# Sex-Related Differences in the Association Between Sleep Apnea and Subsequent Urinary Incontinence Diagnosis

## TL;DR

This study finds that sleep apnea is linked to a higher risk of urinary incontinence, especially in middle-aged women.

## Contribution

The study identifies sex- and age-specific differences in the sleep apnea-urinary incontinence association using a large German cohort.

## Key findings

- Sleep apnea is significantly associated with urinary incontinence in females (HR: 1.38) but not in males.
- The strongest association in females occurs in the 51–60 age group (HR: 1.98).
- No significant association was found between sleep apnea and urinary incontinence in males.

## Abstract

Objective: An association between sleep apnea and various urological symptoms has been reported in the literature. Therefore, the aim of this study is to analyze sex-related differences in the association between sleep apnea und subsequent urinary incontinence diagnosis. Methods: This study examined the incidence of urinary incontinence in a matched pair cohort with and without sleep apnea treated in 1293 general practices in Germany between January 2005 and December 2022 (74,453 vs. 372,256 individuals). The five-year cumulative incidence of urinary incontinence in the cohorts with and without sleep apnea was studied using Kaplan–Meier curves and log-rank tests. Finally, a univariable Cox regression analysis was conducted to assess the association between sleep apnea and urinary incontinence. Stratified analyses were conducted by sex (male/female) and age group (18–50 years, 51–60 years, 61–70 years, >70 years). Results: Sleep apnea was significantly associated with urinary incontinence as compared to individuals without sleep disorder diagnosis (5.1% vs. 4.3%; p < 0.001), and this association remained robust in females (HR: 1.38; 95% CI: 1.29–1.46), but not in males (HR: 1.02; 95% CI: 0.96–1.08) In females, the association was strongest in the age group 51–60 years (HR: 1.98; 95% CI: 1.71–2.30). Conclusions: In conclusion, this study reports a significant association between sleep apnea and subsequent urinary incontinence diagnosis. Sex- and age-related differences should be taken into account, as associations were stronger for middle-aged females followed by younger females and no significant association was found regarding males.