Advertisement

Sleeping problems are associated with increased risk of BPH progression: Results from REDUCE

Login to Access Video or Poster Abstract: MP09-08
Sources of Funding: GlaxoSmithKline Inc. and NIH K24 CA160653

Introduction

While there is a known correlation between nocturia due to BPH and sleep disturbance, it is unknown if sleep disturbances affect BPH development and symptom progression. We examined the relationship between sleep problems as measured by the Medical Outcomes Study Sleep Scale (MOSSS-6) questionnaire and BPH development and progression in the placebo arm of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study.

Methods

REDUCE was a 4-year trial testing prostate cancer chemoprevention with dutasteride in men with a PSA 2.5-10 ng/ml and a negative biopsy. At baseline, men completed the MOSSS-6 questionnaire, a 6-item scale that assesses sleep and is scored 1-100. Men were followed for 4 years and the International Prostate Symptom Scores (IPSS) was obtained at baseline and every 6 months. In men without symptomatic BPH at baseline (IPSS<8), we defined BPH development as two values of IPSS >14, any surgical procedure for BPH, or the start of a drug for BPH. In men with symptomatic BPH at baseline (IPSS≥8), BPH symptom progression was defined as ≥4 IPSS increase from baseline, any surgical procedure for BPH, or the start of a drug for BPH. In men in the placebo arm and not taking alpha blockers or 5-alpha reductase inhibitors at baseline (n=2,588), we tested the association between sleep problems as measured by the MOSSS-6 and BPH development and BPH progression using Cox models, adjusting for age, race, body mass index (BMI), smoking, digital rectal exam, prostate volume, PSA, and baseline IPSS.

Results

During follow-up, 209/1452 men (14%) without BPH at baseline developed BPH and 527/1136 men (46%) with BPH progressed. Median age was 62 (IQR: 58-67) and 90% were white. Median BMI was 26.8 kg/m2 (IQR: 24.7-29.1) and 15% were current smokers. Median MOSSS-6 score was 17 (IQR: 7-27). On multivariable analysis, higher MOSSS-6 scores were associated with increased risk of BPH development in men without BPH at baseline (HR 1.28, p=0.014). Among men with BPH at baseline, higher MOSSS-6 scores were associated with increased risk of BPH symptom progression (HR 1.23, p<0.001).

Conclusions

Among men with BPH symptoms, worse sleep scores predicted the risk of BPH symptom progression. Among asymptomatic men, worse sleep scores predicted the development of BPH. As it is often inferred that BPH leads to sleep problems, the fact that sleep problems in asymptomatic men predict BPH development suggests BPH symptoms may be a manifestation of sleep problems rather than the reverse. Whether treating sleep problems improves BPH symptoms needs to be tested.

Funding

GlaxoSmithKline Inc. and NIH K24 CA160653

Authors
Brandee Branche
Lauren Howard
Daniel Moreira
Ramiro Castro-Santamaria
Gerald Andriole
Martin Hopp
Stephen Freedland
back to top