Abstract
The relationship between male genitourinary conditions and sleep disorders has previously only been reported in single-institution studies with small cohorts. Our objective was to assess the association of erectile dysfunction (ED) and testosterone deficiency with various sleep disorders using a large claims database. The TriNetX Diamond database was queried in June 2022. In men aged 40–70 years, insomnia, sleep apnea, and circadian rhythm sleep disorder were each independently assessed to determine the association with ED and testosterone deficiency and then followed by propensity score matching performed for age, hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, tobacco usage, and obesity. Testosterone deficiency was more likely to be found in men diagnosed with sleep apnea (odds ratio (OR) 1.66 [95% confidence interval (CI) 1.65–1.67]), insomnia (OR 1.74 [95% CI 1.73–1.76]), and circadian rhythm dysfunction (OR 2.63 [95% CI 2.54–2.73]) compared to matched controls. ED was more likely to be found in men diagnosed with sleep apnea (OR 1.02 [95% CI 1.01–1.03]), insomnia (OR 1.30 [95% CI 1.30–1.31]), and circadian rhythm dysfunction (OR 1.54 [95% CI 1.49–1.59]) compared to matched controls. Our results emphasize the negative impact of poor sleep on diseases of the male genitourinary system by identifying these relationships in the largest cohort in the U.S. reported to date.
Similar content being viewed by others
Data availability
The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.
References
Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246–56. https://doi.org/10.1016/j.sleep.2016.08.006
Knudsen HK, Ducharme LJ, Roman PM. Job stress and poor sleep quality: Data from an American sample of full-time workers. Soc Sci Med. 2007;64:1997–2007. https://doi.org/10.1016/j.socscimed.2007.02.020
Wang Y, Mei H, Jiang YR, Sun WQ, Song YJ, Liu SJ, et al. Relationship between duration of sleep and hypertension in adults: a meta-analysis. J Clin Sleep Med. 2015;11:1047–56. https://doi.org/10.5664/jcsm.5024
Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care. 2015;38:529–37. https://doi.org/10.2337/dc14-2073
Wright KP, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev. 2013;17:41–54. https://doi.org/10.1016/j.smrv.2012.02.002
Åkerstedt T, Wright KP. Sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin. 2009;4:257–71. https://doi.org/10.1016/j.jsmc.2009.03.001
Deng N, Haney NM, Kohn TP, Pastuszak AW, Lipshultz LI. The effect of shift work on urogenital disease: a systematic review. Curr Urol Rep. 2018;19:57 https://doi.org/10.1007/s11934-018-0815-y
Roth T Insomnia: Definition, Prevalence, Etiology, and Consequences. J Clin Sleep Med. 2007;3 (5 suppl). https://doi.org/10.5664/jcsm.26929
Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population. Chest. 2006;130:780–6. https://doi.org/10.1378/chest.130.3.780
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70–81. https://doi.org/10.1016/j.smrv.2016.07.002
Cho JW, Duffy JF. Sleep, sleep disorders, and sexual dysfunction. World J Men’s Health. 2019;37:261 https://doi.org/10.5534/wjmh.180045
Kohn TP, Kohn JR, Haney NM, Pastuszak AW, Lipshultz LI. The effect of sleep on men’s health. Transl Androl Urol. 2020;9:S178–S185. https://doi.org/10.21037/tau.2019.11.07
Deng N, Kohn TP, Lipshultz LI, Pastuszak AW. The relationship between shift work and men’s health. Sex Med Rev. 2018;6:446–56. https://doi.org/10.1016/j.sxmr.2017.11.009
Kohn TP, Rodriguez KM, Sigalos JT, Hasan A, Pastuszak AW, Lipshultz LI. PD27-08 poor sleep quality is associated with clinically significant erectile dysfunction. J Urol. 2018;199(4S). https://doi.org/10.1016/j.juro.2018.02.1359
Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med. 2007;8:613–22. https://doi.org/10.1016/j.sleep.2006.09.011
Shlykova N, Davidson E, Krakowsky Y, Bolanos J, Traish A, Morgentaler A. Absent diurnal variation in serum testosterone in young men with testosterone deficiency. J Urol. 2020;203:817–23. https://doi.org/10.1097/JU.0000000000000630
Seehuus M, Pigeon W. The sleep and sex survey: relationships between sexual function and sleep. J Psychosom Res. 2018;112:59–65. https://doi.org/10.1016/j.jpsychores.2018.07.005
Luboshitzky R, Zabari Z, Shen-Orr Z, Herer P, Lavie P. Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab. 2001;86:1134–9. https://doi.org/10.1210/jcem.86.3.7296
Lateef OM, Akintubosun MO. Sleep and reproductive health. J Circadian Rhythms. 2020;18:1 https://doi.org/10.5334/jcr.190
Teloken PE, Smith EB, Lodowsky C, Freedom T, Mulhall JP. Defining association between sleep apnea syndrome and erectile dysfunction. Urology. 2006;67:1033–7. https://doi.org/10.1016/j.urology.2005.11.040
Mun JK, Choi SJ, Kang MR, Hong SB, Joo EY. Sleep and libido in men with obstructive sleep apnea syndrome. Sleep Med. 2018;52:158–62. https://doi.org/10.1016/j.sleep.2018.07.016
Fanfulla F, Malaguti S, Montagna T, Salvini S, Bruschi C, Crotti P, et al. Erectile dysfunction in men with obstructive sleep apnea: an early sign of nerve involvement. Sleep 2000;23:775–81.
