Investigation of sexual life and sleep quality in patients with hereditary angioedema
Main Article Content
Keywords
anxiety, depression, genital attack, hereditary angioedema, sexual life, sleep quality
Abstract
Background: Hereditary angioedema (HAE) is a genetic disorder characterized by recurrent, spontaneous, and sometimes life-threatening episodes of swelling. Attacks of angioedema that negatively impact quality of life can occur anywhere in the body. The chronic and unpredictable course of the disease can also affect mental health, sleep quality, and sexual life.
Objective: This study aimed to investigate sexual function, sleep quality, and related factors in HAE patients.
Material and Methods: In all, 40 patients diagnosed with type 1 and type 2 HAE were followed up in the Immunology and Allergy Clinic, and 40 healthy controls were included in the study. Participants completed the Arizona Sexual Experience Scale (ASEX), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS).
Results: The patient group had significantly higher ASEX and PSQI scores compared to the healthy control group. In the patient group, ASEX scores showed a significant positive correlation with HADS-Depression (HADS-D) and HADS-Anxiety (HADS-A) scores. It was shown that as frequency of monthly attacks in patients increased, both HADS-D and HADS-A scores increased, and with increase in HADS-D scores, sleep efficiency decreased. Furthermore, a strong positive correlation was shown between HADS-A scores and PSQI scores. Longer disease duration, history of genital attacks, and decreased sleep quality were found to be significantly correlated with sexual dysfunction.
Conclusion: The results supported our hypothesis that sexual life and sleep quality are more affected in this patient group than known previously. It is expected that evaluating sexual life, sleep quality, and general well-being in the routine follow-up of these patients may contribute to disease control.
References
1 Zanichelli A, Arcoleo F, Barca MP, Borrelli P, Bova M, Cancian M, et al. A nationwide survey of hereditary angioedema due to C1 inhibitor deficiency in Italy. Orphanet J Rare Dis. 2015;10:11. 10.1186/s13023-015-0233-x
2 Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygoren-Pursun E, et al. The international WAO/EAACI guideline for the management of hereditary angioedema—The 2021 revision and update. World Allergy Organ J. 2022;15(3):100627. 10.1016/j.waojou.2022.100627
3 Karabiber E, Gungoren EY, Ozen A, Baris S, Karakoc-Aydiner E. Subjective assessment of sleep quality in adult patients with hereditary angioedema. Front Neurol. 2025;16:1555562. 10.3389/fneur.2025.1555562
4 Busse PJ, Christiansen SC, Riedl MA, Banerji A, Bernstein JA, Castaldo AJ, et al. US HAEA Medical Advisory Board 2020 Guidelines for the Management of Hereditary Angioedema. J Allergy Clin Immunol Pract. 2021;9(1):132–50 e3. 10.1016/j.jaip.2020.08.046
5 Guan X, Sheng Y, Liu S, He M, Chen T, Zhi Y. Epidemiology, economic, and humanistic burden of hereditary angioedema: a systematic review. Orphanet J Rare Dis. 2024;19(1):256. 10.1186/s13023-024-03265-z
