This original study aims to compare anxiety and depression frequency, and sleep quality in women with or without overactive bladder (OAB). It is known that OAB symptoms have negative impact on physical, emotional and social aspects of the affected individuals (1). In addition, it is known that nocturia is responsible for sleep interruption, as it is one of the most frequent complaints by patients with OAB (2). Based on this knowledge, it is hypothesized that women with OAB are more affected by depression and anxiety symptoms, and are also more likely to have worst sleep quality.

Cross-sectional observational study. There were included women between the ages of 18 and 65, both with and without urinary symptoms of OAB. They were divided into two groups according to ICIQ-OAB results and paired by age. The groups were separated between women with OAB urinary symptoms values of ICIO-OAB superior to one (1) – experimental group (EG);  and the control group (CG), whose ICIQ-OAB score was zero. Women with difficulty in comprehending the research steps, with cognitive deficit, neurogenic OAB, low urinary tract infection (LUTI), sensory deficit in the sacral ou tibial region, chronic kidney disease, deep venous insufficiency, implantable pacemaker or cardioverter defibrillator and pregnant women were excluded from the study. The patients signed the Informed Consent Form. After consent, the patients in the EG were instructed to fill out the mictional diary (MD) during 3 days. On the following week the MD was evaluated and both patient groups were submitted to the following questionnaires: ICIQ-OAB, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS). The participants also had to answer about social demographic information; and a basic anamnesis (urogynecological signs and symptoms, and history of psychiatric diseases). For sample calculation, a Winpepi calculator was used for mean comparison. The standard deviation (SD) was of 1.8 and 0.4. The difference estimated was considered 1,  thus the study predicted a total of 27 patients in each group, and a significance level of 5%.

This study evaluated 20 women – 14 of them on the EG, and 6 on CG – with median age of 46.5 (22.0 – 56.0) and 33 (21 – 55.5) years old (p=0.547). There was a predominance of single women (p=0.779) in both groups. The majority of EG was mixed raced women (64.3%), while the number of white and mixed raced women on CG was equally distributed (p=0.057). As for the micturial symptoms, 85.7% of EG and 16.7% of CG presented nocturia (p=0.131). The GE women complained of urgency urinary incontinence (UUI) (57.1%, p=0.042) and stress urinary incontinence (SUI) (28.6%, p=0.267). No patient from CG reported urinary loss. Regarding the history of psychiatric illness, only 33.3% and 21.4% were respectively reported on CG and EG (p=0.613). Only 6 EG patients' sequence of 3 day mictional diaries were correctly filled, thus the others were not included in the statistical analysis. These medians results (IQ) are: 1900ml (1588-2902ml) of daily liquid intake, 12.3(9.8-15.5) of daily voiding frequency and 1.3(0.0-1.5) of nocturia. The minority of patients on both groups had anxiety diagnosis: 1(16.7%) on CG and 6 (42.9%) on EG (p= 0.354). No people from CG were diagnosed with depression, however, 2 participants on EG (14.3%, p=10) had this diagnosis. At last, the mean total score for PSQI was 7.33±2,0 on CG and 7.43±2.1 on EG, with the p value of 0.925. Ten EG women (71.4%) presented a total score higher than 5, indicating they had great dysfunctions in at least two components, or mild dysfunction in at least 3 components.

When comparing groups E and C there was no statistical difference in anxiety and depression frequency, contradicting previous studies – which showed higher anxiety and depression rates in women with OAB when compared to asymptomatic women (1). The PSQI global mean score was slightly higher on GE than on CG. This findings were also not consistent when compared to previous researches – that showed higher scores in women with OAB (3). Probably this was due to the small sample, with no statistical significance. Nocturia prevalence (on both groups) was compatible with previous publications (2).

According to the results of this study, it was not possible to infer that there is a difference in sleep quality, as well as in anxiety and depression frequency, in both patient groups (with/without OAB symptoms). Moreover, it is possible that nocturia causes an impact on sleep quality, which may lead to anxiety and depression symptoms; however, there were few participants on each group and we suggest a more robust sample to prove, or refute, this hypothesis.

Alves AT, Jácomo RH, Gomide LB, Garcia PA, Bontempo AP dos S, Karnikoskwi MG de O. Relationship between anxiety and overactive bladder syndrome in older women. Rev Bras Ginecol e Obs. 2014;36(7):310–4. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032014000700310
Kwon T, Oh TH, Choi S, Cho WY, Min K, Lee JZ, et al. Influence of daytime or nighttime dosing with solifenacin for overactive bladder with nocturia: Impact On nocturia and sleep quality. J Korean Med Sci. 2017; Sep; 32(9): 1491–1495.
Hernandez C, Schembri M. Beyond the bladder: poor sleep in women with overactive bladder syndrome. Am J Obstet Gynecol [Internet]. 2020; Available from: https://doi.org/10.1016/j.ajog.2019.12.005