Lipid metabolism and neuromuscular junction as common pathways underlying the genetic basis of erectile dysfunction and obstructive sleep apnea

Erectile dysfunction (ED) incidence is higher in patients with obstructive sleep apnea (OSA). Studies have suggested that ED and OSA may activate similar pathways; however, few have investigated the links between their underlying genotypic profiles. Therefore, we conducted an in-silico analysis to test whether ED and OSA share genetic variants of risk and to identify any molecular, cellular and biological interactions between them. Two gene lists were manually curated through a literature review based on a PUBMED search, which resulted in one gene list associated with ED (total of 205 genes) and the other with OSA (total of 2622 genes). Between those gene sets, 35 were common for both lists (Fisher exact test, p-value = 0.027). The Protein-protein interaction (PPI) analysis using the intersect list as input showed that 3 of them had direct interactions (LPL, DGKB and PLCB1). In addition, the biological function of the genes contained in the intersect list suggested that pathways related to lipid metabolism and the neuromuscular junction were commonly found in the genetic basis of ED and OSA. From the shared genes between both conditions, the biological pathways highlighted in this study may serve as preliminary findings for future functional investigations on OSA and ED association.

Sleep disorders are associated with testosterone deficiency and erectile dysfunction-a U.S. claims database analysis

The relationship between male genitourinary conditions and sleep disorders has previously only been reported in single-institution studies with small cohorts. Our objective was to assess the association of erectile dysfunction (ED) and testosterone deficiency with various sleep disorders using a large claims database. The TriNetX Diamond database was queried in June 2022. In men aged 40-70 years, insomnia, sleep apnea, and circadian rhythm sleep disorder were each independently assessed to determine the association with ED and testosterone deficiency and then followed by propensity score matching performed for age, hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, tobacco usage, and obesity. Testosterone deficiency was more likely to be found in men diagnosed with sleep apnea (odds ratio (OR) 1.66 [95% confidence interval (CI) 1.65-1.67]), insomnia (OR 1.74 [95% CI 1.73-1.76]), and circadian rhythm dysfunction (OR 2.63 [95% CI 2.54-2.73]) compared to matched controls. ED was more likely to be found in men diagnosed with sleep apnea (OR 1.02 [95% CI 1.01-1.03]), insomnia (OR 1.30 [95% CI 1.30-1.31]), and circadian rhythm dysfunction (OR 1.54 [95% CI 1.49-1.59]) compared to matched controls. Our results emphasize the negative impact of poor sleep on diseases of the male genitourinary system by identifying these relationships in the largest cohort in the U.S. reported to date.

Lower urinary tract symptoms in young-middle aged males with a diagnosis of obstructive sleep apnea syndrome

BACKGROUND

The aim of the current study is to measure the prevalence and the potential role of International Prostate Symptom Score (IPSS) score as a predictor of obstructive sleep apnea syndrome (OSAS) in male experienced lower urinary tract symptoms (LUTS).

METHODS

A cross-sectional web-based Italian survey was administered via Google Forms between July 17 and October 31, 2022. The urinary functioning was measured through the IPSS questionnaire. Specifically, we considered symptoms occurring more than "about half the time" (score ≥ 3) as bothering symptoms. Multivariable logistic regression models (LRMs) adjusting for age, body mass index (BMI), International Index of Erectile Function-5, IPSS, and hypertension were fitted to predict OSAS in the cohort of men responding to the survey and experiencing LUTS.

RESULTS

Overall, 58 (24.4%) patients had a confirmed diagnosis of OSAS. The overall median IPSS was 5 (inter quartile range [IQR]: 3-8), respectively. According to IPSS items, 24 (10%), 44 (18.4%), 12 (5%), 12 (5%), 12 (5%), 11 (4.6%), 63 (26.4%) patients exhibit incomplete bladder emptying, urinary frequency, intermittency, urgency, weak stream, straining, nocturia with a score ≥ 3, respectively. After multivariable LRMs predicting the developing OSAS, age (odds ratio [OR]: 1.09, p < 0.001), BMI (OR:1.12, p < 0.001) and IPSS total score (OR:1.08, p = 0.02) were independent predicting factors.

CONCLUSION

This analysis revealed that the IPSS total score, age, and BMI are independent predictors of OSAS in males. In this context, the use of IPSS in daily practice could be helpful in assessing the LUTS presence and in supporting physicians to identify a hidden sleep apnea condition.

Is Continuous Positive Airway Pressure a Valid Alternative to Sildenafil in Treating Sexual Dysfunction among OSA Patients? A Systematic Review and Meta-Analysis

Background and Objectives: This study aimed to assess the comparative effectiveness of continuous positive airway pressure (CPAP) therapy and sildenafil pharmacological therapy in improving sexual function among patients with obstructive sleep apnea (OSA) and erectile dysfunction (ED). Materials and methods: Population: Patients affected by OSA and ED; Intervention: CPAP therapy vs. Comparison: Sildenafil pharmacological therapy; Outcomes: Improvement in erectile function, as measured by the International Index of Erectile Function 5 (IIEF-5) scoring system; Time: A systematic review of the literature from the past 20 years; Study Design: Observational studies comparing erectile function improvements after OSA treatment. Results: A total of eight papers were included in the qualitative summary, involving four hundred fifty-seven patients with ED and OSA. Erectile function improvements were observed in both treatment groups. After sildenafil and CPAP treatment, the mean IIEF-5 domain scores were 37.7 and 27.3, respectively (p < 0.001). Sildenafil 100 mg demonstrated a higher therapeutic impact compared to CPAP treatment. Conclusions: CPAP therapy significantly improved sexual parameters in most studies for OSA patients with ED. The findings suggest that CPAP therapy effectively alleviates erectile dysfunction symptoms, resulting in improved sexual performance in OSA patients. The comparison of the two treatments indicates that sildenafil has a more substantial therapeutic impact on erectile function than CPAP therapy; however, a combined treatment will provide a cumulative effect.

The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective, Controlled Cohort

BACKGROUND

Many studies have reported a possible strong relationship between poor sleep quality, sleep disruption, sleep disorders, and erectile dysfunction (ED).

AIM

This study aimed to investigate the relationship between sleep quality and ED.

METHODS

Patients diagnosed with ED by the International Index of Erectile Function-5 (IIEF-5) questionnaire and 72 healthy adult men were included. Participants completed the questionnaire, underwent a detailed physical examination, and provided blood samples. All enrolled subjects then wore the Fitbit Charge 2 that monitored sleep throughout the night.

OUTCOMES

Primary outcome measures included scores on the IIEF-5, General Anxiety Disorder-7 (GAD-7) scale, Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and sleep monitoring parameters obtained from Fitbit Charge 2.

