Association between obstructive sleep apnea and male sexual dysfunction: a prospective cohort study based on 155,688 participants from the UK Biobank

Abstract Obstructive Sleep Apnea (OSA) is a major public health issue, and Erectile Dysfunction (ED) is a common male sexual dysfunction. Previous studies suggested an OSA-ED association, but findings are inconsistent, and little is known about the role of broader sleep characteristics. This prospective cohort study included 155,688 men from the UK Biobank. Exposures (snoring/OSA) were defined via questionnaires/hospital records; the outcome was incident ED. Cox regression analyzed associations, adjusting for covariates. Median follow-up was 11.6 years. Snoring/OSA participants had higher BMI, diabetes, and hypertension, but no significant associations with ED (all P > 0.05). Participants reporting more daytime sleepiness had a significantly higher risk of ED compared to the reference group with less sleepiness (HR = 2.05, 95%CI:1.06–3.97, P = 0.033). Similarly, harder morning awakening was associated with higher risk relative to those who found it easy to wake up (HR = 1.85, 95%CI:1.20–2.84, P = 0.005). Mouth breathing showed a marginally significant association that attenuated after full adjustment (P = 0.071). In this large prospective cohort, OSA and snoring were not significantly related to incident ED, likely due to limited case numbers and underdiagnosis. Subjective sleep disturbances, particularly excessive daytime sleepiness and difficulty getting up in the morning, were identified as significant risk factors for ED. These findings highlight the importance of considering broader sleep quality dimensions in male reproductive health.