6 Nusbaum MR, Hamilton C, Lenahan P. Chronic illness and sexual functioning. Am Fam Phys. 2003;67(2):347–54.
7 Bancroft J, Loftus J, Long JS. Distress about sex: A national survey of women in heterosexual relationships. Arch Sex Behav. 2003;32(3):193–208. 10.1023/A:1023420431760
8 Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): Cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20. 10.1080/00926230590475206
9 Sobel T, David P. Impact of chronic medical disease on sexual function and other conditions. Obst Gynecol Clin North Am. 2024;51(2):323–40. 10.1016/j.ogc.2024.02.006
10 Irwin MR. Sleep and inflammation: Partners in sickness and in health. Nat Rev Immunol. 2019;19(11):702–15. 10.1038/s41577-019-0190-z
11 Hamilton NA, Catley D, Karlson C. Sleep and the affective response to stress and pain. Health Psychol. 2007;26(3):288–95. 10.1037/0278-6133.26.3.288
12 McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): Reliability and validity. J Sex Marital Ther. 2000;26(1):25–40. 10.1080/009262300278623
13 Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1–3):10–9. 10.1016/j.jad.2011.01.011
14 Lumry WR, Castaldo AJ, Vernon MK, Blaustein MB, Wilson DA, Horn PT. The humanistic burden of hereditary angioedema: Impact on health-related quality of life, productivity, and depression. Allergy Asthma Proc. 2010;31(5):407–14. 10.2500/aap.2010.31.3394
15 Fouche AS, Saunders EF, Craig T. Depression and anxiety in patients with hereditary angioedema. Ann Allergy Asthma Immunol. 2014;112(4):371–5. 10.1016/j.anai.2013.05.028
16 Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry. 1996;7:107–115.
17 Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psych Res. 1989;28(2):193–213. 10.1016/0165-1781(89)90047-4
18 Soykan A. The reliability and validity of Arizona Sexual Experiences Scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res. 2004;16(6):531–4. 10.1038/sj.ijir.3901249
19 Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–70. 10.1111/j.1600-0447.1983.tb09716.x
20 Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of the Turkish version of the Hospital Anxiety and Depression Scale. Turkish Journal of Psychiatry. 1997;8:280–287.
21 Csuka D, Veszeli N, Varga L, Prohaszka Z, Farkas H. The role of the complement system in hereditary angioedema. Mol Immunol. 2017;89:59–68. 10.1016/j.molimm.2017.05.020
22 Bork K, Meng G, Staubach P, Hardt J. Hereditary angioedema: New findings concerning symptoms, affected organs, and course. Am J Med. 2006;119(3):267–74. 10.1016/j.amjmed.2005.09.064
23 Christiansen SC, Davis DK, Castaldo AJ, Zuraw BL. Pediatric hereditary angioedema: Onset, diagnostic delay, and disease severity. Clin Pediatr (Phila). 2016;55(10):935–42. 10.1177/0009922815616886
24 Caballero T, Aygoren-Pursun E, Bygum A, Beusterien K, Hautamaki E, Sisic Z, et al. The humanistic burden of hereditary angioedema: Results from the Burden of Illness Study in Europe. Allergy Asthma Proc. 2014;35(1):47–53. 10.2500/aap.2013.34.3685
25 Aygoren-Pursun E, Bygum A, Beusterien K, Hautamaki E, Sisic Z, Wait S, et al. Socioeconomic burden of hereditary angioedema: Results from the hereditary angioedema burden of illness study in Europe. Orphanet J Rare Dis. 2014;9:99. 10.1186/1750-1172-9-99
26 Ramos AR, Wheaton AG, Johnson DA. Sleep deprivation, sleep disorders, and chronic disease. Prev Chronic Dis. 2023;20:E77. 10.5888/pcd20.230197
27 Tandon P, Ismond KP, Purdy G, Cruz C, Etruw E, Suderman K, et al. Acceptability and effectiveness of a fully web-based nutrition and exercise program for ındividuals with chronic disease during COVID-19: Randomized controlled trial. J Med Internet Res. 2025;27:e57537. 10.2196/57537
28 Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: Results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22(Suppl 2):S347–53.