RESULTS

Finally, a total of 107 ED patients and 72 healthy adult men were enrolled in this study. Univariate analysis indicated that the GAD-7 (P < .001), PHQ-9 (P < .001), and PSQI scores (P < .001) significantly differed according to the presence/absence of ED. Further multiple logistic regression analysis showed that the PHQ-9 (odds ratio [OR]: 1.227, 95% confidence interval [CI]: 1.070-1.407; P = .003) and PSQI scores (OR: 1.220, 95%CI: 1.116-1.334; P < .001) were independent risk factors for ED. Analysis of objective sleep monitoring parameters showed that total sleep time (TST) (P = .001), sleep onset latency (SOL) (P = .026), deep sleep (N3) duration (P = .011) and rapid eye movement (REM) sleep duration (P < .001) were significantly differed between the 2 groups, with durations in the ED group significantly lower than those in the non-ED group. In addition, receiver operating characteristic (ROC) curve analysis indicated that the REM sleep duration had the highest area under the curve (AUC: 0.728) of all sleep parameters, with a P value < .001, a sensitivity of 72.2% and a specificity of 73.8%.

CLINICAL IMPLICATIONS

Urologists and andrologists should be aware of impacted sleep quality and depression in ED patients.

STRENGTHS & LIMITATIONS

The strength of this study is that the relationship between sleep quality and ED was assessed with both a subjective scale and an objective sleep monitoring tool. However, our study only described an association between sleep quality and ED and did not establish a causal relationship.

CONCLUSION

Sleep parameters are strongly associated with ED, indicating that poor sleep quality may increase the likelihood of ED. Wu X, Zhang Y, Zhang W, et al. The Association Between Erectile Dysfunction and Sleep Parameters: Data from a Prospective, Controlled Cohort. J Sex Med 2022;XX:XXX-XXX.

Erectile Dysfunction and Obstructive Sleep Apnea: A Review

Erectile dysfunction (ED) is a disease with a wide scope of etiologies. Obstructive sleep apnea (OSA) is considered one of the risk factors for ED and is less studied. A growing lot of evidence show an association between OSA and ED. This study provides an updated review of the relationship between ED and OSA and the possible physiological mechanisms of ED in patients with OSA based on the current evidence. In clinical interviews, patients with ED may benefit from a sleep evaluation. However, further clinical investigations and more basic research are needed to illustrate the relationship between ED and OSA.

Exosomes derived from miR-301a-3p-overexpressing adipose-derived mesenchymal stem cells reverse hypoxia-induced erectile dysfunction in rat models

Background

Erectile dysfunction (ED) has often been observed in patients with obstructive sleep apnea (OSA). Research on adipose-derived mesenchymal stem cell (ADSC)-derived exosomes has shown that they have significant therapeutic effects in many diseases including ED.

Methods

In this study, ED was induced in Sprague Dawley (SD) rats using chronic intermittent hypoxia (CIH) exposure. CIH-mediated influences were then measured in the corpus cavernous smooth muscle cells (CCSMCs).

Results

Our data showed that miR-301a-3p-enriched exosome treatment significantly recovered erectile function in rats and CCSMCs by promoting autophagy and inhibiting apoptosis. The treatment also significantly recovered the level of alpha smooth muscle actin (α-SMA) in rats and CCSMCs. Bioinformatics predicted that phosphatase and tensin homolog (PTEN) and Toll-like receptor 4 (TLR4) might be targets of miR-301a-3p.

Conclusions

Our results indicate that PTEN-overexpression vectors or TLR4-overexpression vectors reverse the therapeutic effects achieved by miR-301a-3p in CCSMCs indicating that PTEN/hypoxia-inducible factor-1 alpha (HIF-1α) and TLR4 signaling pathways play key roles in the progression of ED. The findings in this study suggest that miR-301a-3p should be considered a new therapeutic target for treating ED associated with OSA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-021-02161-8.

Continuous positive airway pressure therapy in obstructive sleep apnoea patients with erectile dysfunction-A meta-analysis

BACKGROUND

Erectile dysfunction (ED) with obstructive sleep apnoea (OSA) is a relatively common issue for men. A number of clinical studies have demonstrated that continuous positive airway pressure (CPAP) therapy may effectively alleviate ED symptoms from patients with OSA.

METHODS

PubMed, MEDLINE, EMBASE and Cochrane Library databases were utilised and searched for the relevant studies up to September 2, 2019. The International Index of Erectile Function 5 (IIEF-5) scoring system from the patients before and after receiving their CPAP therapy were collected according to the strict inclusion and exclusion criteria. REVMEN 5.3 software was applied for the meta-analysis.

RESULTS

A total of seven publications consisted of 206 ED patients with OSA were included in the study. ED patients with OSA received CPAP treatment were significantly improved based on the IIEF-5 scores [Weighted Mean Difference (WMD) = 1.14, 95% confidence interval (CI) = 0.89-1.38, z = 9.09, p < 0.0001].Our research found that the high heterogeneity is mainly due to Zhang's data, with a higher apnoea-hypopnea index (AHI) compared to the other included studies. A moderate heterogeneity (I² = 54%, P = 0.05) was found after removal of Zhang's data.

CONCLUSION

The results suggest that continuous positive airway pressure therapy relive erectile dysfunction symptoms in patients with obstructive sleep apnoea. However, further evidence is needed due to the insufficient number of included patients and high heterogeneity.

[Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review]

OBJECTIVE

The objective of this work was to make a review of urinary tract symptoms and erectile dysfunction involved in obstructive sleep apnea (OSA) but also to study their physiopathology and potential treatments.

METHODS

We conducted a literature review in the Pubmed database using PRISMA guidelines and the MeSH terms: sleep apnea, urinary incontinence, erectile dysfunction, sexuality. All French and English articles published up to 2020 were evaluated.

RESULTS

The initial evaluation identified 240 articles from which 30 were included. References lists review allowed the inclusion of 26 additional articles. Nocturia, overactive bladder (OAB) and erectile dysfunction (ED) were associated with OSA. Increased levels of natriuretic peptides are behind nocturia. Nocturia is associated with higher Apnea/Hypopnea Index (AHI) (49±11 vs 24±8 episodes/hour with P=0.0001). The severity of nocturia is proportional to the severity of OSA with a positive predictive value of 71%. Intermittent nocturnal hypoxemia causes peripheral axonal damage with subsequent urgency incontinence. There is correlation between severity of OAB and the severity of OSA especially when the latter is moderate or severe. An odds ratio of 0.45 (CI95%: 0.18-0.71) is found for ED in patients who don't have OSA, associating the latter to an increased risk of ED. Intermittent nocturnal hypoxemia, the decrease in the levels of nitric oxide, and the increase in blood pressure and levels of endothelin 1 contribute to the development of ED. An early treatment of OSA with continuous positive airway pressure (CPAP) may allow a partial but significant control of urinary symptoms and erectile dysfunction associated with OSA.

