Disrupted Circadian Rhythm as a Mediator of Autonomic Dysregulation and Overactive Bladder in Men with Benign Prostatic Hyperplasia

Overactive bladder (OAB) and nocturnal polyuria (NP) significantly impact quality of life, particularly in aging men with benign prostatic hyperplasia (BPH). While often managed as localized lower urinary tract issues, emerging evidence suggests a complex interplay involving systemic factors. This mini-review explores the hypothesis that BPH-induced sleep disruption, primarily via nocturia, can trigger a cascade involving central circadian dysregulation, subsequent autonomic nervous system (ANS) imbalance, and hormonal shifts (including antidiuretic hormone and testosterone) that ultimately contribute to OAB symptoms and NP. Conditions such as obstructive sleep apnea can exacerbate this cycle. Manifestations of ANS dysfunction, such as altered heart rate variability and nondipping blood-pressure patterns, are increasingly recognized in these patients. Current pharmacological treatments for OAB such as anticholinergic agents and β3-adrenoceptor agonists, may primarily address the downstream consequences of ANS dysregulation. This intricate network highlights the potential need for integrated management strategies targeting sleep, circadian health, and ANS balance alongside traditional urological approaches. Patient summary: Older men often experience frequent nighttime urination (nocturia) associated with an enlarged prostate gland. This review discusses how the resulting poor sleep can disrupt the body's internal clock and control of the nervous system. This disruption can worsen bladder problems such as overactive bladder and increase nighttime urine production, and can potentially affect heart rate patterns and blood pressure. This suggests that managing sleep and the body's rhythms might be important alongside standard bladder treatments for these patients.