29 Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008;31(4):473–80. 10.1093/sleep/31.4.473
30 Benbir G, Demir AU, Aksu M, Ardic S, Firat H, Itil O, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry Clin Neurosci. 2015;69(9):543–52. 10.1111/pcn.12252
31 Csuka D, Fust G, Farkas H, Varga L. Parameters of the classical complement pathway predict disease severity in hereditary angioedema. Clin Immunol. 2011;139(1):85–93. 10.1016/j.clim.2011.01.003
32 Mormile I, Bova M, Cocchiaro A, Rossi FW, Granata F, Spadaro G, et al. Clinical features and burden of genital attacks in hereditary angioedema. J Allergy Clin Immunol Pract. 2022;10(2):643–4 e2. 10.1016/j.jaip.2021.09.046
33 Camyar A, Bulut G, Ozisik M, Altay S, Tuncel OK, Ozgul S, et al. Genital attacks in hereditary angioedema and their effects on sexual life. Medicina (Kaunas). 2024;60(11):1777. 10.3390/medicina60111777
34 Raasch J, Glaum MC, O’Connor M. The multifactorial impact of receiving a hereditary angioedema diagnosis. World Allergy Organ J. 2023;16(6):100792. 10.1016/j.waojou.2023.100792
35 Hinz A, Brahler E. Normative values for the Hospital Anxiety and Depression scale (HADS) in the general German population. J Psychosom Res. 2011;71(2):74–8. 10.1016/j.jpsychores.2011.01.005
36 Banerji A, Davis KH, Brown TM, Hollis K, Hunter SM, Long J, et al. Patient-reported burden of hereditary angioedema: Findings from a patient survey in the United States. Ann Allergy Asthma Immunol. 2020;124(6):600–7. 10.1016/j.anai.2020.02.018
37 Banerji A. The burden of illness in patients with hereditary angioedema. Ann Allergy Asthma Immunol. 2013;111(5):329–36. 10.1016/j.anai.2013.08.019
38 Bork K, Anderson JT, Caballero T, Craig T, Johnston DT, Li HH, et al. Assessment and management of disease burden and quality of life in patients with hereditary angioedema: A consensus report. Allergy Asthma Clin Immunol. 2021;17(1):40. 10.1186/s13223-021-00537-2
39 Hews-Girard J, Goodyear MD. Psychosocial burden of type 1 and 2 hereditary angioedema: A single-center Canadian cohort study. Allergy Asthma Clin Immunol. 2021;17(1):61. 10.1186/s13223-021-00563-0
40 Zarnowski J, Rabe M, Kage P, Simon JC, Treudler R. Prophylactic treatment in hereditary angioedema ıs associated with reduced anxiety in patients in Leipzig, Germany. Int Arch Allergy Immunol. 2021;182(9):819–26. 10.1159/000514973
41 Agostoni A, Cicardi M. Hereditary and acquired C1-inhibitor deficiency: Biological and clinical characteristics in 235 patients. Medicine (Baltimore). 1992;71(4):206–15. 10.1097/00005792-199207000-00003
42 Cho JW, Duffy JF. Sleep, sleep disorders, and sexual dysfunction. World J Mens Health. 2019;37(3):261–75. 10.5534/wjmh.180045
43 Wu JL, Wu RS, Yang JG, Huang CC, Chen KB, Fang KH, et al. Effects of sleep deprivation on serum testosterone concentrations in the rat. Neurosci Lett. 2011;494(2):124–9. 10.1016/j.neulet.2011.02.073
44 Carter JR, Durocher JJ, Larson RA, DellaValla JP, Yang H. Sympathetic neural responses to 24-hour sleep deprivation in humans: Sex differences. Am J Physiol Heart Circ Physiol. 2012;302(10):H1991–7. 10.1152/ajpheart.01132.2011
45 Auyeung TW, Kwok T, Leung J, Lee JS, Ohlsson C, Vandenput L, et al. Sleep duration and disturbances were associated with testosterone level, muscle mass, and muscle strength –A cross-sectional study in 1274 older men. J Am Med Dir Assoc. 2015;16(7):630 e1–6. 10.1016/j.jamda.2015.04.006
46 Auyeung TW, Lee JS, Kwok T, Leung J, Ohlsson C, Vandenput L, et al. Testosterone but not estradiol level is positively related to muscle strength and physical performance independent of muscle mass: A cross-sectional study in 1489 older men. Eur J Endocrinol. 2011;164(5):811–7. 10.1530/EJE-10-0952
