Association between sleep quality and the occurrence of lower urinary tract symptoms among female nurses: Mediating roles of anxiety and depression.

OBJECTIVES

Lower urinary tract symptoms (LUTS) are common among female nurses. However, the occupational contributors and underlying mechanisms remain insufficiently understood. This study examined whether sleep quality predicts the occurrence of LUTS among female nurses and whether anxiety and depression mediate this relationship.

METHODS

This study utilized baseline and first-wave follow-up data from the Nurse Urinary Related Health Study. A total of 3565 female nurses without LUTS at baseline were followed up for a median of 2.81 years. LUTS were assessed via the Chinese version of the International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms. Sleep quality, anxiety, and depression were measured with the Chinese versions of the Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder 2-item, and Patient Health Questionnaire-2, respectively. Logistic regression, multinomial logistic regression, and mediation modeling were used to conduct statistical inference.

RESULTS

During the follow-up period, 1222 female nurses (34.3%) developed LUTS. Poor sleep quality was significantly associated with an increased risk of incident LUTS, with an odds ratio (OR) of 1.41 and 95% confidence interval (CI) of 1.16-1.71. Mediation analysis showed that changes in both anxiety and depression contributed to this association. The product distribution estimates for new-onset and persistent anxiety were 0.587 (95% CI 0.356-0.854) and 1.258 (95% CI 0.409-2.209), respectively, and for new-onset and persistent depression they were 0.604 (95% CI 0.349-0.895) and 0.761 (95% CI 0.029-1.569), respectively.

CONCLUSIONS

Poor sleep quality can contribute to LUTS both directly and indirectly, by triggering or sustaining anxiety and depression. Creating a sleep-supportive work environment and integrating education on sleep health and emotional strategies into routine professional training could be effective measures against LUTS for female nurses.