Walia Arman S, Lomeli Luis de Jesus Martinez, Jiang Pengbo, Benca Ruth, Yafi Faysal A
Department of Urology, University of California-Irvine, Irvine, CA, USA.
Center for Complex Biological Systems, University of California-Irvine, Irvine, CA, USA.
Int J Impot Res. 2019 Jan;31(1):39-45. doi: 10.1038/s41443-018-0057-z. Epub 2018 Aug 31.
Depression and sleep problems are highly prevalent disorders that are often comorbid with other medical disorders. We evaluated the prevalence and associations of these conditions in patients presenting to a Men's Health clinic. In this retrospective study, 124 patients presenting to a Men's Health clinic completed three urological questionnaires (International Index of Erectile Function [IIEF-5], International Prostate Symptom Score [IPSS], and Androgen Deficiency in Aging Males [ADAM]); and four 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]). Questionnaire results were evaluated in conjunction with patient clinical history and associated laboratory values via univariate and multivariate analysis. The mean age of the study participants was 54.1 years (SD 16). Comorbidities included hypertension (22.5%), vascular disease (15%), and diabetes mellitus (13.3%). Body Mass Index (BMI) was >25 in 77.3%. IIEF-5 scores were moderate-severe in 47.9%, ADAM questionnaire was positive in 79%, and IPSS scores were moderate-severe in 42.9% of patients. PHQ-9 demonstrated mild-severe depression in 38.6%, STOP-BANG showed intermediate-high risk for sleep apnea in 55.2%, ISI indicated moderate-severe insomnia in 18.1%, and ESS revealed mild-severe sleepiness in 16.6% of participants. On univariate analysis, BMI was associated with scores on the PHQ-9 (p = 0.035), STOP-BANG (p < 0.001), and ESS (p < 0.006). On multivariate analysis, positive ADAM questionnaire was associated with STOP-BANG (OR 3.29, 95% CI: 1.012-10.69), and IPSS with PHQ-9 (OR 4.64, 95% CI: 1.40-15.43) and ISI (OR 3.27, 95% CI: 1.06-10.1). Overall, patients presenting to a Men's Health Clinic were found to have high prevalence rates for risk of depression, insomnia and sleep apnea. Risks were elevated in older subjects, and those with increased BMI, hypogonadism, and lower urinary tract symptoms. Appropriate screening and referral to appropriate specialists are encouraged.
抑郁症和睡眠问题是非常普遍的疾病，常与其他医学疾病合并存在。我们评估了这些情况在男性健康诊所就诊患者中的患病率及相关性。在这项回顾性研究中，124名到男性健康诊所就诊的患者完成了三份泌尿科问卷（国际勃起功能指数[IIEF - 5]、国际前列腺症状评分[IPSS]和老年男性雄激素缺乏症[ADAM]）；以及四份非泌尿科问卷（用于评估抑郁症的患者健康问卷[PHQ - 9]、STOP - BANG睡眠呼吸暂停问卷[OSA STOP - BANG]、失眠严重程度指数[ISI]和爱泼华嗜睡量表[ESS]）。通过单因素和多因素分析，结合患者临床病史及相关实验室值对问卷结果进行评估。研究参与者的平均年龄为54.1岁（标准差16）。合并症包括高血压（22.5%）、血管疾病（15%）和糖尿病（13.3%）。77.3%的患者体重指数（BMI）>25。47.9%的患者IIEF - 5评分中重度，79%的患者ADAM问卷呈阳性，42.9%的患者IPSS评分中重度。38.6%的患者PHQ - 9显示轻度至重度抑郁，55.2%的患者STOP - BANG显示睡眠呼吸暂停中高风险，18.1%的患者ISI表明中度至重度失眠，16.6%的参与者ESS显示轻度至重度嗜睡。单因素分析显示，BMI与PHQ - 9评分（p = 0.035）、STOP - BANG评分（p < 0.001）和ESS评分（p < 0.006）相关。多因素分析显示，ADAM问卷呈阳性与STOP - BANG相关（比值比3.29，95%置信区间：1.012 - 10.69），IPSS与PHQ - 9（比值比4.64，95%置信区间：1.40 - 15.43）和ISI（比值比3.27，95%置信区间：1.06 - 10.1）相关。总体而言，到男性健康诊所就诊的患者被发现患抑郁症、失眠和睡眠呼吸暂停风险的患病率很高。老年患者、BMI增加、性腺功能减退和下尿路症状患者的风险升高。鼓励进行适当的筛查并转诊至合适的专科医生。
