https://doi.org/10.4081/aiua.2026.15659
Sleep disorders and male sexual dysfunction: a meta-analysis of hormonal and erectile outcomes
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Published: 7 September 2026
Background: Sleep disruptions, including insomnia and obstructive sleep apnea (OSA), are strongly linked to male sexual dysfunction, affecting libido, erectile function, and hormonal balance. This metaanalysis aimed to evaluate the relationship between sleep disorders and male sexual function.
Methods: A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect through September 2025 identified 9 peer-reviewed studies examining the impact of sleep disorders on male sexual health. The Newcastle-Ottawa Scale was used to assess the risk of bias. A meta-analysis was performed to evaluate outcomes, including the International Index of Erectile Function (IIEF), testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels, with a subgroup analysis comparing OSA and shift work sleep disorder (SWSD). Statistical analyses were conducted using R version 4.2.2.
Results: Across seven studies (n = 913), the pooled mean IIEF score was approximately 16, indicating moderate erectile dysfunction, though heterogeneity was high (I² = 97.3%). Subgroup analysis revealed lower IIEF scores in OSA patients (≈14.4) compared to SWSD patients (≈17.5), suggesting more severe dysfunction in OSA. Hormonal analysis (n = 325) showed significantly lower testosterone levels in OSA (≈7-9 nmol/L) versus SWSD (≈20 nmol/L). FSH and LH were elevated in OSA (≈3.8-5.8 IU/L and 3.3-3.9 IU/L, respectively) compared to SWSD (≈2.2 IU/L and 1.8 IU/L). High heterogeneity indicated substantial variation in study design and populations.
Conclusions: Both OSA and SWSD impair sexual and hormonal function, but OSA causes greater erectile and endocrine disruption. Even mild OSA was associated with reduced erectile performance, with the severity worsening dysfunction. Despite consistent trends, high heterogeneity warrants cautious interpretation. Future research should employ standardized tools and uniform populations to clarify mechanisms linking sleep disorders to male sexual health.
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1. Kohn TP, Kohn JR, Haney NM, et al. The effect of sleep on men’s health. he effect of sleep on men’s health. 2019:S178-S85. DOI: https://doi.org/10.21037/tau.2019.11.07
2. Jannini EA, Nappi RE. Couplepause: A New Paradigm in Treating Sexual Dysfunction During Menopause and Andropause. Sex Med Rev. 2018; 6:384-95. DOI: https://doi.org/10.1016/j.sxmr.2017.11.002
3. Lue TF. Erectile dysfunction. N Engl J Med. 2000; 342:1802-13. DOI: https://doi.org/10.1056/NEJM200006153422407
4. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994; 151:54-61. DOI: https://doi.org/10.1016/S0022-5347(17)34871-1
5. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270:83-90. DOI: https://doi.org/10.1001/jama.1993.03510010089036
6. Andersen ML, Gozal D, Tufik S. Exploring the link between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction: implications for male sexual health. Sex Med Rev. 2025; 13:105-15. DOI: https://doi.org/10.1093/sxmrev/qeae068
7. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014; 37:9-17. DOI: https://doi.org/10.5665/sleep.3298
8. Cho JW, Duffy JF. Sleep, Sleep Disorders, and Sexual Dysfunction. World J Mens Health. 2019; 37:261-75. DOI: https://doi.org/10.5534/wjmh.180045
9. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed). 2021; 372.
10. Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997; 49:822-30. DOI: https://doi.org/10.1016/S0090-4295(97)00238-0
11. Corona G, Rastrelli G, Vignozzi L, Maggi M. Androgens and male sexual function. Best Pract Res Clin Endocrinol Metab 2022;36(4):101615. DOI: https://doi.org/10.1016/j.beem.2022.101615
12. Oduwole OO, Huhtaniemi IT, Misrahi M. The roles of luteinizing hormone, follicle-stimulating hormone and testosterone in spermatogenesis and folliculogenesis revisited. Int J Mol Sci. 2021; 22:12735. DOI: https://doi.org/10.3390/ijms222312735
13. Borenstein M, Hedges, LV, Higgins J, Rothstein H. Introduction to meta-analysis: Wiley; 2009. DOI: https://doi.org/10.1002/9780470743386
14. Bae JM. A suggestion for quality assessment in systematic reviews of observational studies in nutritional epidemiology. Epidemiol Health. 2016; 38:e2016014. DOI: https://doi.org/10.4178/epih.e2016014
15. Youssef MA, El Salmawy DA, Abd El Salam M. The Effect of Obstructive Sleep Apnea on Erectile function and Serum Testosterone Level Among Males: An Observational, Analytical Study. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2025; 26:1-8. DOI: https://doi.org/10.21608/ejentas.2025.342669.1801
16. Agrawal P, Singh SM, Able C, et al. Sleep disorders are associated with testosterone deficiency and erectile dysfunction-a U.S. claims database analysis. Int J Impot Res. 2024; 36:78-82.
