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Gu X, Liang L, Lu C, Wang J, Hua B, Li W, Mao Y, Yang Q, Xu B. Exosomes secreted by adipose mesenchymal stem cells overexpressing circPIP5K1C exert. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167223. [PMID: 38718844 DOI: 10.1016/j.bbadis.2024.167223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Erectile dysfunction (ED) seriously affects men's normal life, and obstructive sleep apnoea (OSA) has been diagnosed as a causative factor. Currently, exosomes secreted by adipose mesenchymal stem cells (ADSC) have been used in the non-clinical experimental treatment of ED disease with prominent efficacy due to the advantages of high stability and no immune exclusion. METHODS In this study, chronic intermittent hypoxia (CIH) exposure was used to induce ED-corresponding phenotypes in Sprague Dawley (SD) rats as well as in cavernous smooth muscle cells (CCSMCs). ED symptoms were treated using exosomes secreted by ADSCs overexpressing circPIP5K1C (EXO-circ) injected into the rat corpus cavernosum. RESULTS EXO-circ has the effect of ameliorating ED induced by CIH exposure in rats, the mechanism of which is to promote the expression of the downstream target gene SMURF1 after adsorption of miR-153-3p through the sponge so that SMURF1 and PFKFB3 occur protein-protein binding and ubiquitination degradation of PFKFB3 appears to inhibit the occurrence of spongiotic smooth muscle cells glycolysis, and to restore the function of the smooth muscle. CONCLUSIONS These findings show that EXO-circ have a promising therapeutic potential in OSA-induced ED.
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Affiliation(s)
- Xin Gu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Li Liang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Chao Lu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Jiangyi Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China.
| | - Bao Hua
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Wengfeng Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Yuanshen Mao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Qing Yang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China.
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China.
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Valentina P, Giovanna BE, Paolo B, Eleonora V. Effectiveness of continuous positive airway pressure therapy on romantic relationships and intimacy among individuals with obstructive sleep apnea: A systematic review and a meta-analysis. J Sleep Res 2024:e14262. [PMID: 38925562 DOI: 10.1111/jsr.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
Obstructive sleep apnea is a common yet often overlooked chronic sleep disorder with significant health implications globally. Bedpartners play a vital role in motivating individuals with obstructive sleep apnea to seek medical help, though their sleep quality may suffer, straining the couple's relationship. From September 2023 to January 2024, utilizing PubMed, Scopus, BioMed Central, Cochrane Library, ScienceDirect and www.clinicaltrials.gov databases, this systematic review meticulously examined data from 27 studies to investigate how continuous positive airway pressure therapy, recognized as the gold-standard for treating obstructive sleep apnea, may positively influence psychological dynamics within couples. Additionally, a meta-analysis was conducted on nine studies, to assess the effect of continuous positive airway pressure on erectile function, which is often compromised in patients with obstructive sleep apnea. The PRISMA checklist and specific quality assessments were followed to ensure methodological rigour and transparency. Findings reveal positive changes in conflict resolution for patients with obstructive sleep apnea post- continuous positive airway pressure adaptation (p < 0.05). Emotional functioning (p = 0.002) and social relationships (p < 0.001) also show improvements in bedpartners. While six subjective assessments indicate enhancements in sexual quality of life for patients with obstructive sleep apnea, challenges related to continuous positive airway pressure use as a barrier to intimacy are acknowledged. Focusing on male patients with obstructive sleep apnea, findings demonstrated a substantial improvement in erectile function post-continuous positive airway pressure utilization, with a Z-score of 4.84 (p < 0.00001). Female patients with obstructive sleep apnea using continuous positive airway pressure show no significant improvements in sexual functioning, while female bedpartners report positive changes. These insights emphasize the importance of holistic approaches in addressing the impact of obstructive sleep apnea on both individuals and their relationships.
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Affiliation(s)
- Poletti Valentina
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Battaglia Elvia Giovanna
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Sleep Centre, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Banfi Paolo
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Volpato Eleonora
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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3
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Stilo G, Vicini C, Pollicina I, Maniaci A, Lechien JR, Calvo-Henríquez C, Yáñez MM, Iannella G, Pace A, Cammaroto G, Meccariello G, Cannavicci A, Moffa A, Casale M, La Mantia I. Is Continuous Positive Airway Pressure a Valid Alternative to Sildenafil in Treating Sexual Dysfunction among OSA Patients? A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1318. [PMID: 37512129 PMCID: PMC10384051 DOI: 10.3390/medicina59071318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
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.
