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Effect of combined use of tolterodine and continuous positive airway pressure vs continuous positive airway pressure only treatment on overactive bladder symptoms in women with moderate-to-severe obstructive sleep apnea syndrome: a randomized clinical trial

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Abstract

Introduction and hypothesis

Obstructive sleep apnea syndrome is associated with urological symptoms, including overactive bladder (OAB). This study aims to determine whether combined tolterodine and CPAP therapies are more effective for patients with OSAS than CPAP treatment only.

Methods

Women who underwent polysomnography test and were diagnosed with moderate-to-severe OSAS with apnea-hypopnea index (AHI) were included in the study. Data were collected on AHI, OAB awareness-8-item tool (OAB-V8), incontinence questionnaire-urinary incontinence short form (ICIQ-UI-SF), total daily urine volume (DUV), and the Benefit, satisfaction with treatment and willingness (BSW) tool. Eligible patients were randomized to receive either CPAP treatment only or combined CPAP and tolterodine treatment for 3 months.

Results

Among 103 participants, a total of 60 were included. Patients in both treatment arms showed significant improvements in OAB-V8, ICIQ-UI-SF, and total DUV compared to their baseline. The mean OAB-V8 was 15.7 at baseline and 5.6 at 3 months for the combined treatment arm and 16.6 and 7.6 at 3 months for the CPAP group only (mean baseline-adjusted between-group difference -1.1 [95% CI, −12.3 to −7.4]; p < 0.001). The improvement in the mean ICIQ-UI-SF was also statistically more significant in the combined therapy group than in the CPAP only arm (mean baseline-adjusted between-group difference −3.27 [95% CI, −4.6 to −1.59]; p < 0.001). No statistical significance was found in the improvement of total DUV between the groups.

Conclusions

In this study, combined use of tolterodine with CPAP provides beneficial effects to CPAP treatment only regarding OAB symptoms. Further research is required to confirm these findings in a large cohort.

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References

  1. Kemmer H, Mathes AM, Dilk O, Gröschel A, Grass C, Stöckle M. Obstructive sleep apnea syndrome is associated with overactive bladder and urgency incontinence in men. Sleep. 2009;32(2):271–5. https://doi.org/10.1093/sleep/32.2.271.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Tuncer M, Yazici O, Kafkasli A, Sabuncu K, Salepci B, Narter F, Gungor GA, Yucetas U. Critical evaluation of the overactive bladder and urgency urinary incontinence association with obstructive sleep apnea syndrome in a relatively young adult male population. Neurourol Urodyn. 2017;36(7):1804–8. https://doi.org/10.1002/nau.23184.

    Article  PubMed  Google Scholar 

  3. İrer B, Çelikhisar A, Çelikhisar H, Bozkurt O, Demir Ö. Evaluation of sexual dysfunction, lower urinary tract symptoms and quality of life in men with obstructive sleep apnea syndrome and the efficacy of continuous positive airway pressure therapy. Urology. 2018;121:86–92. https://doi.org/10.1016/j.urology.2018.08.001.

    Article  PubMed  Google Scholar 

  4. Lowenstein L, Kenton K, Brubaker L, Pillar G, Undevia N, Mueller ER, FitzGerald MP. The relationship between obstructive sleep apnea, nocturia, and daytime overactive bladder syndrome in women. Am J Obstet Gynecol. 2008;198(5):598.e591–5. https://doi.org/10.1016/j.ajog.2008.02.024.

    Article  Google Scholar 

  5. Miyauchi Y, Okazoe H, Tamaki M, Kakehi T, Ichikawa H, Arakawa Y, Mori Y, Koui F, Sugimoto M, Kakehi Y. Obstructive sleep apnea syndrome as a potential cause of nocturia in younger adults. Urology. 2020;143:42–7. https://doi.org/10.1016/j.urology.2020.04.116.

    Article  PubMed  Google Scholar 

  6. Park HK, Paick SH, Kim HG, Park DH, Cho JH, Hong SC, Choi WS. Nocturia improvement with surgical correction of sleep apnea. Int Neurourol J. 2016;20(4):329–34. https://doi.org/10.5213/inj.1632624.312.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Drake MJ. Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013. Neurourol Urodyn. 2014;33(5):622–4. https://doi.org/10.1002/nau.22609.

    Article  PubMed  Google Scholar 

  8. Clerget A, Kanbar A, Abdessater M. Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review. Progres en urologie: journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2020;30(17):1069–77. https://doi.org/10.1016/j.purol.2020.07.244.

