Sleep Health, Perceived Stress, and Urinary Incontinence Severity Among Women Veterans in the USA

Urinary incontinence (UI) is common among women Veterans in the USA and may be influenced by sleep health and psychological stress. Understanding relationships between aspects of sleep health and UI, and variation by stress level, may inform novel interventions. The objective was to examine associations between aspects of sleep health (sleep quality, sleep efficiency, daily disturbances) and UI severity, and explore differences by perceived stress level.

We conducted an exploratory cross-sectional analysis of baseline data (April 2020) from women Veterans in the USA in a clinical trial of remote UI treatments. UI severity was measured with the International Consultation on Incontinence-UI Short Form. Sleep health was measured with the Pittsburgh Sleep Quality Index three-factor model to assess sleep quality, sleep efficiency, and daily disturbances. Stress was assessed with the Perceived Stress Scale-10. We used multivariable linear regression to examine associations between each aspect of sleep health and UI severity. We conducted stratified analyses by stress level (low, moderate, high).

Overall, 246 women Veterans were included (mean age 53, SD 11.3). Most (211 out of 246, 85.8%) were poor sleepers, with moderate UI (131 out of 246, 53.3%) and moderately impaired sleep health. In adjusted models, worse sleep quality (β = 0.40; 95% CI 0.04, 0.76; p = 0.03), reduced sleep efficiency (β = 0.57; 95% CI 0.15, 0.98; p = 0.01), and greater daily disturbances (β = 0.98; 95% CI 0.43, 1.54; p < 0.001) were associated with worse UI. Compared with women with low perceived stress, those with high stress had worse sleep health and UI (all p < 0.001).

Sleep health may be a modifiable factor for improving UI-related outcomes, with stress as a potentially relevant contextual factor.