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Affiliation(s)
- Giovanna Stilo
- Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
| | - Claudio Vicini
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy
| | - Isabella Pollicina
- Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
| | - Jérôme René Lechien
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
| | - Christian Calvo-Henríquez
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Miguel Mayo Yáñez
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
| | - Giannicola Iannella
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Annalisa Pace
- Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
| | - Giovanni Cammaroto
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
| | - Giuseppe Meccariello
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy
| | - Angelo Cannavicci
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy
- Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
| | - Antonio Moffa
- Unit of Otolaryngology, University Campus Bio-Medico, 00185 Rome, Italy
| | - Manuele Casale
- Unit of Otolaryngology, University Campus Bio-Medico, 00185 Rome, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
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Hwang JH, Yu BH, Chen YC. Effects of Surgical Treatment for Obstructive Sleep Apnea on Renal and Survival Outcomes in Patients with Chronic Kidney Disease: A Taiwanese Nationwide Cohort Study. J Clin Med 2022; 11:jcm11154411. [PMID: 35956028 PMCID: PMC9369151 DOI: 10.3390/jcm11154411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
The association between surgical treatment for obstructive sleep apnea (OSA) in chronic kidney disease (CKD) patients and end-stage renal disease (ESRD) and survival outcomes is not established, and this study aimed to evaluate this association. A retrospective cohort analysis was conducted from 2001 to 2015, including 32,220 eligible CKD patients with incident OSA. By 1:3 propensity score matching, 1078 CKD patients with incident OSA who received surgery (treated cohort) and 3234 untreated cohort who never received surgery were analyzed. The risk of ESRD in the competing mortality was significantly lower in the treated cohort than in the untreated cohort, with an adjusted hazard ratio (aHR) of 0.38 (95% confidence interval (CI0, 0.15−0.97; p = 0.043). In addition, the adjusted HRs of overall, cardiovascular, and non-cardiovascular mortality in the treated and untreated cohorts were 2.54 (95% CI, 1.79−3.59; p < 0.0001), 1.46 (95% CI, 0.29−7.22; p = 0.64), and 2.62 (95% CI, 1.83−3.75; p < 0.0001), respectively. Furthermore, the risks of overall and non-cardiovascular mortality for the treated cohort primarily occurred during a 3-month follow-up. In conclusion, surgical treatment for incident OSA in CKD patients was associated with decreased ESRD risk, but with increased non-cardiovascular mortality risk, especially within 3 months after surgical treatment.
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Affiliation(s)
- Juen-Haur Hwang
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - Ben-Hui Yu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan;
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan
- Correspondence: ; Tel.: +886-5-264-8000
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Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev 2022; 38:e3494. [PMID: 34514697 PMCID: PMC9286480 DOI: 10.1002/dmrr.3494] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM), a chronic metabolic disease characterised by elevated levels of blood glucose, is among the most common chronic diseases. The incidence and prevalence of DM have been increasing over the years. The complications of DM represent a serious health problem. The long-term complications include macroangiopathy, microangiopathy and neuropathy as well as sexual dysfunction (SD) in both men and women. Erectile dysfunction (ED) has been considered the most important SD in men with DM. The prevalence of ED is approximately 3.5-fold higher in men with DM than in those without DM. Common risk factors for the development of DM and its complications include sedentary lifestyle, overweight/obesity and increased caloric consumption. Although lifestyle changes may help improve sexual function, specific treatments are often needed. This study aims to review the definition and prevalence of ED in DM, the impact of DM complications and DM treatment on ED and, finally, the current and emerging therapies for ED in patients with DM.
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Affiliation(s)
- Giuseppe Defeudis
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Rossella Mazzilli
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Marta Tenuta
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Giovanni Rossini
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Virginia Zamponi
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Soraya Olana
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Antongiulio Faggiano
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Paolo Pozzilli
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
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6
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Hwang JH, Ong HL, Chen YC. Surgical treatments for obstructive sleep apnea decrease the risk of erectile dysfunction: A nationwide cohort study. Andrology 2021; 10:477-485. [PMID: 34748688 DOI: 10.1111/andr.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 11/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND It has been reported that the risk of erectile dysfunction (ED) is significantly higher in patients with obstructive sleep apnea (OSA), compared with patients without OSA. However, there is limited evidence on whether surgical treatments in patients with OSA could decrease ED risk. OBJECTIVES To assess the impact of surgical treatments for OSA on the risk of ED by analysis of claims data from the Taiwan National Health Insurance Research Database between 1997 and 2012. MATERIAL AND METHODS We identified 20,675 male adults with newly diagnosed OSA during the study period; 16,040 patients ever received surgical treatments (treated cohort) and 4635 patients never received surgical treatments (untreated cohort). According to 3:1 propensity score matching, we analyzed 8337 patients in the treated cohort and 2779 controls in the untreated cohort. We estimated the incidence rates (IRs) and hazard ratios (HRs) of incident ED in both cohorts through the end of 2012. RESULTS In a total study follow-up of 64,916 person-years, 396 (3.6%) patients developed impotence. The IRs of ED for the treated and untreated cohorts, respectively, were 55.8 (95% confidence interval [CI], 55.6-55.9) and 76.1 (95% CI, 76.0-76.3) per 1000 person-years. Multivariate Cox proportional hazard analysis showed that surgical treatments for OSA patients were associated with a lower risk for ED (adjusted HR, 0.79; 95% CI, 0.64-0.98). Multivariate stratified analysis further verified that significant risk reduction of ED was present in OSA patients without hypertension, diabetes, hyperlipidemia, hyperuricemia, obesity, chronic kidney disease, and chronic liver disease. CONCLUSIONS We found that OSA patients who received surgical treatments were associated with a lower risk for developing ED by 21%.
