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


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.

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Authors and Affiliations



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.

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Correspondence to Taylor P. Kohn.

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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).

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