Unraveling the intersection of sleep disorders and erectile dysfunction: Outcomes from two EPISONO editions

There is growing interest in the relationship between sleep disorders and erectile dysfunction. We present the results from a 2015 follow-up study in relation to the 2007 edition of Epidemiologic Sleep Study (EPISONO), a population-based sleep study conducted in São Paulo, Brazil, and from the 4th edition of EPISONO (2018), with respect to the incidence and prevalence of erectile dysfunction, and the associated risk factors. We hypothesized that the presence of erectile dysfunction would be associated with total testosterone levels and obstructive sleep apnea in both longitudinal and cross-sectional analyses.

The participants underwent polysomnography, and testosterone assays were performed. They also completed a range of health questionnaires. The sample comprised men aged 20‒80 years. In the longitudinal analysis, incidence the (N = 256) and prevalence (N = 300) of erectile dysfunction were calculated, and a generalized estimating equation model was constructed. For the analysis of the data from 2018, prevalence (N = 314), binomial logistic regression, and mediation-moderation models were calculated.

An overall incidence of 10.55% of erectile dysfunction was found in the follow-up, which was higher in men older than 50 years. In the longitudinal model, older age (odds ratio = 1.09), more depression symptoms (odds ratio = 1.05), and low total testosterone concentration (odds ratio = 2.69) were significant predictors of erectile dysfunction. Psychological well-being (World Health Organization Quality of Life) was a predictor of lowered odds of having erectile dysfunction (odds ratio = 0.87). In EPISONO 2018, a 20.06% general prevalence of erectile dysfunction was identified, and this prevalence was higher in age groups over 50 years. The odds of having erectile dysfunction were increased by age (odds ratio = 1.07), and the psychological domain of World Health Organization Quality of Life was associated with lowered odds of having erectile dysfunction (odds ratio = 0.65). Mediation models revealed a statistically significant mediation of apnea‒hypopnea index between the effect of age on total testosterone. The model that included age as the independent variable, apnea‒hypopnea index as a mediator and erectile dysfunction as the outcome resulted in significant effects of age but not apnea‒hypopnea index.

This study highlights the importance of aging, psychological quality of life, testosterone concentration, and depressive symptoms in the context of erectile dysfunction. An association between obstructive sleep apnea and erectile dysfunction was observed, but it was not independent of age. The longitudinal results emphasize that, besides aging, these are modifiable factors that can be the subject of interventions to mitigate the development of erectile dysfunction over time.