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Affiliation(s)
- Juen-Haur Hwang
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hueih-Ling Ong
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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7
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Barbosa FT, Silva MP, Fontes LES, Pachito DV, Melnik T, Riera R. Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea. Cochrane Database Syst Rev 2021; 9:CD013169. [PMID: 34555186 PMCID: PMC8460287 DOI: 10.1002/14651858.cd013169.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Obstructive sleep apnoea syndrome (OSAS) is associated with several chronic diseases, including erectile dysfunction (ED). The association of OSAS and ED is far more common than might be found by chance; the treatment of OSAS with non-invasive positive airway pressure therapy is associated with improvement of respiratory symptoms, and may contribute to the improvement of associated conditions, such as ED. OBJECTIVES To assess the effectiveness and acceptability of non-invasive positive airway pressure therapy for improving erectile dysfunction in OSAS. SEARCH METHODS We identified studies from the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, AMED EBSCO, and LILACS, the US National Institutes of Health ongoing trials register ClinicalTrials.gov, and the World Health Organisation international clinical trials registry platform to 14 June 2021, with no restriction on date, language, or status of publication. We checked the reference lists of all primary studies, and review articles for additional references, and relevant manufacturers' websites for study information. We also searched specific conference proceedings for the British Association of Urological Surgeons; the European Association of Urology; and the American Urological Association to 14 June 2021. SELECTION CRITERIA We considered randomised controlled trials (RCTs) with a parallel or cross-over design, or cluster-RCTs, which included men aged 18 years or older, with OSAS and ED. We considered RCTs comparing any non-invasive positive airway pressure therapy (such as continuous positive airways pressure (CPAP), bilevel positive airway pressure (BiPAP), variable positive airway pressure (VPAP), or similar devices) versus sham, no treatment, waiting list, or pharmacological treatment for ED. The primary outcomes were remission of ED and serious adverse events; secondary outcome were sex-related quality of life, health-related quality of life, and minor adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently conducted study selection, data extraction, and risk of bias assessment. A third review author solved any disagreement. We used the Cochrane RoB 1 tool to assess the risk of bias of the included RCTs. We used the GRADE approach to assess the certainty of the body of evidence. To measure the treatment effect on dichotomous outcomes, we used the risk ratio (RR); for continuous outcomes, we used the mean difference (MD). We calculated 95% confidence intervals (CI) for these measures. When possible (data availability and homogeneous studies), we used a random-effect model to pool data with a meta-analysis. MAIN RESULTS We included six RCTs (all assessing CPAP as the non-invasive positive airway pressure therapy device), with a total of 315 men with OSAS and ED. All RCTs presented some important risk of bias related to selection, performance, assessment, or reporting bias. None of included RCTs assessed the ED remission rate, and we used the provided ED mean scores as a proxy. CPAP versus no CPAP There is uncertainty about the effect of CPAP on mean ED scores after 4 weeks, using the International index of erectile function (IIEF-5, higher = better; MD 7.50, 95% CI 4.05 to 10.95; 1 RCT; 27 participants; very low-certainty evidence), and after 12 weeks (IIEF-ED, ED domain; MD 2.50, 95% CI -1.10 to 6.10; 1 RCT; 57 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). There is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks, using the Self-esteem and relationship test (SEAR, higher = better; MD 1.00, 95% CI -8.09 to 10.09; 1 RCT; 57 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision); no serious adverse events were reported after 4 weeks (1 RCT; 27 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). CPAP versus sham CPAP One RCT assessed this comparison (61 participants), but we were unable to extract outcomes for this comparison due to the factorial design and reporting of this trial. CPAP versus sildenafil (phosphodiesterase type 5 inhibitors) Sildenafil may slightly improve erectile function at 12 weeks when compared to CPAP, measured with the IIEF-ED (MD -4.78, 95% CI -6.98 to -2.58; 3 RCTs; 152 participants; I² = 59%; low-certainty evidence, downgraded due to methodological limitations). There is uncertainty about the effect of CPAP on sex-related quality of life after 12 weeks, measured with the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire (EDITS, higher = better; MD -1.24, 95% CI -1.80 to -0.67; 2 RCTs; 122 participants; I² = 0%; very low-certainty evidence, downgraded due to methodological limitations). No serious adverse events were reported for either group (2 RCTs; 70 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). There is uncertainty about the effects of CPAP when compared to sildenafil for the incidence of minor adverse events (RR 1.33, 95% CI 0.34 to 5.21; 1 RCT; 40 participants; very low-certainty evidence, downgraded due to methodological limitations and imprecision). The confidence interval was wide and neither a significant increase nor reduction in the risk of minor adverse events can be ruled out with the use of CPAP (4/20 men complained of nasal dryness in the CPAP group, and 3/20 men complained of transient flushing and mild headache in the sildenafil group). AUTHORS' CONCLUSIONS When compared with no CPAP, we are uncertain about the effectiveness and acceptability of CPAP for improving erectile dysfunction in men with obstructive sleep apnoea. When compared with sildenafil, there is some evidence that sildenafil may slightly improve erectile function at 12 weeks.
