Cognitive-emotional associations between non-restorative sleep and erectile dysfunction: the role of rumination...

Erectile dysfunction (ED) is a prevalent male health condition that substantially correlates with impaired sexual function and reduced overall quality of life. Non-restorative sleep (NRS), a prevalent subjective sleep disturbance, has recently been identified as an under-recognized factor linked to ED. Nonetheless, the psychological factors involved in the association between NRS and ED remain poorly clarified. Rumination and psychological resilience are two promising psychological variables that may participate in this correlational pathway yet have not been empirically examined in the NRS-ED context. The present study aimed to explore the potential indirect correlational link between NRS and ED through rumination, and further evaluate whether resilience moderates this associative pathway.

Between February 2024 October 2025, we conducted a cross-sectional study of 880 men with ED recruited from the Andrology Clinic of the First Affiliated Hospital of Anhui Medical University. Participants completed the NRS Scale (lower scores indicate more severe NRS), Ruminative Responses Scale, 10-item Connor-Davidson Resilience Scale, and the 5-item International Index of Erectile Function (IIEF-5). Pearson correlations, bootstrapped mediation, and moderated mediation models with covariate adjustment, and latent profile analysis (LPA) in Mplus were performed to identify rumination subgroups and compare erectile function across profiles.

Non-restorative sleep severity was significantly associated with worse ED and elevated rumination (all P < .001). Rumination partially mediated the association between NRS and ED. Exploratory LPA identified 3 statistical patterns representing sample heterogeneity in rumination severity (low 28.86%, moderate 43.18%, high 27.96%), rather than clinically distinct phenotypes. Higher rumination severity corresponded to significantly poorer erectile function (high vs. low severity IIEF-5 scores: 8.92 ± 3.84 vs. 14.95 ± 5.03). Resilience significantly moderated this pathway, acting as a buffer that attenuated both the effect of NRS on rumination and the subsequent impact of rumination on ED.

Our findings demonstrate that NRS is linked to ED via a ruminative associational pattern, and this association varies across levels of resilience. These findings suggest that integrated therapeutic strategies targeting these cognitive-emotional factors could facilitate more personalized clinical management for patients.