CONCLUSION

OSA is associated with urinary tract symptoms (nocturia and OAB) and erectile dysfunction. The severity of associated symptoms is related to the severity of OSA. Urinary and sexual troubles are reversible after treatment of OSA by CPAP. OSA research is reasonable in case of pathologic nocturia or ED with loss of morning erections.

Blood Oxygen Accumulation Distribution Area Index Is Associated With Erectile Dysfunction in Patients With Sleep Apnea-Results From a Cross-sectional Study

Introduction

Obstructive sleep apnea (OSA) has been linked with erectile dysfunction (ED), but the relatively independent polysomnography (PSG) outcomes of apnea and nocturnal hypoxia may not effectively assess the physiological impairment of OSA well.

Aim

To propose a new calculation method, the blood oxygen accumulation distribution area index (BOADAI), for evaluating the association between OSA and ED.

Methods

In this study, 502 male participants with suspected OSA were enrolled. Clinical questionnaire, physical measurements, and PSG outcomes were obtained by 2 respiratory physicians. ED was assessed by a urologist using the International Index of Erectile Function-5 (IIEF-5). Whole pulse oxygen saturation curves during the sleep time were compressed into a fixed scale image, and the distribution area of oxygen saturation curves was outlined. We then calculated the value of the outlined area and normalized it by total sleep time. The least absolute shrinkage and selection operator logistic regression model was used for selecting the optimal variable associated with ED and model construction. The clinical net benefit of the BOADAI and its related modules was estimated and compared by decision curve analysis.

Main Outcome Measure

ED and OSA were assessed using the IIEF-5, clinical questionnaire, physical measurements, and PSG outcomes.

Results

The frequency of ED in patients with OSA was significantly greater than that in the no-OSA group. Meanwhile, the new BOADAI was negatively correlated with the IIEF-5 score (r = −0.2525, P = .0000). Moreover, the least absolute shrinkage and selection operator method retained BOADAI but not the other PSG parameters such as respiratory disorder index and lowest SaO2. Finally, logistic regression analysis revealed that older age, lips with cyanochroia, systemic hypertension, and BOADAI were independently associated with ED, and decision curve analysis indicated the clinical usefulness of the BOADAI module.

Conclusion

This study revealed novel evidence that OSA is a risk factor for ED. Meanwhile, the BOADAI could act as a potential clinical characteristic to evaluate ED in patients with OSA and to provide clinical treatment recommendations.

Zheng W, Chen X, Huang J, et al. Blood Oxygen Accumulation Distribution Area Index Is Associated With Erectile Dysfunction in Patients With Sleep Apnea—Results From a Cross-sectional Study. Sex Med 2019; 8:36–44.

Salidroside Attenuates Hypoxia-Induced Expression of Connexin 43 in Corpus Cavernosum Smooth Muscle Cells

<b><i>Introduction:</i></b> Connexin 43 (Cx43) is the major component of gap junction in corpus cavernosum smooth muscle, which allows rapid intercellular communication. Cx43 coordinates corpus cavernosum smooth muscle cells and ensures erectile function. The role of hypoxia in Cx43 dysfunction resulting in erectile dysfunction has not been well studied, and salidroside has shown cell protective effects under hypoxia. <b><i>Objective:</i></b> We aimed to investigate the protective role of salidroside and the underlying mechanisms in hypoxia-induced dysfunction of Cx43. <b><i>Methods:</i></b> Corpus cavernosum smooth muscle cells prepared from young male Sprague-Dawley rats were pretreated with or without salidroside and exposed to hypoxic condition for 48 h. The cell viability, expression of hypoxia-inducible factor-1α (HIF-1α) and Cx43, and Ca²⁺ signals were investigated. <b><i>Results:</i></b> Pretreatment with salidroside attenuated loss of hypoxia-induced cell viability markedly and could downregulate the HIF-1α protein expression under hypoxia. Moreover, the expression of Cx43 was significantly increased by hypoxia but was decreased with salidroside pretreatment. The salidroside pretreated group exhibited enhanced release of intracellular Ca²⁺ in corpus cavernosum smooth muscle cells compared with the hypoxia group after stimulation. <b><i>Conclusion:</i></b> Salidroside has a protective effect against hypoxia-induced damage to corpus cavernosum smooth muscle cells.

The effect of CPAP and PDE5i on erectile function in men with obstructive sleep apnea and erectile dysfunction: A systematic review and meta-analysis

Growing evidence has shown that obstructive sleep apnea (OSA) and erectile dysfunction (ED) often coexist. However, the effect of continuous positive airway pressure (CPAP) on erectile function remains controversial. The objective of this review was to clarify the anti-ED effect of CPAP and further compare the efficacy between CPAP, phosphodiesterase type 5 inhibitors (PDE5i) and combination therapy on erectile function in OSA patients concurrent ED. Literature search was performed up to December 1st, 2018 and 26 studies were included in the review. Results showed that CPAP significantly ameliorated the international index of erectile function (IIEF) score, total erectile events (TEE) and nocturnal penile rigidity (NPR), while no significant improvements in nocturnal penile tumescence circumference (NPTC). Moreover, CPAP was inferior to PDE5i in improving IIEF-erectile function, IIEF-intercourse satisfaction, NPTC, successful attempted intercourses rate (SAIR) and erectile dysfunction inventory of treatment satisfaction-question one (EDITS-Q1), while CPAP and PDE5i were of equal efficacy in other domains of IIEF and NPR. Interestingly, CPAP was more effective in improving TEE. Furthermore, CPAP combined with PDE5i was superior to CPAP alone in improving IIEF score, SAIR, and TEE. This review provided promising insights about CPAP-based ED treatment for OSA patients.

Sleep, Sleep Disorders, and Sexual Dysfunction

Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems. Recent research indicates that insufficient sleep, disrupted sleep, and sleep disorders affect many aspects of human health including sexual function. In fact, patients with urological disorders or erectile dysfunction (ED) may have a sleep disorder that contributes to their urological or sexual dysfunction. Obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders and are associated with ED and/or other urological disorders. Therefore, careful attention should be paid to the diagnosis and treatment of concomitant sleep disorders in patients with sexual dysfunction. In this review, we provide an overview of what sleep is and how it is assessed in the clinic or laboratory; our current understanding of the functions of sleep and sleep health; a description of common sleep disorders, as well as how they are diagnosed and treated; and how sleep and its disorders are associated with male sexual dysfunction. Sleep is considered to be a 'third pillar of health', along with diet and exercise. With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.

Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome

Objective

The main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in patients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thickness (BWT) in these patients.

Materials and Methods

The patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evaluated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated.