47 Johnson JM, Nachtigall LB, Stern TA. The effect of testosterone levels on mood in men: A review. Psychosomatics. 2013;54(6):509–14. 10.1016/j.psym.2013.06.018
48 Gaffney CD, Pagano MJ, Kuker AP, Stember DS, Stahl PJ. Osteoporosis and low bone mineral density in men with testosterone deficiency syndrome. Sex Med Rev. 2015;3(4):298–315. 10.1002/smrj.63
49 Kling JM, Kapoor E, Mara K, Faubion SS. Associations of sleep and female sexual function: Good sleep quality matters. Menopause. 2021;28(6):619–25. 10.1097/GME.0000000000001744
2 Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygoren-Pursun E, et al. The international WAO/EAACI guideline for the management of hereditary angioedema—The 2021 revision and update. World Allergy Organ J. 2022;15(3):100627. 10.1016/j.waojou.2022.100627
3 Karabiber E, Gungoren EY, Ozen A, Baris S, Karakoc-Aydiner E. Subjective assessment of sleep quality in adult patients with hereditary angioedema. Front Neurol. 2025;16:1555562. 10.3389/fneur.2025.1555562
4 Busse PJ, Christiansen SC, Riedl MA, Banerji A, Bernstein JA, Castaldo AJ, et al. US HAEA Medical Advisory Board 2020 Guidelines for the Management of Hereditary Angioedema. J Allergy Clin Immunol Pract. 2021;9(1):132–50 e3. 10.1016/j.jaip.2020.08.046
5 Guan X, Sheng Y, Liu S, He M, Chen T, Zhi Y. Epidemiology, economic, and humanistic burden of hereditary angioedema: a systematic review. Orphanet J Rare Dis. 2024;19(1):256. 10.1186/s13023-024-03265-z
6 Nusbaum MR, Hamilton C, Lenahan P. Chronic illness and sexual functioning. Am Fam Phys. 2003;67(2):347–54.
7 Bancroft J, Loftus J, Long JS. Distress about sex: A national survey of women in heterosexual relationships. Arch Sex Behav. 2003;32(3):193–208. 10.1023/A:1023420431760
8 Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): Cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20. 10.1080/00926230590475206
9 Sobel T, David P. Impact of chronic medical disease on sexual function and other conditions. Obst Gynecol Clin North Am. 2024;51(2):323–40. 10.1016/j.ogc.2024.02.006
10 Irwin MR. Sleep and inflammation: Partners in sickness and in health. Nat Rev Immunol. 2019;19(11):702–15. 10.1038/s41577-019-0190-z
11 Hamilton NA, Catley D, Karlson C. Sleep and the affective response to stress and pain. Health Psychol. 2007;26(3):288–95. 10.1037/0278-6133.26.3.288
12 McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): Reliability and validity. J Sex Marital Ther. 2000;26(1):25–40. 10.1080/009262300278623
13 Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1–3):10–9. 10.1016/j.jad.2011.01.011
14 Lumry WR, Castaldo AJ, Vernon MK, Blaustein MB, Wilson DA, Horn PT. The humanistic burden of hereditary angioedema: Impact on health-related quality of life, productivity, and depression. Allergy Asthma Proc. 2010;31(5):407–14. 10.2500/aap.2010.31.3394
15 Fouche AS, Saunders EF, Craig T. Depression and anxiety in patients with hereditary angioedema. Ann Allergy Asthma Immunol. 2014;112(4):371–5. 10.1016/j.anai.2013.05.028
16 Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry. 1996;7:107–115.
17 Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psych Res. 1989;28(2):193–213. 10.1016/0165-1781(89)90047-4
18 Soykan A. The reliability and validity of Arizona Sexual Experiences Scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res. 2004;16(6):531–4. 10.1038/sj.ijir.3901249
19 Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–70. 10.1111/j.1600-0447.1983.tb09716.x
20 Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of the Turkish version of the Hospital Anxiety and Depression Scale. Turkish Journal of Psychiatry. 1997;8:280–287.
