Sleep Health and Female Lower Urinary Tract Symptoms: A Systematic Review

Emerging evidence suggests a close relationship between sleep health and female lower urinary tract symptoms (LUTS). However, available studies have focused on individual sleep disorders or specific urinary symptoms, and no systematic review has comprehensively evaluated this association in women.

A systematic literature search of PubMed/MEDLINE was conducted to identify studies published between January 2020 and July 2026 investigating the association between sleep-related factors and female LUTS. Eligible studies evaluated adult women with one or more sleep disorders or sleep-related characteristics and reported outcomes related to overactive bladder (OAB), urinary incontinence (UI), nocturia, voiding dysfunction, or overall LUTS. Study selection followed the PRISMA 2020 statement. A qualitative synthesis was performed because of substantial methodological heterogeneity.

Twenty-eight studies met the inclusion criteria. The most consistent evidence supported associations between poor sleep quality, obstructive sleep apnea (OSA), and nocturia with female LUTS. Prospective evidence demonstrated that poor sleep quality increased the risk of incident LUTS, while population-based studies identified insomnia as an independent risk factor for nocturia. Women with OAB exhibited poorer sleep quality, greater daytime sleepiness, and a higher risk of OSA, while women with UI generally exhibited poorer sleep quality. Limited evidence also suggested associations involving restless legs syndrome and healthy sleep patterns. Potential mechanisms include autonomic dysregulation, systemic inflammation, circadian rhythm disruption, hormonal alterations, and psychological distress, supporting a bidirectional relationship between sleep disorders and female LUTS.

Current evidence demonstrates a consistent association between sleep health and female LUTS, particularly regarding sleep quality, OSA, and nocturia. Assessment of sleep health may be a reasonable clinical consideration in women with LUTS. Further prospective and interventional studies are warranted to clarify causality and determine whether treatment of sleep disorders improves urinary outcomes.