Download Association Between LUTS and Sleep Disorders and Ramelteon`s

Association Between LUTS and Sleep Disorders and Ramelteon's Effects on LUTS and
Inflammation
Introduction and Objectives: 1) The association of lower urinary tract symptoms (LUTS) and urological
diseases with sleep disorders was investigated in patients who visited urology departments. 2) Of these
patients, those who wished to receive treatment for sleep disorders was given ramelteon (melatonin
receptor agonist), and improvement in LUTS and sleep disorders after the treatment as compared to
before treatment was examined.
Materials and Methods: 1) Outpatients who visited the urology departments at the Kinki University
Faculty of Medicine or the Sakai Hospital, Kinki University Faculty of Medicine, between August 2011 and
January 2012, were assessed using the Athens Insomnia Scale (AIS) and the International Prostate
Symptom Score (IPSS). 2) Those patients who wished to receive treatment with ramelteon were
assessed using the IPSS and Insomnia Severity Index (ISI), and high sensitivity C-reactive protein (hsCRP) was rated.
Results: 1) In total, 1174 patients (mean age, 65.7 ± 13.7 years), with 895 men (67.1 ± 13.2 years old)
and 279 women (61.4 ± 14.6 years old), were included in the study. Approximately half of these patients
were suspected of having a sleep disorder. The odds ratio (OR) for suspected sleep disorders was
significantly higher among patients undergoing treatment for prostate cancer (OR = 1.5) and those with
an overactive bladder (OR = 2.0). With regard to the IPSS subscores, a significant increase in the risk for
suspected sleep disorders was observed among patients with a post-micturition symptom (the feeling of
incomplete emptying) subscore of ≥1 (2.3-fold increase), a storage symptom (daytime frequency +
urgency + nocturia) subscore of ≥5 (2.7-fold increase), a voiding symptom (intermittency + slow stream +
hesitancy) subscore of ≥2 (2.6-fold increase), and a nocturia subscore of ≥2 (1.9-fold increase). 2) Onehundred and fifteen patients (102 men and 13 women) expressed their wish to receive ramelteon
treatment. After 10 weeks of treatment, significant improvements were observed in storage symptoms
(subscore decreased from 5.83 ± 3.87 to 4.72 ± 3.57, p = 0.0003), voiding symptoms (from 4.18 ± 4.35 to
3.62 ± 3.97, p = 0.0487), and nocturia (from 2.43 ± 1.29 to 2.04 ± 1.31, p = 0.0004), as well as in the
quality of life (from 3.59 ± 1.52 to 3.07 ± 1.51; p = 0.0009). ISI and hs-CRP scores were also significantly
changed (from 11.56 ± 5.16 to 9.17 ± 5.33, p < 0.0001; from 0.082 to 0.06, p = 0.026, respectively). A
significant correlation was observed between the amount of changes in ISI and IPSS scores (p = 0.0026),
as well as between the amount of changes in ISI and hs-CRP scores (p = 0.049).
Conclusion: 1) It is generally acknowledged that insomnia closely correlates with nocturia. The present
study has revealed for the first time that other risk factors of sleep disorders include voiding, postmicturition, and storage symptoms. 2) The results also showed that ramelteon improved subjective
symptoms and the quality of life in patients suffering insomnia accompanied by LUTS, which suggests an
indirect indication that the drug has an anti-inflammatory effect.