Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Patients presenting to a Men’s Health clinic are at higher risk for depression, insomnia, and sleep apnea

Abstract

Depression and sleep problems are highly prevalent disorders that are often comorbid with other medical disorders. We evaluated the prevalence and associations of these conditions in patients presenting to a Men’s Health clinic. In this retrospective study, 124 patients presenting to a Men’s Health clinic completed three urological questionnaires (International Index of Erectile Function [IIEF-5], International Prostate Symptom Score [IPSS], and Androgen Deficiency in Aging Males [ADAM]); and four non-urological questionnaires (Patient Health Questionnaire for depression [PHQ-9], STOP-BANG Sleep Apnea [OSA STOP-BANG], Insomnia Severity Index [ISI], and Epworth Sleepiness Scale [ESS]). Questionnaire results were evaluated in conjunction with patient clinical history and associated laboratory values via univariate and multivariate analysis. The mean age of the study participants was 54.1 years (SD 16). Comorbidities included hypertension (22.5%), vascular disease (15%), and diabetes mellitus (13.3%). Body Mass Index (BMI) was >25 in 77.3%. IIEF-5 scores were moderate-severe in 47.9%, ADAM questionnaire was positive in 79%, and IPSS scores were moderate-severe in 42.9% of patients. PHQ-9 demonstrated mild-severe depression in 38.6%, STOP-BANG showed intermediate-high risk for sleep apnea in 55.2%, ISI indicated moderate-severe insomnia in 18.1%, and ESS revealed mild-severe sleepiness in 16.6% of participants. On univariate analysis, BMI was associated with scores on the PHQ-9 (p = 0.035), STOP-BANG (p < 0.001), and ESS (p < 0.006). On multivariate analysis, positive ADAM questionnaire was associated with STOP-BANG (OR 3.29, 95% CI: 1.012–10.69), and IPSS with PHQ-9 (OR 4.64, 95% CI: 1.40–15.43) and ISI (OR 3.27, 95% CI: 1.06–10.1). Overall, patients presenting to a Men’s Health Clinic were found to have high prevalence rates for risk of depression, insomnia and sleep apnea. Risks were elevated in older subjects, and those with increased BMI, hypogonadism, and lower urinary tract symptoms. Appropriate screening and referral to appropriate specialists are encouraged.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151:54–61.

    CAS  Article  Google Scholar 

  2. 2.

    Roumeguère T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC. Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol. 2003;44:355–9.

    Article  Google Scholar 

  3. 3.

    Sanjay S, Bharti GS, Manish G, Rajeev P, Agrawal P, Puspalata A, et al. Metabolic syndrome: an independent risk factor for erectile dysfunction. Indian J Endocrinol Metab. 2015;19:277–82.

    Article  Google Scholar 

  4. 4.

    Chew KK, Finn J, Stuckey B, Gibson N, Sanfilipp F, Bremner A, et al. Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: findings from a linked-data study. J Sex Med. 2010;7:192–202.

    Article  Google Scholar 

  5. 5.

    Eisenberg ML, Li S, Cullen MR, Baker LC. Increased risk of incident chronic medical conditions in infertile men: analysis of United States claims data. Fertil Steril. 2016;105:629–36.

    Article  Google Scholar 

  6. 6.

    Sakalis VI, Karavitakis M, Bedretdinova D, Bach T, Bosch JLHR, Gacci M, et al. Medical treatment of nocturia in men with lower urinary tract symptoms: systematic review by the European Association of Urology Guidelines Panel for male lower urinary tract symptoms. Eur Urol. 2017;72:757–69.

    Article  Google Scholar 

  7. 7.

    Kalejaiye O, Raheem AA, Moubasher A, Capece M, McNeillis S, Muneer A, et al. Sleep disorders in patients with erectile dysfunction. BJU Int. 2017;120:855–60.

    Article  Google Scholar 

  8. 8.

    Khafagy AH. Treatment of obstructive sleep apnoea as a therapeutic modality for associated erectile dysfunction. Int J Clin Pract. 2012;66:1204–8.

