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Prospective evaluation of depression and sleep disorders in patients presenting to a men’s health clinic

Walia, A1; Martinez Lomeli, L2; Jiang, P2; Benca, R2Yafi, FA2

1: University of California Irvine, United States; 2: University of California Irvine, USA

Objectives: Depression and sleep disorders are becoming progressively prevalent. We sought to critically evaluate the prevalence and potential associations of these conditions in patients presenting to a Men’s Health clinic.

Materials and methods: Between 11/2016 and 1/2017, 124 consecutive new patients presenting to a Men’s Health clinic were asked to fill 3 urological (International Index of Erectile Function [IIEF-5], American Urological Association Symptom Index [AUA-SI] and Androgen Deficiency in Aging Males [ADAM]) and 4 non-urological questionnaires (Patient Health Questionnaire for depression [PHQ-9], STOP-BANG Sleep Apnea [OSA STOP-BANG], Insomnia Severity Index [ISI] and Epworth Sleepiness Scale [ESS]). Other demographic, clinical and diagnostic variables such as serum hormone levels were also prospectively collected.

Results: Co-morbidities included hypertension in 23%, vascular disease in 15% and diabetes mellitus in 13%. Body Mass Index (BMI) was 18.5-24.9 in 23%, 25-29.9 in 50% and ≥30 in 23%. Mean total serum testosterone was 411.9ng/dL (SD 393), Estradiol 39.2pg/mL (31.1) and Hemoglobin A1C 6.2% (1.3). IIEF-5 scores were moderate-severe in 48%, ADAM questionnaire was positive in 79% and AUA-SI scores were moderate-severe in 45% of patients. PHQ-9 demonstrated mild-severe depression in 39%, OSA STOP-BANG intermediate-high risk sleep apnea in 55%, ISI moderate-severe insomnia in 19% and ESS mild-severe excessive sleepiness in 17% of participants. On univariate analysis, age was associated with PHQ-9 and OSA STOP-BANG (p <0.001), vascular disease with OSA STOP-BANG (p <0.0011), and BMI with PHQ-9 (p 0.035), OSA STOP-BANG (p <0.001) and ESS (p 0.006). Using logistic regression models, a positive ADAM questionnaire was associated with OSA STOP-BANG (OR 3.29, 95%CI: 1.012-10.69), and AUA-SI with PHQ-9 (OR 4.64, 95%CI: 1.40, 15.43) and ISI (OR 3.27, 1.06-10.1).

Conclusions: Adult males presenting to a Mens’ Health Clinic have high prevalence rates for depression and sleep disorders. Appropriate screening and referral to a specialist, when indicated, are encouraged. Age, increased BMI, vascular disease, hypogonadism and lower urinary tract symptoms seem to be associated with these conditions.


Work supported by industry: no.

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