21 Csuka D, Veszeli N, Varga L, Prohaszka Z, Farkas H. The role of the complement system in hereditary angioedema. Mol Immunol. 2017;89:59–68. 10.1016/j.molimm.2017.05.020
22 Bork K, Meng G, Staubach P, Hardt J. Hereditary angioedema: New findings concerning symptoms, affected organs, and course. Am J Med. 2006;119(3):267–74. 10.1016/j.amjmed.2005.09.064
23 Christiansen SC, Davis DK, Castaldo AJ, Zuraw BL. Pediatric hereditary angioedema: Onset, diagnostic delay, and disease severity. Clin Pediatr (Phila). 2016;55(10):935–42. 10.1177/0009922815616886
24 Caballero T, Aygoren-Pursun E, Bygum A, Beusterien K, Hautamaki E, Sisic Z, et al. The humanistic burden of hereditary angioedema: Results from the Burden of Illness Study in Europe. Allergy Asthma Proc. 2014;35(1):47–53. 10.2500/aap.2013.34.3685
25 Aygoren-Pursun E, Bygum A, Beusterien K, Hautamaki E, Sisic Z, Wait S, et al. Socioeconomic burden of hereditary angioedema: Results from the hereditary angioedema burden of illness study in Europe. Orphanet J Rare Dis. 2014;9:99. 10.1186/1750-1172-9-99
26 Ramos AR, Wheaton AG, Johnson DA. Sleep deprivation, sleep disorders, and chronic disease. Prev Chronic Dis. 2023;20:E77. 10.5888/pcd20.230197
27 Tandon P, Ismond KP, Purdy G, Cruz C, Etruw E, Suderman K, et al. Acceptability and effectiveness of a fully web-based nutrition and exercise program for ındividuals with chronic disease during COVID-19: Randomized controlled trial. J Med Internet Res. 2025;27:e57537. 10.2196/57537
28 Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: Results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22(Suppl 2):S347–53.
29 Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008;31(4):473–80. 10.1093/sleep/31.4.473
30 Benbir G, Demir AU, Aksu M, Ardic S, Firat H, Itil O, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry Clin Neurosci. 2015;69(9):543–52. 10.1111/pcn.12252
31 Csuka D, Fust G, Farkas H, Varga L. Parameters of the classical complement pathway predict disease severity in hereditary angioedema. Clin Immunol. 2011;139(1):85–93. 10.1016/j.clim.2011.01.003
32 Mormile I, Bova M, Cocchiaro A, Rossi FW, Granata F, Spadaro G, et al. Clinical features and burden of genital attacks in hereditary angioedema. J Allergy Clin Immunol Pract. 2022;10(2):643–4 e2. 10.1016/j.jaip.2021.09.046
33 Camyar A, Bulut G, Ozisik M, Altay S, Tuncel OK, Ozgul S, et al. Genital attacks in hereditary angioedema and their effects on sexual life. Medicina (Kaunas). 2024;60(11):1777. 10.3390/medicina60111777
34 Raasch J, Glaum MC, O’Connor M. The multifactorial impact of receiving a hereditary angioedema diagnosis. World Allergy Organ J. 2023;16(6):100792. 10.1016/j.waojou.2023.100792
35 Hinz A, Brahler E. Normative values for the Hospital Anxiety and Depression scale (HADS) in the general German population. J Psychosom Res. 2011;71(2):74–8. 10.1016/j.jpsychores.2011.01.005
36 Banerji A, Davis KH, Brown TM, Hollis K, Hunter SM, Long J, et al. Patient-reported burden of hereditary angioedema: Findings from a patient survey in the United States. Ann Allergy Asthma Immunol. 2020;124(6):600–7. 10.1016/j.anai.2020.02.018
37 Banerji A. The burden of illness in patients with hereditary angioedema. Ann Allergy Asthma Immunol. 2013;111(5):329–36. 10.1016/j.anai.2013.08.019
