Evaluating the complex interplay between androgen deprivation therapy, sleep disturbance and nocturia in prostate cancer. A systemic review of prospective studies, and consideration of the emerging role of transdermal oestrogen.urbance and nocturia in prostate cancer. A systemic review of prospective studies, and consideration of the emerging role of transdermal oestrogen.

Stephen Mangar; Sara Elsharkawy; Livia Airoldi; Dagmara Dimitriou

doi:10.1530/endoabs.109.S7.3

S7.3

Prev Next

Section Contents Cite

Endocrine Abstracts (2025) 109 S7.3 | DOI: 10.1530/endoabs.109.S7.3

SFEBES2025 Symposia Frontiers in Non Reproductive Actions of Sex Hormones Across the Lifecourse (3 abstracts)

Evaluating the complex interplay between androgen deprivation therapy, sleep disturbance and nocturia in prostate cancer. A systemic review of prospective studies, and consideration of the emerging role of transdermal oestrogen.

Stephen Mangar¹ , Sara Elsharkawy¹ , Livia Airoldi² & Dagmara Dimitriou²

Author affiliations

¹ Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK. ²Sleep Education and Research Laboratory, Psychology and Human Development, UCL Institute of Education, London, WC1H 0AA, UK.

Insomnia in prostate cancer patients is common especially in those receiving androgen deprivation therapy (ADT). This review considers the evidence from prospective clinical trials exploring the impact ADT (mainly with LHRH analogue injections) has on sleep disturbance and will consider the relative contribution of hot flushes / night sweats as well as nocturia a common symptom associated with prostate cancer to insomnia. In addition, some initial investigations utilising transdermal oestrogen patches (tE2) will be presented as an alternative to LHRH analogue injections.

A review was performed and identified 17 studies reporting on sleep disturbance and androgen deprivation therapy involving a total of 1417 patients. 7 were prospective non-randomised studies, 3 of which did not utilise an objective method of sleep assessment, and only 2 had a baseline assessment.

The studies showed consistently that up to 68% patients on ADT subjectively reported poor sleep using self-reported questionnaires. Specifically, there was an increased prevalence of insomnia (as determined by the Insomnia Severity Index) in the order of 32-38%. The most frequently reported actigraphy parameters were the fragmentation index (FI), wake associated sleep onset (WASO), and daytime napping. The studies consistently showed a higher FI (>40%), and WASO (approximately 80-90 minutes), with a trend towards increase daytime napping, suggesting that those on ADT find it difficult to stay asleep at night with a more fragmented sleep pattern, for which they compensate by taking more daytime naps. There is conflicting data about the role of nocturia and the relative contribution this has on sleep disturbance compared to hot flash interference. In a subset analysis on 5 patients receiving tE2, preliminary investigations showed that they spent less time in bed at night with less nocturnal wakings and reduced daytime napping. Further studies are underway to better characterise the sleep profile in patients on tE2.