睡眠障碍与男性性功能障碍：激素与勃起结局的荟萃分析。

文献信息

中文摘要

背景： 睡眠紊乱，包括失眠和阻塞性睡眠呼吸暂停（OSA），与男性性功能障碍密切相关，影响性欲、勃起功能和激素平衡。本荟萃分析旨在评估睡眠障碍与男性性功能之间的关系。
方法： 系统检索了截至2025年9月的PubMed、Scopus、Web of Science和ScienceDirect数据库，确定了9项同行评审研究，探讨睡眠障碍对男性性健康的影响。使用纽卡斯尔-渥太华量表评估偏倚风险。进行荟萃分析以评估结局，包括国际勃起功能指数（IIEF）、睾酮、促卵泡激素（FSH）和促黄体生成素（LH）水平，并进行亚组分析比较OSA和轮班工作睡眠障碍（SWSD）。统计分析使用R版本4.2.2进行。
结果： 在七项研究（n = 913）中，合并平均IIEF评分约为16，表明中度勃起功能障碍，但异质性高（I² = 97.3%）。亚组分析显示，OSA患者的IIEF评分较低（约14.4），而SWSD患者较高（约17.5），表明OSA患者功能障碍更严重。激素分析（n = 325）显示，OSA患者的睾酮水平显著较低（约7-9 nmol/L），而SWSD患者较高（约20 nmol/L）。OSA患者的FSH和LH升高（分别约3.8-5.8 IU/L和3.3-3.9 IU/L），而SWSD患者较低（约2.2 IU/L和1.8 IU/L）。高异质性表明研究设计和人群存在显著差异。
结论： OSA和SWSD均损害性功能和激素功能，但OSA导致更严重的勃起和内分泌紊乱。即使轻度OSA也与勃起功能下降相关，且严重程度加重功能障碍。尽管趋势一致，高异质性需要谨慎解释。未来研究应采用标准化工具和统一人群，以阐明睡眠障碍与男性性健康之间的联系机制。

英文摘要

BACKGROUND: Sleep disruptions, including insomnia and obstructive sleep apnea (OSA), are strongly linked to male sexual dysfunction, affecting libido, erectile function, and hormonal balance. This metaanalysis aimed to evaluate the relationship between sleep disorders and male sexual function.
METHODS: A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect through September 2025 identified 9 peer-reviewed studies examining the impact of sleep disorders on male sexual health. The Newcastle-Ottawa Scale was used to assess the risk of bias. A meta-analysis was performed to evaluate outcomes, including the International Index of Erectile Function (IIEF), testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels, with a subgroup analysis comparing OSA and shift work sleep disorder (SWSD). Statistical analyses were conducted using R version 4.2.2.
RESULTS: Across seven studies (n = 913), the pooled mean IIEF score was approximately 16, indicating moderate erectile dysfunction, though heterogeneity was high (I² = 97.3%). Subgroup analysis revealed lower IIEF scores in OSA patients (≈14.4) compared to SWSD patients (≈17.5), suggesting more severe dysfunction in OSA. Hormonal analysis (n = 325) showed significantly lower testosterone levels in OSA (≈7-9 nmol/L) versus SWSD (≈20 nmol/L). FSH and LH were elevated in OSA (≈3.8-5.8 IU/L and 3.3-3.9 IU/L, respectively) compared to SWSD (≈2.2 IU/L and 1.8 IU/L). High heterogeneity indicated substantial variation in study design and populations.
CONCLUSIONS: Both OSA and SWSD impair sexual and hormonal function, but OSA causes greater erectile and endocrine disruption. Even mild OSA was associated with reduced erectile performance, with the severity worsening dysfunction. Despite consistent trends, high heterogeneity warrants cautious interpretation. Future research should employ standardized tools and uniform populations to clarify mechanisms linking sleep disorders to male sexual health.