    Article  CAS  Google Scholar 

  9. Yilmaz Z, Voyvoda B, Şirinocak PB. Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome. Int Braz J Urol. 2018;44(2):330–7. https://doi.org/10.1590/s1677-5538.Ibju.2017.0253.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fernández-Pello S, Gil R, Escaf S, Rodríguez Villamil L, Alzueta A, Rodríguez C, Gonzalo-Orden JM. Lower urinary tract symptoms and obstructive sleep apnea syndrome: Urodynamic evolution before and after one year of treatment with continuous positive airway pressure. Actas urologicas espanolas. 2019;43(7):371–7. https://doi.org/10.1016/j.acuro.2019.03.004.

    Article  PubMed  Google Scholar 

  11. Dinç ME, Avinçsal M, Balcı MBC, Özdemir C. Effect of continuous positive airway pressure on overactive bladder symptoms in patients with obstructive sleep apnea syndrome. Turkish Arch Otorhinolaryngol. 2018;56(3):133–8. https://doi.org/10.5152/tao.2018.3251.

    Article  Google Scholar 

  12. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94. https://doi.org/10.1378/chest.14-0970.

    Article  PubMed  Google Scholar 

  13. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667–89.

  14. Çetinel B, Özkan B, Can G. ICIQ-SF Türkçe versiyonu validasyon (geçerlilik) çalışması. Türk Üroloji Dergisi/Turkish J Urol. 2004;30(3):332–8.

    Google Scholar 

  15. Tarcan T, Mangır N, Özgür MÖ, Akbal C. OAB-V8 Aşırı Aktif Mesane Sorgulama Formu Validasyon Çalışması. Üroloji Bülteni. 2012;21:113–6.

    Google Scholar 

  16. Pleil AM, Coyne KS, Reese PR, Jumadilova Z, Rovner ES, Kelleher CJ. The validation of patient-rated global assessments of treatment benefit, satisfaction, and willingness to continue--the BSW. Value Health: J Int Soc Pharmacoecon Outcomes Res. 2005;8(Suppl 1):S25–34. https://doi.org/10.1111/j.1524-4733.2005.00069.x.

    Article  Google Scholar 

  17. Deger M, Surmelioglu O, Kuleci S, Akdogan N, Dagkiran M, Tanrisever I, Yucel SP. Izol V (2021) The effect of treatment of obstructive sleep apnea syndrome on overactive bladder symptoms. Rev Assoc Med Bras. 1992;67(3):360–5. https://doi.org/10.1590/1806-9282.20200607.

    Article  Google Scholar 

  18. Ipekci T, Cetintas G, Celik O, Ekin RG, Sarac S, Tunckiran A, Ilbey YO. Continuous positive airway pressure therapy is associated with improvement in overactive bladder symptoms in women with obstructive sleep apnea syndrome. Cent European J Urol. 2016;69(1):78–82. https://doi.org/10.5173/ceju.2016.674.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rai BP, Cody JD, Alhasso A, Stewart L. Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2012;12 (12):Cd003193. https://doi.org/10.1002/14651858.CD003193.pub4.

  20. Roehrborn CG, Abrams P, Rovner ES, Kaplan SA, Herschorn S, Guan Z. Efficacy and tolerability of tolterodine extended-release in men with overactive bladder and urgency urinary incontinence. BJU Int. 2006;97(5):1003–6. https://doi.org/10.1111/j.1464-410X.2006.06068.x.

    Article  CAS  PubMed  Google Scholar 

  21. Salvatore S, Serati M, Bolis P. Tolterodine for the treatment of overactive bladder. Expert Opin Pharmacother. 2008;9(7):1249–55. https://doi.org/10.1517/14656566.9.7.1249.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Faculty of Medicine, Van Yuzuncu Yil University, 65090, Van, Tuşba, Turkey

    Kasım Ertaş, Murat Demir, Rahmi Aslan, Recep Eryılmaz, Şevder Kırmızıtoprak & Kerem Taken

  2. Department of Chest Diseases, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey

    Hanifi Yıldız

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  1. Kasım Ertaş
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All authors have contributed to project development, data collection, and manuscript writing.

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Correspondence to Kasım Ertaş.

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Ertaş, K., Yıldız, H., Demir, M. et al. Effect of combined use of tolterodine and continuous positive airway pressure vs continuous positive airway pressure only treatment on overactive bladder symptoms in women with moderate-to-severe obstructive sleep apnea syndrome: a randomized clinical trial. Int Urogynecol J 33, 2031–2036 (2022). https://doi.org/10.1007/s00192-022-05206-5

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