Sleep disorders are emerging as a clinically actionable contributor to male infertility, with growing evidence that disrupted sleep can impair spermatogenesis through converging endocrine, metabolic, and epigenetic pathways.
In a comprehensive review, investigators synthesized the data from epidemiologic, experimental, and clinical studies linking conditions such as insomnia, obstructive sleep apnea (OSA), and circadian misalignment to reduced semen quality, hormonal dysregulation, and sperm DNA damage. Male factor infertility accounts for nearly half of infertility cases worldwide, yet sleep-related risks remain underrecognized in routine andrologic care.
Across multiple population studies, abnormal sleep duration, poor sleep quality, and shift work were consistently associated with lower sperm concentration, motility, and morphology. OSA, in particular, was linked to hypogonadism, erectile dysfunction, and a subsequent higher infertility risk, with untreated disease amplifying oxidative stress and inflammatory signaling within the testes.
The investigators outlined a unifying pathophysiologic framework in which sleep disruption triggered excessive reactive oxygen species generation, chronic inflammation, and hypothalamic–pituitary–gonadal axis dysfunction. They found that circadian misalignment further altered sperm epigenetic programming, raising the possibility of intergenerational reproductive effects. Together, these processes may converge to impair spermatogenesis and sperm genomic integrity.
The review moved beyond association to consider clinical implications. The investigators argued that sleep disorders represent a modifiable risk factor for male infertility and should be systematically assessed during fertility evaluation—particularly in men with unexplained infertility, metabolic comorbidities, or suboptimal response to assisted reproductive technologies.
Potential interventions span airway management for OSA, circadian rhythm restoration, cognitive behavioral therapy for insomnia, antioxidant therapy, and metabolic optimization. While evidence for fertility outcomes remained heterogeneous, several approaches such as continuous positive airway pressure therapy and lifestyle-based circadian correction have shown improvements in testosterone levels and semen parameters.
The investigators concluded that integrating sleep assessment into precision andrology could improve risk stratification and enable earlier, more targeted interventions. They called for longitudinal studies to define which patient subgroups may derive the greatest reproductive benefit from sleep-focused therapies and for greater collaboration between sleep medicine and reproductive specialists to address this overlooked determinant of male fertility.
Source: Andrology
