Sleep quality in patients with neurogenic bladder dysfunction

Introduction: Psychopathological diseases in urological patients cohort became the object of interest during last years. Insomnia is one of the most frequent. The main complaints are decreased working capacity, mood changes, decreased social adaptation and quality of life. Objective: To evaluate sleep disorders changes in adults with neurogenic detrusor overactivity (NDO) after botulinum toxin type A (BTA) treatment. Materials and methods: 54 patients (39 women, 15 men) with NDO were enrolled into the trial. The middle age was 59.5±1.6 years (28-69 years). NDO was confirmed by urodynamic study. Patients were divided into 2 groups: I - NDO without incotinence and II - NDO with urge incotinence. The treatment method for all patients was intradetrusor injections of BTA (200U in 20 ml of saline). BTA was injected into 20 points. Control examination including urodynamic study was conducted in 2 months after injections. Patients completed «Insomnia Scale (IS)» questionnaire before and after treatment. IS reflects sleep quality in 5 domains (0-5 scores each). Results: Before treatment, all patients showed sleep disorders (decreased sleep duration, frequent nocturnal awakenings, and lack of rest feeling after awakening). Two month after treatment the patients of both groups showed improvement in urodynamic parameters: group I - nocturia decreased from 2.8 ± 0.9 to 0.7 ± 0.2 (-75.0%), group II - from 4.6 ± 0.4 to 1.9 ± 0.4 (-58.7%), maximal cystometric capacity increased in group I from 137.1 ± 5.6 to 291.8 ± 8.5 ml. (+ 112.8%); in group II from 118.5 ± 6.4 to 246.8 ± 3.8 ml. (+ 108.3%). By subjective assessment sleep quality significantly increased in both groups (41,6% - in the I group and 61,9% - in the II group). Conclusions: BTA intradetrusor injections in NDO patients with sleep disorders is an effective method of treatment. It significantly improves urodynamic parameters; patients sleep quality and quality of life in total. Sleep quality score must be taken into account when assessing the status of patients with NDO, both before and after treatment.