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.
Subscribe to Journal
Get full journal access for 1 year
only $37.38 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
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.
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.
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.
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.
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.
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.
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.
Khafagy AH. Treatment of obstructive sleep apnoea as a therapeutic modality for associated erectile dysfunction. Int J Clin Pract. 2012;66:1204–8.
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.
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.
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.
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.
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.
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.
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.
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.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.
Kroenke K, Spitzer RL, Williams JB. Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep. 2001;2:297–307.
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.
De Wit LM, Straten AV, Herten MV. Depression and body mass index, a u-shaped association. BMC Public Health. 2009;9:14.
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.
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.
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.
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.
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.
Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305:2173–4.
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.
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.
We would like to thank Anna-Marie Hosking for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
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
The Journal of Sexual Medicine (2019)
The effect of soy isoflavone combined with calcium on bone mineral density in perimenopausal Chinese women: a 6-month randomised double-blind placebo-controlled study
International Journal of Food Sciences and Nutrition (2019)