Sexual dysfunction is a prevalent health issue among men, encompassing conditions such as erectile dysfunction (ED), premature ejaculation (PE), and reduced libido. ED, the most common form, affects approximately 40% of men at age 40 and nearly 70% at age 70. Psychological factors, including depression and anxiety, exacerbate its impact. Sleep disorders, particularly insomnia and obstructive sleep apnea (OSA), significantly influence sexual function by disrupting hormonal balance and vascular function. This systematic review evaluates the relationship between sleep disorders, sleep quality, and sleep duration with male sexual dysfunction.

A comprehensive literature search was conducted in Embase, MEDLINE, and Google Scholar until November 30, 2024. The review followed PRISMA guidelines and included studies assessing sleep disorders and male sexual dysfunction. Cross-sectional, longitudinal observational, and cohort studies were included, while case reports, reviews, animal studies, and non-English publications were excluded. Data extracted included study type, sample size, sleep disorder type, evaluation methods, and sexual dysfunction parameters. Study quality was assessed using the Newcastle-Ottawa Scale.

A total of 42 studies, covering 43 different samples, were included. The majority focused on OSA (n=31), followed by restless leg syndrome (n=3) and shift work sleep disorder (n=2). Erectile dysfunction (ED) was the most assessed condition, followed by premature ejaculation (PE). The Apnea-Hypopnea Index (AHI) was the primary diagnostic tool for OSA, while the Pittsburgh Sleep Quality Index (PSQI) was commonly used for sleep quality assessment. The International Index of Erectile Function (IIEF-5 and IIEF-15) was the predominant tool for ED evaluation. Studies reported significant variations in sexual dysfunction prevalence. In severe OSA cases, ED prevalence reached 100%, while some studies reported lower rates. AHI scores correlated with ED severity, with ED prevalence increasing from 23.6% in mild OSA to 59.7% in severe OSA. Sleep quality and duration were also linked to sexual dysfunction; individuals with poor sleep quality exhibited higher ED and PE prevalence. Furthermore, comorbidities such as obesity, hypertension, diabetes, hyperlipidemia, and smoking were frequently associated with both sleep and sexual dysfunction.

This review highlights the multifactorial relationship between sleep disturbances and sexual dysfunction. The correlation between higher OSA severity and increased BMI, diabetes prevalence, and sexual dysfunction suggests a complex interplay between metabolic and vascular health. CPAP therapy showed promising results in improving erectile function, although findings were mixed regarding its superiority to sildenafil. Psychological factors, including depression, further complicated the relationship between sleep disorders and sexual dysfunction.
While most studies supported a strong link between sleep disorders and SD, some found inconsistent results, underscoring the need for standardized methodologies and larger longitudinal studies. The bidirectional nature of sleep and sexual health requires an integrated approach, including psychological evaluation, metabolic management, and targeted sleep interventions.

This systematic review underscores the significant association between sleep disorders and male sexual dysfunction, particularly in OSA and poor sleep quality. Screening for sleep disorders should be incorporated into clinical evaluations of ED, and interventions such as CPAP therapy, cognitive behavioral therapy for insomnia, and circadian rhythm regulation may improve both sleep and sexual health outcomes. Future research should focus on larger, longitudinal studies and interventional trials to clarify causal mechanisms and optimize treatment strategies.

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. The Journal of urology. 1994;151(1):54-61. Epub 1994/01/01. doi: 10.1016/s0022-5347(17)34871-1. PubMed PMID: 8254833.
2.	Patel DV, Halls J, Patel U. Investigation of erectile dysfunction. The British journal of radiology. 2012;85 Spec No 1(Spec Iss 1):S69-78. Epub 2012/11/09. doi: 10.1259/bjr/20361140. PubMed PMID: 23118101; PubMed Central PMCID: PMCPMC3746402.
3.	Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nature reviews Disease primers. 2016;2:16003. Epub 2016/05/18. doi: 10.1038/nrdp.2016.3. PubMed PMID: 27188339; PubMed Central PMCID: PMCPMC5027992.