Results

The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO₂) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO₂) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002).

Conclusion

The results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measurements between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

The role of dietary polyphenols in the management of erectile dysfunction-Mechanisms of action

The incidence of erectile dysfunction (ED) is on the increase and it is estimated that it will affect about 322 million men globally by the year 2025 if adequate measures are not taken to curb it. Natural polyphenols in plant based diets have gained public interest in recent times due to their roles in the prevention of various disease that implicate free radicals/reactive oxygen species and recently on ED. However, the role of polyphenols in the management of ED has not been explored due perhaps to limited data available. Hence this study which reviewed the role of dietary polyphenols in the management of ED and their mechanisms of action. Literature search was carried out in several electronic data bases such as Pubmed, Google Scholar, Medline, Agora and Hinari from1972 to 2016 to identify the current status of knowledge on the role of polyphenols in the management of erectile dysfunction. Progress made so far in this direction suggests inhibition of arginase, acetylcholinesterase, angiotensin converting enzyme, rho-kinase II; activation of endothelial and neuronal NO synthase; decreased synthesis of luteinizing hormone and testosterone reduction; activation of silent information regulator 2-related enzymes (sirtuin1) as well as free radical/reactive oxygen species inhibition as the mechanisms through which the polyphenols identified in this review exert beneficial roles in the management of ED.

Association of Sleep Disordered Breathing with Erectile Dysfunction in Community Dwelling Older Men

PURPOSE

We investigated the association between sleep disordered breathing and erectile dysfunction in older men.

MATERIALS AND METHODS

We performed a cross-sectional analysis of community dwelling men age 67 years or older enrolled in the Osteoporotic Fractures in Men Sleep Study. Participants underwent overnight polysomnography (2003 to 2005) and completed sexual health questionnaires (2005 to 2006). We defined sleep disordered breathing using the apnea-hypopnea index or nocturnal hypoxemia. Erectile dysfunction was defined using the MMAS (Massachusetts Male Aging Study) scale and, in sexually active men, the International Index of Erectile Function. We used logistic regression to examine the association between sleep disordered breathing and erectile dysfunction.

RESULTS

Mean participant age was 76±5 years. Of the 2,676 men completing the MMAS, 70% had moderate to complete erectile dysfunction. Among 1,099 sexually active men completing the IIEF-5 (5-item International Index of Erectile Function), 26% had moderate to severe erectile dysfunction. A higher apnea-hypopnea index was associated with greater odds of MMAS defined moderate to complete erectile dysfunction after adjusting for age and study site (OR 1.39, 95% CI 1.00-1.92 for severe sleep disordered breathing vs none, p trend=0.008), but not after further adjustment for body mass index, socioeconomic status and comorbidities (OR 1.05, 95% CI 0.75-1.49, p trend=0.452). Greater nocturnal hypoxemia was associated with increased odds of MMAS defined moderate to complete erectile dysfunction (unadjusted OR 1.36, 95% Cl 1.04-1.80 vs none) but this was attenuated after adjustment for age and study site (OR 1.24, 95% CI 0.92-1.66). Sleep disordered breathing was not associated with erectile dysfunction by 5-item International Index of Erectile Function.

CONCLUSIONS

In this cross-sectional analysis in older men sleep disordered breathing was associated with higher odds of erectile dysfunction in unadjusted analyses that was largely explained by higher body mass index and increased comorbidity among men with sleep disordered breathing. Prospective studies accounting for obesity and multimorbidity would further clarify the association of sleep disordered breathing and erectile dysfunction.

Characterisation of pomegranate juice effects on human corpus cavernosum

Pomegranate (POM) juice may benefit the erectile process, but the scientific evidence is lacking. This study evaluates the molecular characterisation and confirmation of POM's action on human corpus cavernosum (HCC) obtained from patients (n = 16) undergoing penile prosthesis implantation. After phenylephrine contraction, the relaxant effects of POM with various inhibitors in the presence and absence of palmitic acid (PA)-induced acute oxidative stress were investigated. Electrical field stimulation (EFS)- and acetylcholine (ACh)-induced relaxation were performed using organ bath preparation. Expression of neuronal nitric oxide synthase (nNOS), endothelial (eNOS), phosphodiesterase (PDE)-5A and cGMP levels were assessed in cells from ex vivo organ cultures of HCC, using RT-PCR, ELISA and immunohistochemistry techniques. POM induced marked relaxation of HCC (maximum response: 97.0 ± 3.1%) and reversed the PA-induced decrease of EFS (20 Hz). nNOS transcription was increased by 7-fold in POM-treated cells without influencing eNOS and PDE5A expressions. We conclude that POM induced marked relaxation of HCC via: (i) nNOS stimulation, and (ii) downstream relaxation stimulated by nNOS and cGMP and bypassing the NO and PDE5. This action provides a rationale for the therapeutic or preventative use of POM in men with erectile dysfunction who do not respond well to PDE5 inhibitors.

Erectile dysfunction is a marker for obstructive sleep apnea

PURPOSE

To investigate the prevalence of erectile dysfunction (ED) in patients with obstructive sleep apnea (OSA) with and without any other comorbidities.

METHODS

The patient group was newly diagnosed as having OSA (apnea-hypopnea index [AHI] > 5/h) using a polysomnographic examination. A group of subjects with simple snoring were included into the control group. Clinically relevant comorbidities were systematically assessed in face-to-face interviews. All patients were asked to complete the 15-item International Index of Erectile Function (IIEF-15) questionnaire for the evaluation of ED. The patients with OSA and ED were evaluated according to these comorbidities.

RESULTS

Of the 94 patients, 39 patients were excluded because of severe diseases. OSA was observed in 38 (69.1%) of the 55 patients. ED was seen in 24 (63.2%) patients with OSA, and in 8 (47.1%) patients without OSA (p > 0.05). There were no statistical differences between the groups' ages, IIEF scores, and body mass index (BMI) scores. There were statistically significant differences between the groups' AHI scores (p < 0.05). There was a significant correlation between the groups' AHI scores, BMI, and age (p < 0.05). There was no statistically significant difference in patients with OSA, with and without comorbidity in terms of ED.

CONCLUSION

The rate of ED was higher in patients with OSA who had no other comorbidities. Therefore, ED can be a sensitive marker of OSA.

Altered bulbocavernosus reflex in patients with multiple system atrophy

OBJECTIVES

Multiple system atrophy (MSA) is characterized by a combination of symptoms including autonomic dysfunction, parkinsonism, cerebellar ataxia, and cortico-spinal disorders. The disease can have either predominant parkinsonism or cerebellar features (MSA-P and MSA-C, respectively). The measurement of the bulbocavernosus reflex (BCR) and pudendal nerve somatosensory-evoked potentials (PSEPs) was originally developed to diagnose diabetic cystopathy and other neuropathologic diseases that share similar symptoms with MSA. We investigated the relationship between abnormalities of neurophysiological parameters and MSA, and estimated the potential value of BCR.

