AUA 2018: Insomnia Induces Lower Urinary Tract Symptoms: The Natural History and Risk Factors for LUTS from the Nagahama Longitudinal Study

San Francisco, CA ( The development of lower urinary tract symptoms (LUTS) has been known to be associated with increasing age and bother in both males and females, although the natural history and risk factors for the progression still remain unclear. 

Investigators in Japan have investigated the phenomenon of LUTS using the Nagahama cohort study, a large-scale, longitudinal, and population-based health survey in Nagahama, Japan. Hiromitsu Negoro, MD of the Kyoto University evaluated the natural history and risk factors associated with LUTS in a podium presentation at the 2018 AUA.

Data from the Nagahama cohort study is comprised of questionnaire surveys, as well as anthropometric, physiological, and biochemical measures of subjects aged 30-75 years. The first survey was performed in 9804 people from 2008 to 2010, and the follow-up evaluation was performed after 5 years as the second survey. The final study population included 5284 participants older than the age of 50, each of whom had 5-year follow-up. Associated clinical factors such as BMI, high blood pressure, hyperlipidemia, renal failure, diabetes, depression and insomnia were recorded and compared to the severity of LUTS, as determined by IPSS scores. 

The study population had a median age of 62 years old (range: 50-75 years), of which 40% were male and median BMI was 22 kg/m2 (range: 14-46). The prevalence of LUTS (defined as IPSS >7) was 23% in this group. After 5 years of follow-up, total IPSS increased 0.29 points from 5.24 to 5.54 (p<0.0001). Comorbidities were assessed across all groups and compared to IPSS scores.

Intermittency, urgency, weak stream, and nocturia all significantly increased while frequency significantly decreased across all groups. When comparing medical comorbidities to the progression of IPSS scores, age, male gender, insomnia, and depression, were all associated. Insomnia was shown to be significantly associated with incomplete voiding, intermittency, weak stream, and the need to strain. Depression was also noted to be associated with incomplete voiding, frequency, straining, and nocturia, and hypertension and diabetes were not associated with LUTS development or progression. In a post-hoc analysis, insomnia was significantly associated with LUTS development in asymptomatic men and LUTS progression in symptomatic men.

Overall LUTS was shown to progress through the 5 years of follow-up in this large longitudinal population-based health surveillance study. Risk factors for the IPSS progression included age, male gender, depression and insomnia. Of these, insomnia was the most widely associated with the development and progression of LUTS, prompting the authors to consider insomnia as an independent risk factor for LUTS. The authors considered the possibility that disturbances in the internal biological clock may affect both insomnia and LUTS, although future research will need to assess this hypothesis.

Presented by: Hiromitsu Negoro, Kyoto University, Kyoto, Japan
Co-Authors:  Arinobu Fukunaga, Satoshi Funada, Takashi Kobayashi, Toshinari Yamasaki, Takahiro Inoue, Kyoto, Japan, Koji Yoshimura, Shizuoka, Japan, Takahisa Kawaguchi, Fumihiko Masuda, Osamu Ogawa, Kyoto, Japan

Written by:  Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA