Sleep quality as a predictor of sexual dysfunction in men with type 2 diabetes
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252396Keywords:
Type 2 diabetes mellitus, Hypogonadism, Testosterone, Clinical insomnia, Sexual dysfunction, Insomnia severity index, Androgen deficiency in ageing maleAbstract
Background: Sexual dysfunction and hypogonadism are common yet under‐recognized complications of type 2 diabetes mellitus (T2DM). Sleep disturbances—particularly clinical insomnia—may exacerbate neuroendocrine and metabolic dysregulation, but their role as predictors of sexual dysfunction and testosterone deficiency in diabetic men remains unclear.
Methods: In this cross‐sectional study, 54 men with T2DM (age 35–60 years) attending our outpatient clinic were evaluated for insomnia (insomnia severity index, ISI), hypogonadal symptoms (androgen deficiency in ageing male, ADAM questionnaire), morning serum total testosterone (TT), and sexual dysfunction (self‐reported clinical interview). Clinical insomnia was defined as ISI >15; biochemical hypogonadism as TT <3 ng/ml; confirmed hypogonadism as ADAM‐positive plus TT <3 ng/ml. Participants were stratified by insomnia status (n=18 versus 36) and compared using t–tests and χ² tests. Logistic regression adjusted for age, body mass index (BMI), glycated haemoglobin (HbA1c), and diabetes duration identified independent predictors of confirmed hypogonadism.
Results: Clinical insomnia was present in 33.3% of the cohort. Overall, 37.0% of men reported sexual dysfunction. Insomniac participants had higher rates of sexual dysfunction (66.7% versus 22.2%; p<0.001), ADAM‐positivity (83.3% versus 36.1%; p=0.001), biochemical hypogonadism (44.4% versus 11.1%; p=0.006), and confirmed hypogonadism (38.9% versus 8.3%; p=0.014) compared to non‐insomniacs. In multivariable analysis, clinical insomnia remained the only independent predictor of confirmed hypogonadism (OR 12.14; 95% CI 1.16–126.60; p=0.037).
Conclusions: Clinical insomnia in men with T2DM is strongly associated with both sexual dysfunction and testosterone deficiency, and independently predicts confirmed hypogonadism. These findings support integrating sleep‐quality assessment into diabetic care pathways and targeting insomnia as a modifiable factor to improve sexual and endocrine health.
Metrics
References
Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab. 2004;89(11):5462-8. DOI: https://doi.org/10.1210/jc.2004-0804
Grossmann M. Low testosterone in men with type 2 diabetes: significance and treatment. J Clin Endocrinol Metab. 2011;96(8):2341-53. DOI: https://doi.org/10.1210/jc.2011-0118
Pitteloud N, Hardin M, Dwyer AA, Valassi E, Yialamas M, Elahi D, et al. Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men. J Clin Endocrinol Metab. 2005;90(5):2636-41. DOI: https://doi.org/10.1210/jc.2004-2190
Vien T, Mhetli M, Chachati A, Lardinois C, Beckers F, Wauters M, et al. Pro-inflammatory cytokines and sleep disturbances in type 2 diabetes. Sleep Med Rev. 2020;54:101358.
Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev. 2005;9(3):211-24. DOI: https://doi.org/10.1016/j.smrv.2005.01.006
Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305(21):2173-4. DOI: https://doi.org/10.1001/jama.2011.710
Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307. DOI: https://doi.org/10.1016/S1389-9457(00)00065-4
Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49(9):1239-42. DOI: https://doi.org/10.1053/meta.2000.8625
Smith A, Jones B, Williams K, Garcia R, Evans P, White L, et al. Sleep quality and testosterone levels in middle‐aged men. J Clin Endocrinol Metab. 2019;104(4):1234-41.
Rodriguez C, Lee D, Chen H, Kim J, Patel S, Park M, et al. Acute sleep deprivation suppresses morning testosterone in healthy males. Sleep Med. 2021;82:45-50.
Laaksonen DE, Niskanen L, Punnonen K, Nyyssönen K, Tuomainen TP, Valkonen VP, et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004;27(5):1036-41. DOI: https://doi.org/10.2337/diacare.27.5.1036
Camacho EM, O’Neill TW, Finn JD, Pye SR, Lee DM, Tajar A, et al. Age-associated changes in hypothalamic–pituitary–testicular function and their relationship to age-related decline in serum testosterone: results from the European Male Ageing Study. Eur J Endocrinol. 2013;168(3):445-55. DOI: https://doi.org/10.1530/EJE-12-0890
Corona G, Maseroli E, Rastrelli G, Isidori AM, Sforza A, Mannucci E, et al. Testosterone, hypogonadism and sexual dysfunction in men with type 2 diabetes. J Sex Med. 2012;9(1):199-210.
Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes. 2014;7:95-105. DOI: https://doi.org/10.2147/DMSO.S36455
Minkel J, Moreta M, Mistry S, Htaik O, Jones C, Basner M, et al. Emotional and cognitive effects of sleep deprivation and recovery in the context of a simulated operational mission. Sleep. 2014;37(5):851-61.
Rao PM, Kelly DM, Jones TH. Testosterone and insulin resistance in the metabolic syndrome and T2DM in men. Nat Rev Endocrinol. 2013;9(8):479-93. DOI: https://doi.org/10.1038/nrendo.2013.122
Downloads
Published
How to Cite
Issue
Section