METHODS

Fifty-one MSA patients (28 and 23 MSA-P and 23 MSA-C patients, respectively) and 30 healthy controls who were seen at the Department of Neurology were included in the study. A Keypoint EMG/EP system was used to test BCR and PSEPs, and the latencies and amplitudes were recorded for statistical analyses.

RESULTS

The BCR was elicited in 78.4% patients with MSA (22/28 MSA-P, 18/23 MSA-C). Prolonged BCR latencies were found in patients with MSA compared with healthy controls (p < 0.001). BCR amplitudes were significantly lower in the MSA group than the control group (p < 0.001). PSEP P41 amplitudes were not significantly different between the MSA and control groups in males (p = 0.608) or females (p = 0.897). There were no significant differences in PSEP latencies among the MSA-P, MSA-C, and control groups (p = 1.0, p = 0.263, and p = 0.060, respectively).

DISCUSSION

MSA patients exhibit prolonged BCR latencies and lower amplitudes, which provides a rough anatomical localization of nervous system lesions in MSA patients.

Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment

OBJECTIVE

Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA).

METHODS

Before and after 1 year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26–77) received a survey with questions drawn from two self-administered questionnaires on sexuality – Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used the Epworth sleepiness scale (ESS).

RESULTS

Response rate was 76%. We found no significant changes in satisfaction with relation to partner or life as a whole, but satisfaction with sexual life (LiSat-11) and both general and functional aspects of sexuality (BSFI) were significantly improved after 1 year of CPAP treatment. ESS score decreased significantly after 1 year of CPAP treatment.

CONCLUSION

One year of CPAP treatment improves all aspects of sexual function in male patients with OSA. Our data indirectly suggest that organic factors are the most likely explanation to these improvements.

A pathway underlying the impact of CPAP adherence on intimate relationship with bed partner in men with obstructive sleep apnea

PURPOSE

Our aim was to determine the pathway underlying the effects of continuous positive airway pressure (CPAP) adherence on intimate relationship with bed partner in men with obstructive sleep apnea (OSA). We hypothesized that CPAP with good adherence affected the intimate relationship with bed partner directly and indirectly, and it was mediated through daytime sleepiness and activity level in men with OSA.

METHODS

Data were obtained from an education program for enhancing CPAP adherence. Men who were newly diagnosed of OSA and CPAP therapy naïve were recruited in a tertiary teaching hospital.

RESULTS

Self-reported quality of life [Functional Outcomes of Sleep Questionnaire], daytime sleepiness [Epworth Sleepiness Scale (ESS)], and negative emotion symptoms [depression, anxiety, stress scale] were assessed before and after CPAP treatment at 1-year assessment. Seventy-three men were included in the data analysis, with a mean ± SD age of 52 ± 10 years, body mass index of 29.0 ± 5.2 kg/m(2), ESS of 9.5 ± 5.6, and median [interquartile range(IR)] apnea and hypopnea index of 31 (21, 56) events/h. The median (IR) CPAP daily usage was 4.3(0, 6.1) h/day. From the path analysis, CPAP therapy was shown to improve intimate relationship directly (ß = 0.185) and indirectly (ß = 0.050) by reducing daytime sleepiness and increasing activity level. However, negative emotion symptoms were not the mediators between CPAP adherence and the intimate relationship.

CONCLUSIONS

CPAP therapy with good adherence is related directly and indirectly to a better intimate relationship with bed partner in men with OSA. It was possibly attributed to reduced daytime sleepiness and increased activity level.

Erectile Dysfunction in Patients with Sleep Apnea--A Nationwide Population-Based Study

Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients.

Effects of nasal continuous positive airway pressure therapy on partners' sexual lives

To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P < 0.01. Pre- and post-treatment FSFI scores in women were 21.54 ± 6.62 and 29.94 ± 3.76, respectively, P < 0.01. Pre- and post-treatment BDI scores in women were 14.61 ± 9.69 and 12.42 ± 8.92, respectively, P < 0.01. Following treatment of men with OSA, our data indicate benefits for nasal CPAP therapy on sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.

Severe obstructive sleep apnoea syndrome and erectile dysfunction: a prospective randomised study to compare sildenafil vs. nasal continuous positive airway pressure

BACKGROUND

A high incidence of erectile dysfunction (ED) among patients with obstructive sleep apnoea syndrome (OSAS) has been reported, with a strong correlation between obstructive sleep apnoea, ED, and quality of life (QOL), and it has been estimated that 10-60% of patients with OSAS suffer from ED. In this prospective randomised controlled trial, we investigated 82 men with ED consecutively who were referred to the outpatient clinic for sleep disorders and had severe OSAS (AHI> 30 events/h) without any other comorbidities as a possible cause of ED. The aim of this study was to evaluate and compare the efficacy of sildenafil vs. continuous positive airway pressure (CPAP) in men with ED and severe OSAS.

METHODS

Eighty-two patients were randomised to two main treatment groups: group 1 patients (n = 41) were treated with 100-mg sildenafil 1 h before sexual intercourse without CPAP, and group 2 patients (n = 41 men) were treated with only nasal CPAP during night time sleep. Both groups were evaluated with the same questionnaires (International Index of Erectile Function-EF domain; Sex Encounter Profile; Erectile Dysfunction Inventory Treatment Satisfaction) 12 weeks after treatment.

RESULTS

In patients receiving sildenafil treatment, 58.2% of those who attempted sexual intercourses were successful compared to 30.4% in the CPAP group. The mean number of successful attempts per week was significantly higher in the sildenafil group compared with the CPAP group (2.9 vs. 1.7, respectively; p < 0.0001). The mean IIEF-EF domain scores were significantly higher in the sildenafil group compared with the CPAP group (p < 0.0001). The overall satisfaction rate was 68% with sildenafil treatment and 29% with CPAP treatment.

CONCLUSIONS

This study confirms that severe OSAS is strongly associated with erectile dysfunction. CPAP and sildenafil (100 mg) are safe and effective therapies for OSAS-related ED patients. In the present study sildenafil was more effective than CPAP in treating ED associated with OSAS, as indicated by a significantly higher rate of successful attempts at intercourse and higher IIEF-EF domain scores. Our study, to date, is the only that has investigated sildenafil in patients with severe OSAS.