38 Bork K, Anderson JT, Caballero T, Craig T, Johnston DT, Li HH, et al. Assessment and management of disease burden and quality of life in patients with hereditary angioedema: A consensus report. Allergy Asthma Clin Immunol. 2021;17(1):40. 10.1186/s13223-021-00537-2
39 Hews-Girard J, Goodyear MD. Psychosocial burden of type 1 and 2 hereditary angioedema: A single-center Canadian cohort study. Allergy Asthma Clin Immunol. 2021;17(1):61. 10.1186/s13223-021-00563-0
40 Zarnowski J, Rabe M, Kage P, Simon JC, Treudler R. Prophylactic treatment in hereditary angioedema ıs associated with reduced anxiety in patients in Leipzig, Germany. Int Arch Allergy Immunol. 2021;182(9):819–26. 10.1159/000514973
41 Agostoni A, Cicardi M. Hereditary and acquired C1-inhibitor deficiency: Biological and clinical characteristics in 235 patients. Medicine (Baltimore). 1992;71(4):206–15. 10.1097/00005792-199207000-00003
42 Cho JW, Duffy JF. Sleep, sleep disorders, and sexual dysfunction. World J Mens Health. 2019;37(3):261–75. 10.5534/wjmh.180045
43 Wu JL, Wu RS, Yang JG, Huang CC, Chen KB, Fang KH, et al. Effects of sleep deprivation on serum testosterone concentrations in the rat. Neurosci Lett. 2011;494(2):124–9. 10.1016/j.neulet.2011.02.073
44 Carter JR, Durocher JJ, Larson RA, DellaValla JP, Yang H. Sympathetic neural responses to 24-hour sleep deprivation in humans: Sex differences. Am J Physiol Heart Circ Physiol. 2012;302(10):H1991–7. 10.1152/ajpheart.01132.2011
45 Auyeung TW, Kwok T, Leung J, Lee JS, Ohlsson C, Vandenput L, et al. Sleep duration and disturbances were associated with testosterone level, muscle mass, and muscle strength –A cross-sectional study in 1274 older men. J Am Med Dir Assoc. 2015;16(7):630 e1–6. 10.1016/j.jamda.2015.04.006
46 Auyeung TW, Lee JS, Kwok T, Leung J, Ohlsson C, Vandenput L, et al. Testosterone but not estradiol level is positively related to muscle strength and physical performance independent of muscle mass: A cross-sectional study in 1489 older men. Eur J Endocrinol. 2011;164(5):811–7. 10.1530/EJE-10-0952
47 Johnson JM, Nachtigall LB, Stern TA. The effect of testosterone levels on mood in men: A review. Psychosomatics. 2013;54(6):509–14. 10.1016/j.psym.2013.06.018
48 Gaffney CD, Pagano MJ, Kuker AP, Stember DS, Stahl PJ. Osteoporosis and low bone mineral density in men with testosterone deficiency syndrome. Sex Med Rev. 2015;3(4):298–315. 10.1002/smrj.63
49 Kling JM, Kapoor E, Mara K, Faubion SS. Associations of sleep and female sexual function: Good sleep quality matters. Menopause. 2021;28(6):619–25. 10.1097/GME.0000000000001744
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Mar 1, 2026
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Sadi Aykan, F., Bakay, H., Çölkesen, F., Gıca, Şakir, Kılınç, M., Evcen, R., Önalan, T., Kahraman, S., Yıldız, E., & Arslan, Şevket. (2026). Investigation of sexual life and sleep quality in patients with hereditary angioedema. Allergologia Et Immunopathologia, 54(2), 10-21. https://doi.org/10.15586/aei.v54i2.1546
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How to Cite
Sadi Aykan, F., Bakay, H., Çölkesen, F., Gıca, Şakir, Kılınç, M., Evcen, R., Önalan, T., Kahraman, S., Yıldız, E., & Arslan, Şevket. (2026). Investigation of sexual life and sleep quality in patients with hereditary angioedema. Allergologia Et Immunopathologia, 54(2), 10-21. https://doi.org/10.15586/aei.v54i2.1546