Titel: Sleep and quality of life in men with lower urinary tract symptoms – and their partners

Disputation: Linköpings universitet i Berzeliussalen, Hälsouniversitetet, Linköping fredagen den 30 januari 2009, kl 9.00

Fakultetsopponent: Docent Ralf Peeker vid institutionen för kliniska vetenskaper, Urologi, Sahlgrenska akademin, Göteborg

Department of Clinical and Experimental Medicine, Division of Surgery, Faculty of Health Sciences Linköping University, SE 581 85 Linköping, Sweden

Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE 581 85 Linköping, Sweden

ABSTRACT
Aims The overall aim was to determine how lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) affect sleep, health related quality of life and disease specific quality of life, and how the men’s urinary symptoms affect their partners.
Subjects and methods: In papers I–II, a descriptive design with a pre-test and post-test was used and in papers III-IV the design was descriptive and comparative. The method was self-administered questionnaires.
In papers I- II: The questionnaires were translated in the ethnographic mode. In paper I the reliability of the questionnaire was tested in 122 patients with LUTS/ BPO. The disease specific quality of life was studied before and after intervention in 572 consecutive patients with BPO, aged 45-94 yrs. In paper II, the partner specific quality of life was studied in partners to men with BPO before and after transurethral resection of the prostate (TURP). The reliability and the responsiveness of the questionnaire were tested in two groups with 51 partners each. Papers III-IV: A study of 239 men with LUTS, aged 45-80 yrs, and their partners (n=126) who were compared to randomly selected men from the population (n=213) and their partners (n=131). The men had an extra control group, men with inguinal hernia (n=200). Sleep and health related quality of life (HRQOL) was studied in both men and their partners. The partners’ specific quality of life was also studied and the men with LUTS answered questions about urinary symptoms and disease specific quality of life.
Results: Papers I-II: All the tested questionnaires showed an acceptable reliability and responsiveness. I: Before and after intervention the prevalence of urinary incontinence was 46 % and 16 % respectively. II: Partners were affected by the patients’ BPO symptoms before and improved after the patients TURPs. III: Most sleep variables were significantly impaired in men with LUTS compared to one or both of the control groups. The men with LUTS had a significantly higher prevalence of insomnia (40 %) than both control groups and significantly lower sleep efficiency (49 %) than men with hernia. The men with LUTS were significantly impaired in most domains of the health related quality of life compared to men in the population. IV: There were no significant differences between the two partner groups regarding the quantity and quality of sleep or the health related quality of life.
Conclusions: All tested questionnaires showed an acceptable reliability and responsiveness.
The prevalence of urinary incontinence before and after intervention was higher than earlier reported.
Men with LUTS had significantly poorer sleep quality, reduced sleep efficiency and a higher prevalence of insomnia than men in the population and men with inguinal hernia.
The HRQOL is impaired in men with LUTS compared to men in the population and men with inguinal hernia.
Partners are affected by the patients’ symptoms, and it is emotional rather than practical aspects that affect them most.
Partners of men with LUTS did not differ significantly from partners in the population with regard to sleep and health related quality of life.
Key words: Benign prostatic hyperplasia; Benign prostatic obstruction; Disease specific quality of life; Health related quality of life; Inguinal hernia; Insomnia; Lower urinary tract symptoms; Population; Sleep disorders; Sleep quality.
ISBN: 978-91-7393-724-5 ISSN: 0345-0082