17. Belladelli F, Li S, Zhang CA, et al. The Association Between Insomnia, Insomnia Medications, and Erectile Dysfunction. Eur Urol Focus. 2024; 10:139-45. DOI: https://doi.org/10.1016/j.euf.2023.08.005
18. Kim H, Kim KT, Shin WC, et al. Erectile dysfunction in patient with obstructive sleep apnea: effects of continuous positive airway pressure. Aging Male. 2024; 27:2317165. DOI: https://doi.org/10.1080/13685538.2024.2317165
19. Zheng Z, Pan J, Chen Z, et al. The association between shift work, shift work sleep disorders and premature ejaculation in male workers. BMC public health. 2024; 24:1772. DOI: https://doi.org/10.1186/s12889-024-19141-1
20. Rodriguez KM, Kohn TP, Kohn JR, et al. Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function. J Sex Med. 2020; 17:1687-93. DOI: https://doi.org/10.1016/j.jsxm.2020.06.009
21. Pascual M, de Batlle J, Barbé F, et al. Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of Continuous Positive Airway Pressure (CPAP). PLoS One. 2018;13:e0201930. DOI: https://doi.org/10.1371/journal.pone.0201930
22. Li Z, Tang T, Wu W, 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. DOI: https://doi.org/10.1016/j.rmed.2016.09.001
23. İ rer B, Çelikhisar A, Çelikhisar H, et al. Evaluation of Sexual Dysfunction, Lower Urinary Tract Symptoms and Quality of Life in Men With Obstructive Sleep Apnea Syndrome and the Efficacy of Continuous Positive Airway Pressure Therapy. Urology. 2018;121:86-92. DOI: https://doi.org/10.1016/j.urology.2018.08.001
24. Dilixiati D, Kadier K, Laihaiti D, et al. The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis. J Sex Med. 2023;20:766-80. DOI: https://doi.org/10.1093/jsxmed/qdad054
25. Liu L, Kang R, Zhao S, et al. Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Sex Med. 2015; 12:1992-2003. DOI: https://doi.org/10.1111/jsm.12983
26. Zhong O, Liao B, Wang J, et al. Effects of Sleep Disorders and Circadian Rhythm Changes on Male Reproductive Health: A Systematic Review and Meta-analysis. front Physiol. 2022; Volume 13. DOI: https://doi.org/10.3389/fphys.2022.913369
27. Agrawal P, Singh SM, Able C, et al. Sleep disorders are associated with testosterone deficiency and erectile dysfunction - a U.S. claims database analysis. Int J Impot Res.2024; 36:78-82. DOI: https://doi.org/10.1038/s41443-022-00649-2
28. Khaled HN, El-Helbawy RH, El Gayed EMA, Khalaf AM. Hypogonadism in men with obstructive sleep apnea and its related risk factors. Egyptian Journal of Dermatology and Venerology. 2023;43:144-50. DOI: https://doi.org/10.4103/ejdv.ejdv_40_22
29. Zhang W, Wu X, Zhang Y, et al. Association between obstructive sleep apnea and male reproductive function: a cross-sectional study with stratified analysis. Front Endocrinol (Lausanne). 2025;16:1636484. DOI: https://doi.org/10.3389/fendo.2025.1636484
30. DI Bello F, Califano G, Collà Ruvolo C, et al. Erectile dysfunction and obstructive sleep apnea syndrome: a post-hoc evaluation of Italian survey results. Minerva Urol Nephrol. 2025;77:538-545. DOI: https://doi.org/10.23736/S2724-6051.24.05925-1
Ethics Approval
CRediT authorship contribution
M. Almurayyi: protocol development, manuscript writing, manuscript review, S.T. Alshahrani: protocol development, manuscript writing, manuscript review, W.I. Alshardi: data collection, manuscript writing, editing, and manuscript review. M.A. Alshahrani: data analysis, manuscript writing., A.A. Asiri: data collection and manuscript review, K.M. Al- Ghamdi: data collection and manuscript review, M.A. Alhifthi: data collection, manuscript writing, editing, and manuscript review, M. Alshahrani: data collection and manuscript review, O. Safar: protocol development, manuscript writing, editing, manuscript review.
Supporting Agencies
Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
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