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Affiliation(s)
- Frederico T Barbosa
- Departament of Surgery, Universidade Federal de São Paulo , Sao Paulo, Brazil
| | - Michele P Silva
- Cardiology, Intensive care unit, Alcides Carneiro Hospital, Petropolis, Brazil
- Cochrane Afilliate Rio de Janeiro, Cochrane, Petrópolis, Brazil
| | - Luís Eduardo S Fontes
- Cochrane Afilliate Rio de Janeiro, Cochrane, Petrópolis, Brazil
- Department of Evidence-Based Medicine, Intensive Care, Gastroenterology, Petrópolis Medical School, Petrópolis, Brazil
| | - Daniela V Pachito
- Diretoria de Compromisso Social, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Tamara Melnik
- Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica em Saúde, Cochrane Brazil, São Paulo, Brazil
| | - Rachel Riera
- Cochrane Afilliate Rio de Janeiro, Cochrane, Petrópolis, Brazil
- Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde (NEP-Sbeats) , Universidade Federal de São Paulo, Sao Paulo, Brazil
- Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
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8
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Kabak M, Akbudak M. Obstructive sleep apnea syndrome as a potential cause of sexual dysfunction in women : Sexual dysfunction in women. Sleep Breath 2021; 25:1511-1517. [PMID: 33404962 DOI: 10.1007/s11325-020-02275-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/28/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is defined as the cessation of respiration due to recurrent and partial or complete blockade of the upper airways during sleep. Nocturnal hypoxemia due to OSA may accompany these conditions, with significant negative impact on the life quality of patients leading to mental and/or sexual dysfunction. OSA as a cause of sexual dysfunction in women has been subject to very little research. The goal of this study was to examine the effect of OSA on sexual functions in women suffering from this disorder. METHODS Patients with OSA were categorized into two groups, those with and those without sexual dysfunction. RESULTS When women with OSA and healthy women were compared, age (p < 0.001), body mass index (BMI) (p < 0.001), Beck Anxiety Inventory (BAI) (p < 0.001), Beck Depression Inventory (BDI) (p = 0.001), there was a significant difference in the Arizona Sexual Experience Scale (ASEX), (p = 0.02). When women with OSA were compared in terms of sexual dysfunction, a significant difference was found in apnea-hypopnea index (AHI) (p = 0.01) and ASEX (p < 0.001). There were no significant differences in hormonal parameters between the two groups. CONCLUSION Sexual dysfunction in females is a largely under-recognized but important condition. Symptoms caused by OSA may include sexual dysfunction which may increase the prevalence of depression and anxiety, further reducing the quality of life.
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Affiliation(s)
- Mehmet Kabak
- Department of Chest Disease, Mardin State Hospital, Mardin, Turkey.
| | - Mahir Akbudak
- Department of Psychiatry, Mardin State Hospital, Mardin, Turkey
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9
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Zojaji R, Kerachi M, Imani MM, Zojaji SH, Shomeiri S. Increased Rate of Sexual Dysfunction by Increased Severity of Nasal Obstruction in Patients With Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2020; 130:706-711. [PMID: 33111542 DOI: 10.1177/0003489420967698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a common chronic respiratory disorder. This study aimed to investigate the relation between nasal obstruction and sexual dysfunction in men with CRS. METHODS In this case-control study, 100 married men aged 19 to 48 years with CRS and 56 healthy married men were selected, consecutively. For assessment of nasal obstruction severity NOSE scale (Nasal Obstruction Symptom Evaluation) was used and IIEF (International Index of Erectile Function) inventory was used to assess sexual function. RESULTS Mean age of patients with CRS and controls was 33.25 ± 6.5 and 30.58 ± 7.12 years, respectively. Nasal obstruction was moderate in 70% of patients and 95% of patients had some degrees of erectile dysfunction. A significant association was found between nasal obstruction severity and sexual function and by increasing severity of nasal obstruction, sexual function decreased significantly in CRS patients. Sexual function in total (IIEF score) and in its domains, except for sexual desire, were significantly higher in control group (P < .05). CONCLUSION There is significant inverse association between severity of nasal obstruction and sexual function. Sexual function decreases with increasing severity of nasal obstruction in CRS. CRS patients also have lower sexual function scores than healthy control males.
