The relationship between male genitourinary conditions and sleep disorders has only been reported in small sample sizes. Our objective was to assess the association of erectile dysfunction (ED) and testosterone de ciency with various sleep disorders using a large claims database. The TriNetX Diamond database, a research network of over 220 million patients, was queried in June 2022. In men aged 40-70 years, insomnia (ICD-10 G47.0), sleep apnea (G47.33), and circadian rhythm sleep disorder (G47.2) were each independently assessed to determine the association with ED (N52) and testicular hypofunction (E29.1). A propensity-score-matched control cohort was generated with an absence of sleep disorders (G47 & F51), sleep deprivation (Z72.820), or morbid obesity with alveolar hypoventilation (E66.2).Propensity score matching was performed for age, hypertension (I10-16), hyperlipidemia (E78), diabetes mellitus (E08-13), ischemic heart disease (I20-25), tobacco usage (Z72.0), and obesity (E66). Sensitivity analyses were conducted via a negative polysomnography testing (CPT 1013314) cohort. Men diagnosed with a sleep disorder had signi cantly higher odds of testosterone de ciency and ED compared to propensity-score matched controls. Our results emphasize the negative impact of poor sleep on diseases of the male genitourinary system by identifying these relationships in the largest cohort in the U.S. reported to date.
Introduction
Erectile dysfunction (ED) affects an estimated 30 million men in the United States with an estimated 82% of men with erectile dysfunction experiencing depressive symptoms. Prior literature has shown that initiation of therapy for ED is associated with a decrease in depressive symptoms; however, the rates of antidepressant continuation following initiation of erectile dysfunction has not been analyzed.
Objective
Our goal was to analyze the rate of antidepressant continuation for depression after prescribing testosterone or PDE-5 inhibitors for erectile dysfunction.
Methods
We queried the TriNetX Diamond network database, a health research network including 212 million patients, including healthcare encounters, insurance claims data, and prescription data between 2009-2021. We identified men with a diagnosis of depression (ICD-10: F32-33), 12 consecutive prior months of antidepressant prescriptions (VA Formulary: CN609), and a diagnosis of erectile dysfunction (ICD-10: N52). We then compared rates of antidepressants continuation over the following year in men who were prescribed PDE5i or testosterone for their erectile dysfunction versus men who had never been prescribed testosterone or PDE5i for their erectile dysfunction. The two cohorts were matched on age, race, and ethnicity. Rates of antidepressant discontinuation were compared with risk ratios (RR) and 95% confidence interval (95% CI).
Results
We identified 31,306 men that were prescribed a PDE-5 inhibitor without testosterone and an equal number of men that weren't prescribed testosterone nor PDE5i. We found that 54% of men receiving PDE5i continued using antidepressants after 12 months; while, 49% of men that weren't prescribed testosterone nor PDE5i continued using antidepressants (RR: 1.11, 95% CI: 1.10-1.13). We identified 4,468 patients who were prescribed testosterone without a PDE5i and an equal number of men that weren't prescribed testosterone nor PDE5i prescriptions. We found that 61% of men receiving testosterone prescriptions continued the use of antidepressants over subsequent 12 months; while 49% of men that weren't prescribed testosterone nor PDE5i continued using antidepressants (RR: 1.24, 95% CI: 1.20-1.29).
Conclusions
We conclude that patients who were prescribed PDE-5 inhibitors or testosterone were more likely to continue usage of antidepressants after 1 year despite the potential negative sexual dysfunction side effects that they may cause. The patient's psychiatric conditions and comorbidities should be considered when prescribing medications for sexual wellbeing in order to more holistically treat patients.
Disclosure
No
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