    CAS  Article  Google Scholar 

  9. 9.

    Rosen R, Catania J, Lue T, Althof S, Henne J, Hellstrom W, et al. Impact of Peyronie’s disease on sexual and psychosocial functioning: qualitative findings in patients and controls. J Sex Med. 2008;5:1977–84.

    Article  Google Scholar 

  10. 10.

    Pastuszak AW, Badhiwala N, Lipshultz LI, Khera M. Depression is correlated with the psychological and physical aspects of sexual dysfunction in men. Int J Impot Res. 2013;25:194–9.

    CAS  Article  Google Scholar 

  11. 11.

    Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med. 1998;60:458–65.

  12. 12.

    Huang CL, Wu MP, Ho CH, Wang JJ. The bidirectional relationship between anxiety, depression, and lower urinary track symptoms: a nationwide population-based cohort study. J Psychosom Res. 2017;100:77–82.

    Article  Google Scholar 

  13. 13.

    Barry MJ, Fowler FJ, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association Symptom Index for benign prostatic hyperplasia. J Urol. 1992;148:1549–57.

    CAS  Article  Google Scholar 

  14. 14.

    Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    CAS  Article  Google Scholar 

  15. 15.

    Mohamed O, Freundlich RE, Dakik HK, Grober ED, Najari B, Lipshultz LI, et al. The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism. Int J Imp Res. 2010;22:20–4.

    CAS  Article  Google Scholar 

  16. 16.

    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.

    Article  Google Scholar 

  17. 17.

    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.

    CAS  Article  Google Scholar 

  18. 18.

    Kroenke K, Spitzer RL, Williams JB. Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.

    CAS  Article  Google Scholar 

  19. 19.

    Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep. 2001;2:297–307.

    Article  Google Scholar 

  20. 20.

    Kocalevent RD, Hinz A, Brähler E. Standardization of the depression screener Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2013;35:551–5.

    Article  Google Scholar 

  21. 21.

    De Wit LM, Straten AV, Herten MV. Depression and body mass index, a u-shaped association. BMC Public Health. 2009;9:14.

    Article  Google Scholar 

  22. 22.

    Ogden C, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D. Trends in obesity in the United States, 1988–94 through 2013–4. JAMA. 2016;315:2292–9.

    CAS  Article  Google Scholar 

  23. 23.

    Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA. Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol. 2001;166:563–8.

    CAS  Article  Google Scholar 

  24. 24.

    Glover L, Gannon K, McLoughlin J, Emberton M. Men’s experiences of having lower urinary tract symptoms: factors relating to bother. BJU Int. 2004;94:563–7.

    Article  Google Scholar 

  25. 25.

    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.

    Article  Google Scholar 

  26. 26.

    Endeshaw YW, Schwarts AV, Stone K. Health ABC Study. Nocturia, insomnia symptoms and mortality among older men: the health, aging, and body composition study. J Clin Sleep Med. 2016;12:789–96.

    Article  Google Scholar 

  27. 27.

    Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305:2173–4.

    Article  Google Scholar 

  28. 28.

    Reynolds AC, Dorrian J, Liu PY,  Van Dongen HP, Wittert GA, Harmer LJ, et al. Impact of five nights of sleep restriction on glucose metabolism, leptin, and testosterone in young adult men. PLoS ONE. 2012;7:41218.

    Article  Google Scholar 

  29. 29.

    Macrea MM, Martin TJ, Zagrean L. Infertility and obstructive sleep apnea: the effect of continuous positive airway pressure therapy on serum prolactin levels. Sleep Breath. 2010;14:253–7.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Anna-Marie Hosking for this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Faysal A. Yafi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Walia, A.S., Lomeli, L.d.J.M., Jiang, P. et al. Patients presenting to a Men’s Health clinic are at higher risk for depression, insomnia, and sleep apnea. Int J Impot Res 31, 39–45 (2019). https://doi.org/10.1038/s41443-018-0057-z

Download citation

Further reading

Search

Quick links