Non-restorative sleep is linked to erectile dysfunction via a ruminative associational pattern, and this association varies across levels of resilience.
Key Findings
Results
Non-restorative sleep severity was significantly associated with worse erectile dysfunction and elevated rumination.
Cross-sectional study of 880 men with ED recruited from the Andrology Clinic of the First Affiliated Hospital of Anhui Medical University between February 2024 and October 2025.
All associations were statistically significant at P < .001.
NRS was measured with the NRS Scale where lower scores indicate more severe NRS.
ED severity was measured using the 5-item International Index of Erectile Function (IIEF-5).
Pearson correlations and bootstrapped mediation models with covariate adjustment were used.
Results
Rumination partially mediated the association between non-restorative sleep and erectile dysfunction.
Bootstrapped mediation analysis was used to test the indirect pathway from NRS through rumination to ED.
The mediation was partial, meaning NRS also had a direct association with ED independent of rumination.
Rumination was measured using the Ruminative Responses Scale.
Covariate adjustment was applied in the mediation models.
Results
Latent profile analysis identified three statistical rumination severity subgroups with significantly different levels of erectile function.
Three latent profiles were identified: low rumination severity (28.86% of sample), moderate rumination severity (43.18%), and high rumination severity (27.96%).
Authors noted these represent 'statistical patterns representing sample heterogeneity in rumination severity rather than clinically distinct phenotypes.'
IIEF-5 scores differed significantly across profiles: high rumination severity group scored 8.92 ± 3.84 versus low rumination severity group scoring 14.95 ± 5.03.
Latent profile analysis was conducted in Mplus software.
Results
Psychological resilience significantly moderated the pathway from non-restorative sleep through rumination to erectile dysfunction.
Resilience was measured using the 10-item Connor–Davidson Resilience Scale (CD-RISC-10).
Resilience acted as a buffer, attenuating both the effect of NRS on rumination and the subsequent impact of rumination on ED.
A moderated mediation model was used to test these effects.
Higher resilience was associated with a weaker indirect association between NRS and ED through rumination.
Methods
The study recruited a clinical sample of men with ED, all from a single urology/andrology setting.
Total sample size was 880 men with ED.
Participants were recruited from the Andrology Clinic of the First Affiliated Hospital of Anhui Medical University.
Recruitment period spanned February 2024 to October 2025.
The study design was cross-sectional, limiting causal inference.
What This Means
This research suggests that poor sleep quality — specifically a type called non-restorative sleep, where a person wakes up feeling unrefreshed — is linked to erectile dysfunction (ED) not only directly but also through a psychological pathway involving rumination (repetitive, negative thinking). In a study of 880 men seeking care for ED, those who reported worse non-restorative sleep also tended to engage in more rumination, and higher rumination was in turn associated with more severe ED. Men who fell into a statistical high-rumination group had average erectile function scores of about 8.9 out of a possible 25, compared to roughly 15 out of 25 for men in the low-rumination group, indicating meaningfully poorer sexual function.
Importantly, the study also found that psychological resilience — a person's ability to cope with and bounce back from stress — appeared to weaken these associations. Men with higher resilience showed less of a connection between their sleep problems and rumination, and less of a connection between rumination and ED severity. The researchers identified three broad rumination subgroups (low, moderate, and high severity) within the sample, though they caution these reflect statistical variation in the data rather than firmly distinct clinical categories.
This research suggests that addressing the psychological side of sleep disturbance — particularly repetitive negative thinking — and building resilience may be relevant considerations in the broader clinical management of ED. Because the study was cross-sectional (measuring everything at one point in time), it cannot prove that poor sleep or rumination causes ED; the relationships could run in multiple directions. Future research with longitudinal designs would be needed to better understand the direction and strength of these associations.
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Pan Gao, Yao Jiang, Zhi Cao, Fan Wu, Yu-Kuai Ma, Peng Yang, et al.. (2026). Cognitive–emotional associations between non-restorative sleep and erectile dysfunction: the role of rumination profiles and resilience. Sexual Medicine. https://doi.org/10.1093/sexmed/qfag072