Analysis of the vertebrobasilar system in patients with obstructive sleep apnea

We conducted a prospective study to evaluate the vertebrobasilar system in adults with and without obstructive sleep apnea (OSA). Our study population was made up of 48 patients with OSA and 21 healthy volunteers who served as controls; the OSA patients were subdivided into one group with mild or moderate OSA (n = 22) and another with severe OSA (n = 26). Each participant underwent Doppler ultrasonography three times to measure the diameter of the vertebral artery, the peak systolic velocity (PSV), the resistive index (RI), and the vertebral artery flow volume; the mean of the three measurements was calculated for each patient, for the OSA and control groups, and for various subgroups. No significant differences in vessel diameter, PSV, or RI were seen among any of the subgroups. Overall, the vertebral artery flow volume was slightly, but not significantly, higher in all patients with OSA (206 ml/min) than in the control group (177 ml/min); this difference might reflect the body's daytime response to the chronic apneic events experienced during sleep. The only statistically significant difference we found was in vertebral artery flow volume between the controls and the subgroup with mild or moderate OSA (p = 0.026); no difference was seen between the controls and the patients with severe OSA (p = 0.318). Likewise, no significant difference in any of the four parameters was seen when patients were subclassified by body mass index and arterial oxygen saturation level.

Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure

INTRODUCTION

Obstructive sleep apnea (OSA), particularly intermittent nocturnal hypoxemia, is associated with erectile dysfunction (ED).

AIM

We investigated in patients with OSA whether continuous positive airway pressure (CPAP) therapy has a long-term effect on sexual function, including ED, in the presence of other risk factors for ED.

METHODS

Within a long-term observational design, we reassessed 401 male patients who had been referred for polysomnography, with respect to erectile and overall sexual function. Mean ± standard deviation follow-up time was 36.5 ± 3.7 months. Patients with moderate to severe ED were stratified according to the regular use of CPAP.

MAIN OUTCOME MEASURE

Changes of sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire, including the domains erectile function (EF), intercourse satisfaction, orgasmic function (OF), sexual desire (SD), and overall satisfaction (OS).

RESULTS

Of the 401 patients, 91 returned a valid IIEF-15 questionnaire at follow-up. Their baseline characteristics were not different from those of the total study group. OSA (apnea-hypopnea index >5/hour) had been diagnosed in 91.2% of patients. In patients with moderate to severe ED (EF domain <17), CPAP users (N = 21) experienced an improvement in overall sexual function (IIEF-15 summary score; P = 0.014) compared with CPAP non-users (N = 18), as well as in the subdomains OF (P = 0.012), SD (P = 0.007), and OS (P = 0.033). Similar results were obtained in patients with poor overall sexual dysfunction (IIEF-15 summary score <44). In patients with moderate to severe ED and low mean nocturnal oxygen saturation (≤93%, median), also the EF subdomain improved in CPAP users vs. non-users (P = 0.047).

CONCLUSIONS

These data indicate that long-term CPAP treatment of OSA and the related intermittent hypoxia can improve or preserve sexual function in men with OSA and moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA-induced sexual dysfunctions.

Erectile dysfunction in obstructive sleep apnea syndrome--prevalence and determinants

INTRODUCTION

OSAS (Obstructive Sleep apnea syndrome) is defined by recurrent episodes of upper airway obstruction during sleep, causing multiple clinical consequences. Literature review suggests that OSAS induces a spectrum of abnormalities in neural, hormonal and vascular regulation that contribute to the development of ED (erectile dysfunction). The aims of this study were to estimate the prevalence of ED in OSAS patients and evaluate its determinants.

METHODS

62 patients from Hospital S. João Sleep Laboratory with newly diagnosed OSAS were included in the study and answered the IIEF-5 (international index erectile function 5 item version) questionnaire.

RESULTS

The prevalence of ED in OSAS patients was 64.4%. Age and Diabetes constituted themselves as independent risk factors for more severe degrees of ED: OR=1.226 (95%CI: 1.062-1.415) and OR=31.205 (95%CI: 1.222-796.557), respectively. Compared with nonsmokers, ex-smokers group revealed a positive association with ED: OR=4.32 (95%CI: 1.09-17.11). Hypertension and ACEI (angiotensin converting enzyme inhibitors) or ARB (angiotensin II receptor blockers) therapy were also correlated to ED symptoms: OR=3.25 (95%CI: 1.09-9.65) and 7.39 (95%CI: 1.52-35.99), respectively. No association was found relating BMI (p=0.254), alcoholic habits (p=0.357), acute myocardial infarction (p=0.315), dyslipidemia (p=0.239),metabolic syndrome (p=0.215) and ED. OSAS severity was not associated with ED in our sample.

CONCLUSIONS

The prevalence of ED in OSAS patients is high. ED determinants in our sample were age and diabetes. Past smoking habits, hypertension and ACEI/ARB therapy also revealed a statistically significant association with ED.

[Factors related with the presence of erectile dysfunction in patients with obstructive sleep apnea]

BACKGROUND AND OBJECTIVE

Obstructive sleep apnea (OSA) syndrome can contribute to the development of erectile dysfunction (ED) through multiple mechanisms. The aim was to identify factors influencing the presence of ED in these patients.

PATIENTS AND METHODS

Cross sectional study in men diagnosed with OSA by polysomnography. We obtained information about demographic variables, apnea-hypopnea index (AHI), comorbidity, blood pressure, drugs, Epworth Sleepiness Scale, physical examination, electrocardiogram, ankle-brachial index and blood and urine analysis. The presence of ED was assessed by questionnaire IIEF-5.

RESULTS

We included 142 patients, mean age was 53 (11) years. The prevalence of ED was 69%. We found significant differences in AHI between patients with mild and severe ED (41 [21] vs 63 [18], P=.023). ED was associated with hypertension (odds ratio [OR]=3.56 [1.64-7.72]), hypercholesterolemia (OR=7.19 [2.39-21.68]), diabetes mellitus type 2 (OR=3.07 [1.02-9.48]) and ischemic heart disease (OR=1.51 [1.33-1.70]); and treatment with antihypertensive (OR=4.05 [1.76-9.31)], lipid-lowering drugs (OR=9.71 [2.2-22.72]), anti-diabetic drugs (OR=3.21 [0.69-14.89]), antiplatelet and anticoagulant agents (OR=6.44 [1.45-28.64]). After logistic regression analysis, only age (OR=1.11 [1.05-1.16]) and hypercholesterolemia (OR=4.87 [1.49-15.96]) were associated with ED.

CONCLUSIONS

Patients with OSA have a high prevalence of ED, mainly in severe OSA. Factors influencing the presence of ED in patients with OSA are primarily age and hypercholesterolemia. Other factors that may be related include hypertension, poor metabolic control, ischemic heart disease, and treatment with antihypertensive, lipid-lowering and anti-diabetic drugs.

