Best Paper by a Fellow Award: Botox for Sleep Effectiveness: Effect of Botox on Nocturia and Sleep Quality

Objectives: While nocturia is one of the most bothersome symptoms reported in overactive bladder syndrome (OAB), there is sparse data evaluating the effect of OAB therapies for treatment of nocturia and changes in sleep disturbance. The objective of this study was to evaluate the effect of treatment with onabotulinum toxin A (BTX) on nocturia and sleep quality in women with OAB.

Methods: This is a prospective observational study of adult women with OAB syndrome and at least 2 nocturia episodes/night receiving BTX for treatment of OAB in the clinic setting. Primary outcome was change in nocturia episodes measured by 2-day bladder diary. Secondary outcomes were subjective reports of sleep quality and quality of life. Sleep disturbance was categorized by scores on validated questionnaires based on the American Psychiatric Association classification. Demographics and clinical information were extracted from medical records. Participants completed a bladder diary and questionnaires assessing sleep quality and quality of life at baseline and 5 weeks following BTX injection. Normality of the data was assessed with D'Agostino-Pearson test. Difference between baseline and post-treatment measurements were assessed using McNemar's Chi-squared test, Paired t-test, and Wilcoxon signed rank test with continuity correction.

Results: Baseline and 5-week post-BTX data were obtained for 39 participants. The mean age was 71 (+/-11.7) years and 59% self-identified as African American. Most participants had previously tried OAB medications (54% anticholinergic, 62% beta-3 agonists). 11 (28%) participants had previously had BTX injection with median time from last injection of 13 (IQR 12, 19) months. 35 (90%) participants had 100U, 3 (8%) had 200U and 1 (2%) had 300U of BTX injected. 7 (18%) participants had a 2-week postvoid residual >150mL with only 1participant requiring intermittent self-catheterization for management. 1 (2%) participant had post-procedure urinary tract infection defined as symptoms requiring antibiotics during the study period. Median baseline nocturia episodes was 3.5 (IQR 2.5, 5.0) with 45% of participants reporting mild to moderate sleep disturbance. At 5 weeks post-treatment, there was a significant decrease in nocturia episodes (-1.8, p< 0.001) and significant increases in longest sleep interval, time to first awakening and average sleep interval (p < 0.001) (Figure 1). There was a significant decrease of participants reporting mild to moderate sleep disturbance (-27%, p=0.006) and a significant increase in nocturia-related quality of life scores (p < 0.001) (Figure 2). Most participants (62%) reported overall improvement in their bladder symptoms post-treatment.

Conclusions: For women with OAB and at least 2 nocturia episodes/night, BTX was associated with a significant decrease in nocturia episodes and sleep disturbance with increases in sleep intervals and quality of life. Assessment and treatment of nocturia and related sleep disturbance in the OAB population is vital to increasing quality of life and improving sleep quality.