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Affiliation(s)
- Ramin Zojaji
- Department of Otorhinolaryngology, Islamic Azad University, Mashhad Branch, Mashhad, Iran.,ENT Department, St. Joseph Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahnaz Kerachi
- Department of Otorhinolaryngology, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | | | - Seyedeh H Zojaji
- Science Department, Ryerson University, Toronto, Ontario, Canada
| | - Soheil Shomeiri
- Department of Internal Medicine, School of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
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10
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Li Z, Fang Z, Xing N, Zhu S, Fan Y. The effect of CPAP and PDE5i on erectile function in men with obstructive sleep apnea and erectile dysfunction: A systematic review and meta-analysis. Sleep Med Rev 2019; 48:101217. [PMID: 31715462 DOI: 10.1016/j.smrv.2019.101217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/20/2019] [Accepted: 09/22/2019] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Zeyan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, PR China
| | - Zhiqing Fang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, PR China
| | - Naidong Xing
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, PR China
| | - Shiqin Zhu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, PR China.
| | - Yidong Fan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, PR China.
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11
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Liu PY. A Clinical Perspective of Sleep and Andrological Health: Assessment, Treatment Considerations, and Future Research. J Clin Endocrinol Metab 2019; 104:4398-4417. [PMID: 31042277 PMCID: PMC6735730 DOI: 10.1210/jc.2019-00683] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT Sleep that is insufficient, misaligned, or disrupted causes hypersomnolence and neuropsychological deficits, adversely affects cardiometabolic health, and is increasingly recognized to impair other biological processes that lead to conditions important to men, such as hypogonadism, erectile dysfunction, and infertility. EVIDENCE ACQUISITION Literature review from 1970 to December 2018. EVIDENCE SYNTHESIS High-quality and complementary epidemiological and interventional studies establish that abnormal sleep is associated with increased mortality, hypertension, and other cardiometabolic disorders (insufficient, disrupted, and misaligned sleep), as well as reduced fecundity and total sperm count (insufficient sleep), erectile dysfunction (disrupted sleep), and low testosterone (both). Circadian misalignment shifts the peak of testosterone's diurnal rhythm to occur soon after waking up, irrespective of the biological clock time, but it does not change the mean concentration. Preliminary studies show that extending sleep in individuals who are chronically sleep deprived may become a strategy to reduce insulin resistance and hypertension. Continuous positive airway pressure therapy can improve erectile function, and possibly systemic testosterone exposure, but only when used adherently by men with obstructive sleep apnea. Both high-dose and replacement-dose testosterone therapies modestly worsen sleep-disordered breathing, but they also improve cardiometabolic function and sexual desire. Persistence of either the adverse or beneficial outcomes over the longer term requires further investigation. CONCLUSIONS Sleep is increasingly recognized to be essential for healthy living. Establishing the effect of abnormal sleep, and of improving sleep, on andrological issues of prime interest to men will promote prioritization of sleep, and may thereby improve overall long-term health outcomes.