Neural injury in sleep apnea

Sleepiness has long been recognized as a presenting symptom in obstructive sleep apnea syndrome, but persistent neurocognitive injury from sleep apnea has been appreciated only recently. Although therapy for sleep apnea markedly improves daytime symptoms, cognitive impairments may persist despite long-term therapy with continuous positive airway pressure. We know now that certain groups of neurons, typically those that are more metabolically active, are more vulnerable to injury than others. Animal models of sleep apnea oxygenation patterns have been instrumental in elucidating mechanisms of injury. The hypoxia/reoxygenation events result in oxidative, inflammatory, and endoplasmic reticulum stress responses in susceptible neural groups. With molecular pathways being fleshed out in animal models, it is time to carefully and systematically examine neural injury in humans and test the applicability of findings from animal models. To succeed, however, we cannot view sleep apnea as an isolated process. Rather, injury in sleep apnea is more likely the consequence of overlapping injuries from comorbid conditions. The progress in elucidating mechanisms of neural injury is palpable, and it now seems we indeed are closer to developing therapies to prevent and treat neural injury in obstructive sleep apnea.

Effects of sildenafil on autonomic nervous function during sleep in obstructive sleep apnea

OBJECTIVE

To evaluate the effects of sildenafil on the autonomic nervous system in patients with severe obstructive sleep apnea.

METHODS

Thirteen male patients with severe obstructive sleep apnea (mean age 43+/-10 years with a mean body mass index of 26.7+/-1.9 kg/m(2)) received a single 50-mg dose of sildenafil or a placebo at bedtime. All-night polysomnography and heart rate variability were recorded. Frequency domain analysis of heart rate variability was performed for the central five-minute sample of the longest uninterrupted interval of slow wave and rapid eye movement sleep, as well as for one-minute samples during apnea and during slow wave and rapid eye movement sleep after resumption of respiration.

RESULTS

Compared to the placebo, sildenafil was associated with an increase in the normalized high-frequency (HF(nu)) components and a decrease in the low/high-frequency components of the heart rate variability ratio (LF/HF) in slow wave sleep (p<0.01 for both). Differences in heart rate variability parameters between one-minute post-apnea and apnea samples (Delta = difference between resumption of respiration and apnea) were assessed. A trend toward a decreasing magnitude of DeltaLF activity was observed during rapid eye movement sleep with sildenafil in comparison to placebo (p=0.046). Additionally, DeltaLF/HF in SWS and rapid eye movement sleep was correlated with mean desaturation (s(R =) -0.72 and -0.51, respectively, p= 0.01 for both), and DeltaHF(nu) in rapid eye movement sleep was correlated with mean desaturation (s(R=) 0.66, p= 0.02) and the desaturation index (s(R=) 0.58, p = 0.047).

CONCLUSIONS

The decrease in arousal response to apnea/hypopnea events along with the increase in HF(nu) components and decrease in LH/HF components of the heart rate variability ratio during slow wave sleep suggest that, in addition to worsening sleep apnea, sildenafil has potentially immediate cardiac effects in patients with severe obstructive sleep apnea.

The relationship between sleep apnea and overactive bladder

Approximately 4% to 5% of middle-aged men are affected by obstructive sleep apnea (OSA) syndrome, which is known to cause urologic disorders, cardiovascular diseases, and an increased risk of stroke. The correlation between OSA, erectile dysfunction, and nocturia is well known; a recent study demonstrated the association between overactive bladder and urgency incontinence. This article discusses the current literature and therapeutic options, as well as our own experiences and consequences for affected patients.

Association Analysis of Endothelial Nitric Oxide Synthase G894T Gene Polymorphism and Erectile Dysfunction Complaints in a Population-Based Survey

Introduction

Erectile dysfunction (ED) is a common disorder leading to a serious, negative impact on the quality of the patient’s life. The gene encoding endothelial nitric oxide synthase (eNOS) is an interesting candidate gene for understanding the physiopathology of ED, as it is involved in the catalytic production of nitric oxide (NO), the neurotransmitter that plays a critical role in penile tumescence and erection.

Aim

To evaluate a potential association between the G894T polymorphism in the eNOS gene and ED complaints in a population-based sample in São Paulo, Brazil.

Main Outcome Measures

The prevalence of ED complaints was estimated according to the answer to the question “How would you describe your ability to get and keep an erection that is adequate for satisfactory intercourse?” ED was considered to be present if the response was “sometimes” or “never.”

Methods

A total of 449 men were enrolled in the study and answered an eight-item questionnaire to ascertain sexual performance/ED and satisfaction. The eNOS G894T polymorphism was genotyped using a standard polymerase chain reaction method.

Results

Univariate analysis demonstrated that ED was associated with diabetes, hypertension, sleep apnea severity, increasing age and body mass index, as well as testosterone levels (P &lt;0.05). Forward multiple regression models indicated that age was the only independent factor associated with ED in this population (odds ratio=1.09; 95% CI 1.06–1.11; P &lt;0.0001). Genotypic and allelic analyses provided no evidence for an association between this polymorphism and the risk for ED complaints in this sample. Population stratification did not affect the association test results.

Conclusions

This is the first study to examine the effect of polymorphisms in the eNOS gene and the risk for ED utilizing a case-control approach in the Brazilian population. Our results do not support a major role for eNOS gene polymorphisms in ED in this population.

Erectile dysfunction in severe sleep apnea patients and response to CPAP

The aim of this study was to investigate frequency and degree of ED in patients with severe sleep apnea and to evaluate the results of only continuous positive airway pressure (CPAP) therapy on ED in patients with severe obstructive sleep apnea syndrome (OSAS). This was a prospective clinical trial study. Patients with severe sleep apnea (40) were randomized into two groups. Multiple questionnaire investigation and laboratory evaluation were performed for ED, severity of OSAS and psychological status. Group 1 was treated with CPAP and group 2 was treated with only antidepressant medication for at least 1 month. Patients were evaluated after 1 month of therapy and compared with initial ones. Before CPAP, the International Index of Erectile Function (IIEF)-5 scores were significantly correlated only with body mass index (BMI; P=0.007) and not correlated significantly with Epworth Sleepiness Scale scores (P=0.286), lowest SaO(2) (P=0.182), Beck's Depression Inventory scores (P=0.302) and apnea/hypopnea index (P=0.279). After 1 month of regular CPAP usage, mean value of IIEF-5 score was 15.71+/-5.12 before CPAP and were improved up to 19.06+/-3.94, statistically significant. All subjects responded positively to the CPAP treatment and their erection status was improved positively. We have found a correlation between severe OSAS and ED. CPAP is effective in improvement of sexual performance of these patients.

Sexual dysfunction in women with obstructive sleep apnea

BACKGROUND

Female sexual dysfunction is vastly under-recognized but has been previously described in chronic disease states. Sexual dysfunction in male patients with obstructive sleep apnea (OSA) is well described, but not in females.

