Neurourologic Outcomes in Men With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a highly prevalent multisystem disorder characterized by intermittent hypoxia, autonomic dysregulation, and sleep fragmentation. Storage-predominant lower urinary tract symptoms (LUTS)-including urgency, urgency incontinence, and overactive bladder-also involve central and autonomic neural pathways. Although OSA has been independently linked to nocturia and cognitive impairment, no large-scale studies have examined OSA, storage LUTS, and neurocognitive outcomes concurrently in a population with male LUTS.

Using the TriNetX Research Network, we conducted a retrospective cohort study of men ≥ 50 years with the diagnosis code "BPH without baseline LUTS". Two cohorts were constructed, consisting of men who received a diagnosis of obstructive sleep apnea within 1 year after the initial BPH diagnosis and those with no documented diagnosis of OSA at any time. Propensity score matching (1:1) produced two balanced cohorts of 89,074 patients each. Ten outcomes representing LUTS and cognitive conditions were evaluated using risk ratios, hazard ratios, and Kaplan-Meier analyses.

OSA was associated with increased risk and earlier onset of urgency and urgency incontinence, overactive bladder, frequency of micturition, and neuromuscular bladder dysfunction. OSA was strongly associated with mild cognitive impairment and physiologic neuropsychiatric disorders, with no difference in Alzheimer's disease incidence.

These findings raise the possibility that lower urinary tract symptoms deserve greater attention in the evaluation of men with OSA, specifically in relation to nervous system as opposed to purely cardio-renal mechanisms.