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Affiliation(s)
- Peter Y Liu
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Correspondence and Reprint Requests: Peter Y. Liu, PhD, Division of Endocrinology and Metabolism, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Research Institute, 1124 West Carson Street, Box 446, Torrance, California 90502. E-mail:
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12
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Miner M, Parish SJ, Billups KL, Paulos M, Sigman M, Blaha MJ. Erectile Dysfunction and Subclinical Cardiovascular Disease. Sex Med Rev 2019; 7:455-463. [DOI: 10.1016/j.sxmr.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/01/2018] [Accepted: 01/06/2018] [Indexed: 12/27/2022]
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13
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Silva MP, Fontes LES, Pachito DV, Melnik T, Riera R. Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea. Hippokratia 2018. [DOI: 10.1002/14651858.cd013169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Michele P Silva
- Alcides Carneiro Hospital; Cardiology, Intensive care unit; Petropolis Brazil
| | - Luís Eduardo S Fontes
- Petrópolis Medical School; Department of Evidence-Based Medicine, Intensive Care, Gastroenterology; Av Barao do Rio Branco, 1003 Petrópolis RJ Brazil 25680-120
| | - Daniela V Pachito
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Tamara Melnik
- Brazilian Cochrane Centre; Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica em Saúde; Federal University of Sao Paulo (Unifesp) Martiniano de Carvalho Street, 864/ cj 302 São Paulo São Paulo Brazil 01321-000
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
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14
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Walia AS, Lomeli LDJM, Jiang P, Benca R, Yafi FA. Patients presenting to a Men’s Health clinic are at higher risk for depression, insomnia, and sleep apnea. Int J Impot Res 2018; 31:39-45. [DOI: 10.1038/s41443-018-0057-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/22/2018] [Accepted: 06/17/2018] [Indexed: 11/09/2022]
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15
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Pascual M, de Batlle J, Barbé F, Castro-Grattoni AL, Auguet JM, Pascual L, Vilà M, Cortijo A, Sánchez-de-la-Torre M. Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of Continuous Positive Airway Pressure (CPAP). PLoS One 2018; 13:e0201930. [PMID: 30089160 PMCID: PMC6082539 DOI: 10.1371/journal.pone.0201930] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/20/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is among the least studied risk factors for erectile dysfunction (ED). We aimed to determine ED prevalence in newly-diagnosed OSA patients, describe their main characteristics and assess continuous positive airway pressure (CPAP) effects on ED. METHODS Cross-sectional study assessing ED prevalence in OSA patients and open-label, parallel, prospective randomized controlled trial evaluating 3-month CPAP treatment effects on sexual function, satisfaction, and psychological, hormonal and biochemical profiles. Male patients newly diagnosed with moderate/severe OSA (apnea-hypopnea index >20 events·h-1), aged 18-70 years, attending the sleep unit of a Spanish hospital during 2013-2016 were considered. A total of 150 patients were recruited (75 randomized ED patients). ED was defined as scores <25 on International Index Erectile Function 15 test. Wilcoxon's matched-pairs signed-ranks and rank-sum tests were used. RESULTS ED prevalence was 51%. Patients with ED were older (p<0.001), had greater waist-to-hip ratios (p<0.001), were more frequently undergoing pharmacological treatment (p<0.001) and had higher glucose levels (p = 0.024) than non-ED patients. Although significant increases in erectile function (mean(SD) change: +4.6(7.9); p = 0.002), overall satisfaction (+1(2.2); p = 0.035), and sexual satisfaction (+2.1(4.3); p = 0.003) were found after CPAP treatment, only differences in sexual satisfaction (p = 0.027) and erectile function (p = 0.060) were found between study arms. CPAP treatment did not impact psychological, hormonal or biochemical profiles. CONCLUSIONS This study confirmed the relationship between OSA and ED, suggesting the potential usefulness of ED screening in OSA patients, but could not determine conclusively whether CPAP is an effective stand-alone ED treatment, regardless of positive results on sexual satisfaction. TRIAL REGISTRATION ClinicalTrials.gov NCT03086122.
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Affiliation(s)
- Mercè Pascual
- Urology Department, Hospital Universitari Santa Maria, Lleida, Spain
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Anabel L. Castro-Grattoni
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
| | - Josep M. Auguet
- Urology Department, Hospital Universitari Santa Maria, Lleida, Spain
| | - Lydia Pascual
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
| | - Manel Vilà
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
| | - Anunciación Cortijo
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- * E-mail:
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16
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Jara SM, Hopp ML, Weaver EM. Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea: Follow-up Study of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2018; 144:587-593. [PMID: 29800001 DOI: 10.1001/jamaoto.2018.0485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Obstructive sleep apnea reduces sexual quality of life (QOL) as a result of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. Treatment for obstructive sleep apnea may improve sexual QOL. Objective To test the association of long-term continuous positive airway pressure (CPAP) treatment with sexual QOL for patients with obstructive sleep apnea. Design, Setting, and Participants Prospective cohort study at a single, tertiary medical center of patients with newly diagnosed obstructive sleep apnea who were prescribed CPAP treatment from September 1, 2007, through June 30, 2010 (follow-up completed June 30, 2011). The statistical analysis was performed from February 1 through December 31, 2017. Exposures Use of CPAP treatment objectively measured by the number of hours per night. Users of CPAP were defined as patients who used CPAP treatment for more than 4 hours per night, and nonusers were defined as patients who used CPAP treatment for fewer than 0.5 hours per night. Main Outcomes and Measures Data were collected from eligible patients before CPAP