OAB effects on sleep and depression greatest among those taking antidepressants

By Lucy Piper, medwireNews Reporter

medwireNews: The degree to which people with overactive bladder (OAB) experience sleep disturbance, fatigue, and depression is no greater than that for the general population, except for those on antidepressants whose OAB may have a significant impact, shows a study by David Walker (Astellas Way, Northbrook, Illinois, USA) and colleagues.

The findings, published in Neurourology and Urodynamics in September 2023, “highlight the importance of the assessment of depression in the treatment of those diagnosed with OAB,” say the authors.

Prevalence of Sleep and Depression Medications

They note that “[a]lthough patients overall reported sleep disturbance and depression consistent with the US population mean, a substantial portion indicated they were receiving treatment,” with 34.0% reporting taking antidepressants and 25.8% sleep medications.

Baseline Characteristics of OAB Participants

The observational study involved 159 individuals with OAB who completed a series of patient-reported outcomes measures. Most (67.3%) of the participants were women, just over half were at least 65 years of age, and 46.5% were taking OAB medications. The mean Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) total score at baseline was 27.5 out of a possible 100 points.

Comparative Analysis with General Population

Mean scores for self-reported health on the Patient-Reported Outcomes Measurement Information System (PROMIS)-29 were 51.8 points for the Sleep Disturbance scale, 50.8 points for the Fatigue scale, and 49.2 points for the Depression scale.

These were all within 0.3 standard deviations of what would be expected for a general population, an average score for which would be 50 points.

Correlation Analysis between OAB Symptoms and Mental Health

There was also little correlation between OAB symptoms, as measured on LURN SI-29, and the PROMIS-29 measures of sleep disturbance, fatigue, depression, or anxiety, the researchers say.

The only exception was for the symptom bother subscale on the OAB Questionnaire Short Form (OAB-q SF), which showed a moderate positive association with sleep disturbance.

Impact of Antidepressant Usage on OAB Patients

The researchers highlight, however, that in subgroup analyses 54 patients who were taking antidepressants had significantly lower and therefore worse mean scores than 104 people who were not for health-related quality of life (HRQoL; 61.3 vs 73.3 points) and higher scores and therefore greater symptom bother (48.1 vs 35.4 points) on the OAB-q SF.

This was accompanied by significantly more severe urinary symptoms on the LURN SI-29 for total score (31.7 vs 25.4 points), incontinence (21.6 vs 13.2 points), voiding difficulty (27.7 vs 20.8 points), and urgency (45.4 vs 34.9 points).
Patients taking antidepressants also had significantly worse outcomes on six of eight PROMIS measures, with increased anxiety (57.1 vs 49.3 points), depression (54.3 vs 46.5 points), sleep disturbance (53.9 vs 50.7 points), and fatigue (53.6 vs 49.3 points), and reduced physical function (45.5 vs 48.7 points) and participation in social roles (47.8 vs 54.1 points).

Antidepressant use appeared to affect OAB medication adherence, the investigators note, with patients taking versus not taking these medications having significantly lower and therefore worse mean scores on the PROMIS medication adherence scale for total score (35.8 vs 39.3 points) and medication-taking behaviors (19.7 vs 22.4).

Associations with Sleep Medication Usage

The 41 individuals taking sleep medications had greater anxiety and depression, and were less able to participate in social roles and activities than the 116 people not taking such medications, but “there was no association between sleep medication use and urinary symptoms,” Walker et al report.

Conclusion and Implications for Clinical Practice

They conclude: “Findings from the present study characterize the experience of sleep disturbance and depression in the context of the quality of life in a sample of individuals with OAB and highlight the importance of assessing depression and sleep in the clinic setting.”

Read the article here: Neurol Urodyn 2023: doi:10.1002/nau.25348

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