Clocks & Sleep · Nov 7, 2025

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

By Becker LI, Vetter C, Kostev K et al.

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.

doi.org/10.3390/clockssleep7040065Open accessPubMed 41283314Populations