treatment was prescribed and 12 months later by using the validated Symptoms of Nocturnal Obstruction and Related Events-25 (SNORE-25) QOL instrument. The 2 sex-specific items used to create the sexual QOL domain were taken from the SNORE-25. The sexual QOL domain was scored in a range from 0 to 5 (higher score is worse). The difference in sexual QOL between CPAP users and nonusers was analyzed using a paired, 2-tailed t test and multivariable linear regression adjusted for potential confounders. Results Of the 182 participants in the cohort, 115 (63.2%) were men (mean [SD] age, 47.2 [12.3] years) with severe OSA (mean [SD] apnea-hypopnea index, 32.5 [23.8] events per hour). At the 12-month follow-up, 72 CPAP users (mean [SD] use, 6.4 [1.2] hours per night) had greater improvement than 110 nonusers (0 [0] hours per night) in sexual QOL scores (0.7 [1.2] vs 0.1 [1.1]; difference, 0.54; 95% CI, 0.18-0.90; effect size, 0.47). A moderate treatment association was observed after adjustment for age, sex, race/ethnicity, marital status, income level, educational level, body mass index, apnea-hypopnea index, and the Functional Comorbidity Index (adjusted difference, 0.49; 95% CI, 0.09-0.89; effect size, 0.43). Subgroup analysis revealed a large treatment association for women (adjusted difference, 1.34; 95% CI, 0.50-2.18; effect size, 0.87) but not for men (adjusted difference, 0.16; 95% CI, -0.26 to 0.58; effect size, 0.19). Conclusions and Relevance Successful CPAP use may be associated with improved sexual QOL. Subgroup analysis revealed a large improvement in women but no improvement in men. Further study is warranted to test other measures of sexual QOL and other treatments. Trial Registration ClinicalTrials.gov Identifier: NCT00503802.
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Affiliation(s)
- Sebastian M Jara
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Martin L Hopp
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward M Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.,Surgery Service, Department of Veterans Affairs Medical Center, Seattle, Washington
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Campos-Juanatey F, Fernandez-Barriales M, Gonzalez M, Portillo-Martin JA. Effects of obstructive sleep apnea and its treatment over the erectile function: a systematic review. Asian J Androl 2018; 19:303-310. [PMID: 26763546 PMCID: PMC5427785 DOI: 10.4103/1008-682x.170440] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Erectile dysfunction (ED) is considered a condition with a broad range of etiologies. Obstructive sleep apnea (OSA) syndrome is one of the lesser studied risk factors for ED. We intend to summarize the current evidence on the relationship between OSA and sexual impairment, focusing on the results in terms of erectile function of the different therapies offered to OSA patients. A systematic review was conducted, selecting articles related to the physiology of OSA and ED, and to the treatments of OSA syndrome and their reported outcomes in erectile and sexual function. Higher prevalences of ED in the OSA groups have been published. However, whether this effect on the erectile function occurs in the entire range of OSA severities remains unclear. Several hypotheses were proposed to explain the physiology of this association. Continuous Positive Airway Pressure as a treatment for OSA patients with ED has achieved a significative improvement in the sexual parameters in most of the studies. Phosphodiesterase type 5 inhibitors (iPDE5) on demand are useful as a treatment for ED in this subgroup of patients, with high satisfaction rates. The surgical treatment for the OSA evidenced benefits over the erectile function, and the effect on the sexual satisfaction of the therapy using Mandibular Advancement Devices is still undefined.
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Affiliation(s)
- Felix Campos-Juanatey
- Urology Department, Marques de Valdecilla University Hospital, Santander, 39008, Spain.,Institute of Investigation Marques de Valdecilla, Santander, 39011, Spain
| | | | - Monica Gonzalez
- Sleep and Ventilation Unit, Marques de Valdecilla University Hospital, Santander, 39008, Spain
| | - Jose A Portillo-Martin
- Urology Department, Marques de Valdecilla University Hospital, Santander, 39008, Spain.,Institute of Investigation Marques de Valdecilla, Santander, 39011, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, 39011, Spain
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18
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Kalejaiye O, Raheem AA, Moubasher A, Capece M, McNeillis S, Muneer A, Christopher AN, Garaffa G, Ralph DJ. Sleep disorders in patients with erectile dysfunction. BJU Int 2017; 120:855-860. [PMID: 28710780 DOI: 10.1111/bju.13961] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the prevalence of obstructive sleep apnoea (OSA) in men presenting with erectile dysfunction (ED) at a single centre. PATIENTS AND METHODS All men attending a specialised andrology outpatient department with a new diagnosis of ED were included in this prospective study. All patients completed three questionnaires: the International Index of Erectile Function (IIEF) and two sleep questionnaires [the Obstructive Sleep Apnoea Screening questionnaire and the Insomnia Severity Index (ISI)]. Their ED management was subsequently undertaken in accordance with local and European guidelines. An OSA diagnosis was made based on a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire and those patients were referred for specialist management. RESULTS Between February and September 2016, 129 patients with ED completed the study questionnaires. In all, 71 patients (55%) had a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire, indicating a need for specialist sleep referral. Men who scored ≥3 on the Obstructive Sleep Apnoea Screening questionnaire were significantly older (61.4 vs 46.5 years; P < 0.001) and had a significantly higher body mass index (29.4 vs 26.7 kg/m2 ; P < 0.001) when compared to the control group (OSA score of <3). The sleep apnoea group (OSA score of ≥3) had significantly worse IIEF-ED scores (6.2 vs 9.1; P = 0.018) and ISI scores (7.9 vs 5.5; P = 0.061). CONCLUSION Men presenting to the andrology clinic with ED are at significant risk of having undiagnosed sleep disorders. This has serious adverse health consequences, as well as being associated with potential dangers at work and travel. The patient compliance was high with 78% completing all three questionnaires. It is feasible to screen this population for sleep disturbance and this should be part of the ED assessment.
