Delay of first voiding episode is associated with longer reported sleep duration

OBJECTIVES

Time to first void is a common outcome in nocturia clinical trials, but its relationship to other conventional self-reported sleep measures is uncertain. We examined associations between change in time to first void and change in sleep duration over the course of such a trial.

METHODS

Secondary data analyses were based on a previously published study of a medication treating nocturia in 757 adult patients studied for periods up to 5 months. We used repeated-measures logistic regression models with generalized estimating equations (GEE) to examine the odds ratios (ORs) for achieving 6.0, 6.5, or 7.0 hours of total sleep duration based on increases of time to first void of 1, 2, or 3 hours.

RESULTS

Increases in time to first void were associated with longer sleep durations from beginning to end of study. A 1-hour increment in time to first void was associated with a higher likelihood of obtaining a total sleep duration of e6 (OR = 1.43; 95% confidence interval [CI], 1.19-1.73), e6.5 (OR = 1.30; 95% CI, 1.16-1.47), or e7 (OR = 1.24; 95% CI, 1.12-1.37) hours, after controlling for baseline time to first void, baseline sleep duration, time, and age (all Ps < .0001). Similar results were seen for 2- and 3-hour increments in time to first void.

CONCLUSIONS

Time to first void may be an important supplementary variable about which to inquire in population-based studies.

Efficacy of degarelix in prostate cancer patients following failure on luteinizing hormone-releasing hormone agonist treatment: results from an open-label, multicentre, uncontrolled, phase II trial (CS27)

OBJECTIVE

To evaluate the efficacy of second-line degarelix in patients with prostate cancer (PCa) after treatment failure with a luteinizing hormone-releasing hormone (LHRH) agonist.

METHODS

This 1-year exploratory, multicentre, open-label phase II trial was performed in 2 patient cohorts (Cohort 1, n = 25; Cohort 2, n = 12) in Germany. Patients with castrate-resistant PCa after primary hormonal treatment received degarelix 240 mg, followed by 11 monthly maintenance doses of 80 mg. The primary endpoint was the proportion of patients with decreasing/stable prostate-specific antigen (PSA) (relative change ⩽+10% of baseline PSA) after 3 months.

RESULTS

At Month 3, the response rate (intention-to-treat, last observation carried forward analysis) was 16.7% [95% confidence interval (CI): 4.74-37.38] in Cohort 1 and 33.3% (95% CI: 9.92-65.11) in Cohort 2. The probability of completing 12 months without PSA progression was 8.8% (95% CI: 1.51-24.3) in Cohort 1 and 8.3% (95% CI: 0.5-31.1) in Cohort 2. Degarelix was well tolerated; the most frequently reported adverse events were local injection-site reactions.

CONCLUSIONS

In PCa patients who failed LHRH therapy, degarelix was well tolerated and achieved a limited PSA response. Phase III trials show that disease control benefits with degarelix versus agonists are more clearly demonstrated as first-line therapy.

Short time to first void is associated with lower whole-night sleep quality in nocturia patients

STUDY OBJECTIVE

To examine associations between diary-based reports of the time to first void and a commonly used measure of sleep across the entire night, the Pittsburgh Sleep Quality Index (PSQI).

DESIGN AND SETTING

Data from the Baseline phase of a large, multi-site, US-based, randomized clinical trial of a nocturia medication were analyzed. We examined age-adjusted associations between time to first void as reported in a 3-day diary and PSQI Global and individual subscale scores.

PATIENTS

757 patients with nocturia completing Baseline measurements.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Using quartile analysis, higher scores indicating poorer sleep on all PSQI scales were associated (p's ≤ 0.05) with short time to first void durations. Among individuals in the lowest quartile of time to first void (< 1.17 hours), the odds ratio (OR) of a PSQI Global score > 5 was nearly 3 times (2.96; 95% CI 1.75-5.01) that of those in the highest quartile (> 2.50 h). Shorter time to first void was associated with lower sleep quality, shorter sleep duration, poorer sleep efficiency, and greater daytime dysfunction.

CONCLUSIONS

Time to first void may serve as a valuable adjunctive, self-report measure for characterizing poor sleep among populations with nocturia.

Increases in duration of first uninterrupted sleep period are associated with improvements in PSQI-measured sleep quality

OBJECTIVE

Urology clinical trials assessing bladder function have relied on the self-reported duration of the first uninterrupted sleep period (FUSP) as a proxy outcome for sleep, but the relationship between this measure and more conventional self-reported measures of sleep is unknown. In this study, we examined the association between changes in FUSP and a widely used self-reported measure of sleep, the Pittsburgh Sleep Quality Index (PSQI).

METHODS

We conducted post hoc (secondary) analyses of unpublished data from a previously published randomized clinical trial (NCT00477490) of desmopressin (a medication used to treat nocturia) and examined relationships between baseline and 4-week change in FUSP and PSQI global and subscale scores for participants (N = 580 to N = 606) having complete data.

RESULTS

Data indicated strong associations between change in PSQI global score and FUSP change in six of seven subscale scores. A reduction of 1.8 points in the PSQI global score was associated with a 72-min lengthening of FUSP.

CONCLUSIONS

Results suggest that FUSP is a potentially valuable metric that correlates with changes in perceived sleep duration, depth, quality for the entire night, efficiency, latency, and daytime function. An increase in FUSP was related to improvement in nearly all PSQI subscales. The validity of this measure in the general population remains to be determined.

Desmopressin melt improves response and compliance compared with tablet in treatment of primary monosymptomatic nocturnal enuresis

Primary nocturnal enuresis is a prevalent childhood condition that can persist into adulthood. Desmopressin is an antidiuretic available as orally disintegrating lyophilisate (melt) or solid tablet. Recent findings suggesting different food interactions and clinical characteristics, including compliance, between desmopressin melt and tablet motivated a post hoc analysis of a previously reported randomised, crossover study. The efficacy of desmopressin melt compared with tablet was evaluated using the International Children's Continence Society (ICCS) responder definitions. Compliance was further analysed using detailed criteria, and the association between efficacy and compliance was examined. In total, 221 patients aged 5-15 years, already receiving desmopressin tablets were randomised to the treatment sequence melt (120/240 μg)/tablet (0.2/0.4 mg) or tablet/melt in two consecutive 3-week periods. The probability of being a responder (partial or full) during either period was significantly more likely with desmopressin melt compared with tablet (odds ratio, 2.0; confidence intervals, 1.07-3.73; p = 0.03). There was no period effect on compliance in the tablet/melt sequence and no difference in the number of completely compliant patients in each formulation group; however, more patients were >75 % compliant in period 1 compared with period 2 in the melt/tablet sequence. Increased compliance was associated with greater reductions in the number of wet nights for both formulations.

CONCLUSIONS

Desmopressin melt, compared with tablet, improves the probability of being a responder. Switching from tablet to melt formulation increased patient compliance. Increased compliance was associated with increased efficacy. Switching to desmopressin melt may benefit patients with suboptimal responses to desmopressin tablet.