Solifenacin improves sleep quality in patients with OAB regardless of administration timing
The administration of the antimuscarinic drug solifenacin decreased urination urgency and nocturia regardless of timing of intake, improving sleep disruption in patients with overactive bladder (OAB), according to a new study.
In this open-label, multicentre study, 127 patients (mean age 59.2 years) with OAB and nocturia were randomized to receive solifenacin 5 mg once daily at daytime (n=62) or nighttime (n=65) for >12 weeks. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale (AIS) were used to evaluate OAB symptoms and sleep quality. [J Korean Med Sci 2017;32:1491-1495]
At 12 weeks, daytime and nighttime solifenacin intake significantly improved nocturia episodes (from 2.4 to 1.2 and from 2.3 to 0.9, respectively; p<0.001 for both) and sleep-related parameters such as IPSS (from 17.9 to 7.9 and from 17.0 to 8.1, respectively), OABSS (from 8.8 to 4.6 and from 8.1 to 4.6, respectively), and AIS (from 11.6 to 7.2 and from 10.4 to 6.4, respectively; p<0.001 for all).
The researchers attributed the improvement in AIS to the reduction in nocturia episodes.
At 12 weeks, mean nocturnal urine volume decreased with both daytime (from 406 mL to 213 mL; p=0.325) and nighttime dosing (from 442 mL to 268 mL; p=0.204), though these results were not significant.
Adverse event (AE) rates were 14.5 percent and 12.3 percent in the daytime and nighttime groups, respectively (p=0.797), the most common being dry mouth and mild constipation.
“[The] lower AE rates related with nighttime dosing may be related to the maximum serum concentrations being reached while the patients were sleeping,” said the researchers.
While the findings highlight the persistent 24-hour efficacy of nighttime dosing, and despite previous evidence showing nighttime dosing to be more effective than daytime dosing in improving tolerance and nocturia, and reducing AE rates, [Urology 2006;67:731-736; Urology 2001;57:414-421] the results did not reflect a significant difference between day- and nighttime intake, noted the researchers.
The use of antimuscarinic drugs improves urination urgency and frequency by effectively reducing involuntary contractions and increasing bladder capacity in patients with storage symptoms, thereby improving sleep quality, said the researchers.
It is important to address OAB symptoms and nocturia as these can significantly influence quality of life, efficiency, vigour, and awareness of health, primarily due to sleep disruption, said the researchers, who called for more trials to further evaluate the overall impact of improved OAB symptoms on quality of life and patient satisfaction.