Sleep disorders and male sexual dysfunction: a meta-analysis of hormonal and erectile outcomes.

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.