, OSAS was shown to beassociated with nocturia and ED. Therefore, the patients with complaint of either nocturia orED should be investigated for OSAS. Similarly, ED should be considered in patientspresented with OSAS. Although, this prospective study is valuable as the first clinicalobservation evaluating the relationship between OSAS and LUTS, it is obvious that furthertrials with substantially higher number of patients are required on this issue.Key words: LUTS, Benign Prostate Hyperplasia, OSAS, IPSS, Polysomnography,Uroflowmetry, Nocturia, IIEF