OBJECTIVE

The objective of this study was to assess the prevalence of sexual dysfunction in women with OSA.

METHODS

We studied 21 consecutive pre-menopausal women with OSA, referred to our sleep lab, and who had a positive study for sleep apnea (respiratory disturbance index (RDI) > 5), and 11 healthy pre-menopausal women were included as the control group. Subjects were administered the Female Sexual Function Index (FSFI) questionnaire and a mood scale-Profile of Mood States.

RESULTS

Of the study group, 11 women (52.4%) had FSFI scores in the poor range (<23) as compared to the control group, in which none of the women (0%) had FSFI scores in the poor range (<23). Negative mood domain scores were not different in patients with poor FSFI compared to patients with normal FSFI scores. There was no correlation between obesity, severity of sleep apnea, or mood disorders on overall scores of sexual dysfunction. Among individual domains, there was a correlation between RDI and arousal scores.

CONCLUSION

In our study, we have found that prevalence of sexual dysfunction is high among women with OSA. Physicians should routinely screen and evaluate women with OSA for sexual dysfunction.

Sleep apnea is an independent correlate of erectile and sexual dysfunction

INTRODUCTION

Obstructive sleep apnea (OSA) has been linked with erectile dysfunction (ED), but it is unknown whether this association is maintained in the presence of other risk factors for ED.

AIM

The aim of this study was to evaluate the relationship between ED/sexual dysfunction and polysomnographic measures of sleep apnea in patients with known risk factors for ED.

METHODS

Prospective cross-sectional analysis of 401 male patients undergoing in-lab polysomnography for suspected OSA. Erectile (EF) and sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire.

MAIN OUTCOME MEASURES

Severity of OSA via apnea-hypopnea index (AHI) and mean/lowest nocturnal oxygen saturation (SaO(2)). The IIEF-15 including the sexual domains: EF, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction.

RESULTS

OSA (AHI > 5/h) was diagnosed in 92% of patients. ED (EF subdomain < or = 25) was present in 69% of patients with, and 34% of patients without OSA (P < 0.001). Multivariate stepwise regression analyses including known risk factors for ED, such as age, obesity, coronary heart disease, peripheral occlusive disease, hypertension, diabetes, prostate surgery, and beta-blocker treatment, and measures of sleep apnea identified mean nocturnal SaO(2) as independently associated with ED (P = 0.002; mean [95% CI] normalized slope 0.126 [0.047; 0.205]). Age (P < 0.001), peripheral occlusive disease (P = 0.001), prostate surgery (P = 0.018), and hypertension (P = 0.021) were confirmed as risk factors for ED, but did not abolish the sleep apnea-associated risk. Similar results were obtained for sexual dysfunction. Logistic regression analysis using the diagnosis of ED (EF subdomain < or = 25) as binary dependent variable confirmed that mean nocturnal SaO(2) (P = 0.012), as well as age (P < 0.001) were independently associated with ED.

CONCLUSIONS

ED and overall sexual dysfunction were highly prevalent in patients with suspected OSA. Irrespective of known risk factors, mean nocturnal SaO(2) was an additional, independent correlate of these dysfunctions, suggesting that OSA-related intermittent nocturnal hypoxemia specifically contributes to their development.

Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor?

INTRODUCTION

Erectile dysfunction (ED) is a well-known entity with determined risk factors, which generally has a negative impact on quality of life. Obstructive sleep-disordered breathing (SDB), often referred to as obstructive sleep apnea, stands among the possible risk factors for ED.

DISCUSSION

Literature review suggests that SDB induces a spectrum of abnormalities in neural, hormonal, and vascular regulation that may contribute to the development of ED. While more studies are required to imply SDB as a risk factor for ED, several case series and expert opinion have contributed evidence for a causal relationship.

CONCLUSION

In clinical practice, men presenting with symptoms of sexual dysfunction often have concomitant sleep disorders requiring treatment. There is now evidence to suggest that treating SDB may be an effective treatment for ED. It is the authors' opinion that patients with erectile dysfunction would benefit from a sleep evaluation.

Erectile dysfunction and sleep related disorders

PURPOSE

There are reported links between erectile dysfunction and sleep disorders. We reviewed the physiology of penile erection during sleep and the possible links between the pathophysiology of erectile dysfunction and the most commonly diagnosed sleep disorders.

MATERIALS AND METHODS

A MEDLINE search using the identifiers erectile dysfunction, sleep, sleep disorders, sleep apnea, insomnia and narcolepsy was performed to identify the current literature pertaining to erectile dysfunction and sleep disorders. The peer reviewed literature and relevant surveys from 1985 to 2006 were subsequently reviewed.

RESULTS

An association between erectile dysfunction and sleep disorders appears to exist in survey studies relying on self-report and in small case series. Hormonal, neural and endothelial mechanisms have been implicated in linking sleep disorders with erectile dysfunction. Treatment of sleep disorders, specifically sleep apnea with continuous positive airway pressure, has been shown to improve patient erectile function.

CONCLUSIONS

Clinicians should consider concomitant sleep disorders when evaluating patients with erectile dysfunction, especially in those refractory to routine therapy. Further studies are necessary to clearly define the causative link between sleep disorders and erectile dysfunction.

Snoring as a risk factor for sexual dysfunction in community men

INTRODUCTION

Severe obstructive sleep apnea has been associated with sexual dysfunction; however, it is unclear whether milder forms of sleep disturbances might also be associated with sexual problems.

AIM

To evaluate the association between snoring and five measures of sexual dysfunction in a population-based sample of men.

METHODS

A stratified random sample of men residing in Olmsted County, Minnesota completed a questionnaire containing questions from the Brief Male Sexual Function Inventory (BMSFI) and a sleep questionnaire.

MAIN OUTCOME MEASURES

Levels of sexual drive (libido), erectile function, ejaculatory function, sexual problem assessment, and sexual satisfaction as assessed by the BMSFI.

RESULTS

Of 827 men with a regular sexual partner, subjects were divided into categories of heavy (N = 95), moderate (N = 573), and none/mild (N = 159) snoring. Their median age was 64 years (range 51-90). The sexual satisfaction domain score was significantly lower in the heavy snoring group (P value = 0.01). The odds of low sexual satisfaction was 2.3 (95% CI 1.2, 4.1) among the heavy snorers compared with the none/mild snoring group. This association remained statistically significant after adjustment for smoking, medical comorbidities, and mental health status. However, there was no significant difference in ejaculatory function, erectile function, sexual drive, and sexual problem assessment across snoring categories.

CONCLUSIONS

These data provide evidence of an association between snoring severity and reduced sexual satisfaction in a population of elderly community males. Snoring was not associated with biologic measures of sexual dysfunction.