ED and sleep apnea: meta-analysis finds worse erectile function even in mild OSA

A 2026 systematic review/meta-analysis looked at 9 studies examining sleep disorders and male sexual health.

Main findings:

• Across 7 studies (913 men), the pooled IIEF score was ~16, consistent with impaired erectile function. • Men with OSA had lower IIEF scores (~14.4) than men with shift-work sleep disorder (~17.5). • Importantly, even mild OSA was associated with significantly worse erectile function compared with healthy controls (SMD −0.65). • Erectile dysfunction tended to become worse as OSA severity increased. • Testosterone was also generally lower in the OSA studies, averaging roughly 7–9 nmol/L, although results varied considerably between studies.

IIEF = International Index of Erectile Function, a validated questionnaire where lower scores indicate worse sexual function.

Possible mechanisms discussed include intermittent hypoxia, sleep fragmentation, endothelial dysfunction, oxidative stress, autonomic dysregulation, and disruption of testosterone/hormonal regulation.

Big caveat: heterogeneity was extremely high for several pooled analyses, and most included studies were observational, so this shows an association rather than proving OSA directly causes ED.

Paper: https://doi.org/10.4081/aiua.2026.15659