睡眠健康与女性下尿路症状：一项系统综述

文献信息

中文摘要

目的： 新出现的证据表明睡眠健康与女性下尿路症状（LUTS）之间存在密切关系。然而，现有研究多集中于个别睡眠障碍或特定泌尿系统症状，尚无系统综述全面评估女性中的这一关联。
方法： 对PubMed/MEDLINE进行系统文献检索，以识别2020年1月至2026年7月间发表的、探讨睡眠相关因素与女性LUTS关联的研究。纳入标准为评估患有一种或多种睡眠障碍或睡眠相关特征的成年女性，并报告与膀胱过度活动症（OAB）、尿失禁（UI）、夜尿症、排尿功能障碍或总体LUTS相关的结局。研究选择遵循PRISMA 2020声明。由于方法学异质性显著，进行了定性综合。
结果： 28项研究符合纳入标准。最一致的证据支持睡眠质量差、阻塞性睡眠呼吸暂停（OSA）和夜尿症与女性LUTS之间的关联。前瞻性证据表明，睡眠质量差会增加新发LUTS的风险，而基于人群的研究将失眠确定为夜尿症的独立危险因素。患有OAB的女性表现出更差的睡眠质量、更严重的日间嗜睡以及更高的OSA风险，而患有UI的女性通常表现出更差的睡眠质量。有限的证据还提示不宁腿综合征和健康睡眠模式也涉及关联。潜在机制包括自主神经失调、全身性炎症、昼夜节律紊乱、激素变化和心理困扰，支持睡眠障碍与女性LUTS之间的双向关系。
结论： 当前证据表明睡眠健康与女性LUTS之间存在一致关联，尤其是在睡眠质量、OSA和夜尿症方面。对于患有LUTS的女性，评估睡眠健康可能是合理的临床考虑。需要进一步的前瞻性和干预性研究来阐明因果关系，并确定治疗睡眠障碍是否能改善泌尿系统结局。

英文摘要

PURPOSE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.