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.

  • Article
  • Published:

Sleep disorders are associated with testosterone deficiency and erectile dysfunction—a U.S. claims database analysis

International Journal of Impotence Research volume 36, pages 78–82 (2024)Cite this article

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

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

  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. Roth T Insomnia: Definition, Prevalence, Etiology, and Consequences. J Clin Sleep Med. 2007;3 (5 suppl). https://doi.org/10.5664/jcsm.26929

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  CAS  PubMed  Google Scholar 

  19. Lateef OM, Akintubosun MO. Sleep and reproductive health. J Circadian Rhythms. 2020;18:1 https://doi.org/10.5334/jcr.190

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. Budhiraja R, Parthasarathy S, Quan SF. Endothelial dysfunction in obstructive sleep apnea. J Clin Sleep Med. 2007;3:409–15.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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

    Article  CAS  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Pranjal Agrawal & Sajya M. Singh

  2. University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Corey Able

  3. The James Buchanan Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA

    Taylor P. Kohn & Amin S. Herati

Authors
  1. Pranjal Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sajya M. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corey Able
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taylor P. Kohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amin S. Herati
    View author publications

    You can also search for this author in PubMed Google Scholar

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

Correspondence to Taylor P. Kohn.

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.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-022-00649-2

This article is cited by

Search

Advanced search

Quick links