Budhiraja R, Parthasarathy S, Quan SF. Endothelial dysfunction in obstructive sleep apnea. J Clin Sleep Med. 2007;3:409–15.
Li Z, Tang T, Wu W, Gu L, Du J, Zhao T, et al. Efficacy of nasal continuous positive airway pressure on patients with OSA with erectile dysfunction and low sex hormone levels. Respir Med. 2016;119:130–4. https://doi.org/10.1016/j.rmed.2016.09.001
Zhang XB, Lin QC, Zeng HQ, Jiang XT, Chen B, Chen X. Erectile dysfunction and sexual hormone levels in men with obstructive sleep apnea: efficacy of continuous positive airway pressure. Arch Sex Behav. 2016;45:235–40. https://doi.org/10.1007/s10508-015-0593-2
Bakker JP, Weaver TE, Parthasarathy S, Aloia MS. Adherence to CPAP. Chest. 2019;155:1272–87. https://doi.org/10.1016/j.chest.2019.01.012
Kuhn E, Schwarz EI, Bratton DJ, Rossi VA, Kohler M. Effects of CPAP and mandibular advancement devices on health-related quality of life in OSA. Chest. 2017;151:786–94. https://doi.org/10.1016/j.chest.2017.01.020
Melehan KL, Hoyos CM, Hamilton GS, Wong KK, Yee BJ, McLachlan RI, et al. Randomized trial of CPAP and Vardenafil on erectile and arterial function in men with obstructive sleep apnea and erectile dysfunction. J Clin Endocrinol Metab. 2018;103:1601–11. https://doi.org/10.1210/jc.2017-02389
Chen L, Shi GR, Huang DD, Li Y, Ma CC, Shi M, et al. Male sexual dysfunction: a review of literature on its pathological mechanisms, potential risk factors, and herbal drug intervention. Biomedicine Pharmacother. 2019;112:108585 https://doi.org/10.1016/j.biopha.2019.01.046
Pastuszak AW, Moon YM, Scovell J, Badal J, Lamb DJ, Link RE, et al. Poor sleep quality predicts hypogonadal symptoms and sexual dysfunction in male nonstandard shift workers. Urology. 2017;102:121–5. https://doi.org/10.1016/j.urology.2016.11.033
Author information
Authors and Affiliations
Contributions
PA: Conceptualization, Methodology, Formal Analysis, Writing, Visualization. SMS: Formal Analysis, Writing, Visualization. CA: Writing. TPK: Conceptualization, Methodology, Formal Analysis, Writing, Visualization, Supervision. ASH: Conceptualization, Supervision.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Agrawal, P., Singh, S.M., Able, C. et al. Sleep disorders are associated with testosterone deficiency and erectile dysfunction—a U.S. claims database analysis. Int J Impot Res 36, 78–82 (2024). https://doi.org/10.1038/s41443-022-00649-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-022-00649-2
- Springer Nature Limited
This article is cited by
-
Does testosterone influence the association between sleep and frailty in men: results from the European Male Aging Study
BMC Geriatrics (2023)
-
Assessing physiologic changes during sexual activity using wearable devices: a pilot study
International Journal of Impotence Research (2023)
-
Comment on: “Risk of Erectile Dysfunction in Male Patients with Gout Treated with Febuxostat or Allopurinol: A Propensity Score-Matched Cohort Study”
Drugs (2023)