Increased Risk of ED Among Patients With Sleep Disorders

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Increased Risk of ED Among Patients With Sleep Disorders

Abstract and Introduction


Aims: Few studies have investigated the relationship between sleep disorders (SD) and erectile dysfunction (ED). Therefore, this study explored whether patients with SD in an Asian population are at an increased risk of developing ED.

Methods: This longitudinal nationwide population-based cohort study investigated the incidence and risk of developing ED in 34,548 men newly diagnosed with SD between 2002 and 2008 from the National Health Insurance Research Database. A total of 138,192 controls without SD were randomly recruited from the general population and frequency matched according to age and sex. The follow-up period began from the date of entering the study cohort until the date of an ED event, censoring, or 31 December 2010. We conducted Cox proportional hazard regression analyses to estimate the effects of SD on the risk of ED.

Results: The SD cohort had a 2.11-fold adjusted hazard ratio (HR) of subsequent ED development compared with the non-SD cohort [95% confidence interval (CI) = 1.89–2.37]. The incidence of ED increased with age for both cohorts and was higher for the patients in the SD cohort. Compared with the participants without SD or comorbidities, the patients without SD with any comorbidity exhibited a 1.79-fold risk of developing ED (95% CI = 1.54–2.09); the highest risk was for those with both SD and any comorbidity (HR = 3.34, 95% CI = 2.82–3.95). Furthermore, SD patients who had a particular number of comorbidities showed the dose–response effect of developing ED.

Conclusion: This nationwide cohort study determined that ED risk evidently increased in SD patients compared with the general population.


Erectile dysfunction (ED) affects millions of men worldwide and is characterised by the inability to attain or maintain penile erection during sexual activity. The prevalence of this condition increases with age. Feldmen et al. used a self-administered questionnaire as part of the Massachusetts Male Aging Study and reported that ED affects approximately 40% of men at age 40; this rate increases to nearly 70% of men at age 70. Because men with ED may be embarrassed to discuss such information with their physicians, it still remains an under-diagnosed and under-treated condition that impairs quality of life for the individual and potentially for his partner.

A sleep disorder (SD) is defined as difficulty falling or staying asleep, falling asleep at erratic times, or too much sleep. The association is evident between sleep disorders and comorbidities, such as prior psychiatric disorders, circulatory diseases, and, gastrointestinal diseases. Recent studies have reported that SDs may predispose patients to the risks of cardiovascular and cerebrovascular events.

A high proportion of men with chronic stable coronary artery disease have ED, which in turn has been reported to be a predictor of ischemic heart diseases. However, the relationship between SD and ED remains unclear. Therefore, we explored the association of SD with the development of ED in Taiwan. The results are from a nationwide population-based cohort study assessing the possibilities of the increased risk of ED among SD patients.

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