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Affiliation(s)
- Odunayo Kalejaiye
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - Amr Abdel Raheem
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK.,Department of Andrology, Cairo University, Cairo, Egypt
| | - Amr Moubasher
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - Marco Capece
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - Sara McNeillis
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - Asif Muneer
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - Andrew N Christopher
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - Giulio Garaffa
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
| | - David J Ralph
- St. Peter's Andrology Centre and the Institute of Urology, University College London Hospitals, London, UK
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Erectile dysfunction is independently associated with apnea-hypopnea index and oxygen desaturation index in elderly, but not younger, community-dwelling men. Sleep Health 2017; 3:250-256. [PMID: 28709511 DOI: 10.1016/j.sleh.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/01/2017] [Accepted: 04/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE(S) To examine the association between obstructive sleep apnea (OSA) and other sleep indices using polysomnography (PSG) data and erectile dysfunction (ED) in a representative cohort of men. DESIGN Cross-sectional. SETTING Community-based. PARTICIPANTS Aged 40+ years (n=734; mean age [SD], 60.8 [10.9]). MEASUREMENTS Men with no prior OSA diagnosis who underwent in-home PSG (Embletta X100; 2010-11) and ED assessment (Global Impotence Rating) were selected. Un-adjusted and multi-adjusted regression models of ED were fitted against PSG measures, along with qualifying sociodemographic, lifestyle, and health-related covariates. Mediation effects were examined using the Baron-Kenny method. RESULTS Of the men examined, 24.7% (n=181) had ED, most notably in men older than 65years (cf. men 35-49 and 50-64years; P<.001). There was no significant association between ED and any of the PSG measures for allaged men. Given an observed ageinteraction within OSA categories (P=.005), analyses were repeated in age-stratified samples (<65 years; 65+ years). In men younger than 65years, only severe OSA was found to have an association with ED (2.01; 1.13-4.69) in unadjusted models. For men aged 65+ years, an independent association with ED was found for apnea-hyponea index (AHI; 1.55;1.02-2.36), moderate (AHI:10.0-19.9; 1.79;1.18-2.43), and severe (AHI:20.0+; 4.84;2.56-9.93) OSA, and oxygen desaturation index (ODI; both continuous [1.48;1.03-1.99] and >16 seconds [2.79;1.23-6.32]). The effect of AHI on ED was shown to be primarily mediated through ODI (63.4%, Sobel P value=.29). CONCLUSIONS In younger, community-based men, there appeared no independent relationship between objective measures of sleep and ED. However, there appears a strong, independent relationship between OSA, ODI, and ED in men 65 years and older.
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Steinke E, Palm Johansen P, Fridlund B, Broström A. Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review. Int J Clin Pract 2016; 70:5-19. [PMID: 26620672 DOI: 10.1111/ijcp.12751] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective. METHODS A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis. RESULTS Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction. CONCLUSIONS The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.
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Affiliation(s)
- E Steinke
- School of Nursing, Wichita State University, Wichita, KS, USA
| | - P Palm Johansen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, and The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - B Fridlund
- Department of Nursing Science, School of Health & Welfare, Jönköping University, Jönköping, Sweden
| | - A Broström
- Department of Nursing Science, School of Health & Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
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21
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Zhang XB, Lin QC, Zeng HQ, Jiang XT, Chen B, Chen X. Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:235-40. [PMID: 26370402 DOI: 10.1007/s10508-015-0593-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/25/2015] [Accepted: 06/30/2015] [Indexed: 05/28/2023]
Abstract
In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.
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Affiliation(s)
- Xiao-Bin Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China.
| | - Qi-Chang Lin
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Hui-Qing Zeng
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China
| | - Xing-Tang Jiang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China
| | - Bo Chen
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China
| | - Xiao Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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Jeon YJ, Yoon DW, Han DH, Won TB, Kim DY, Shin HW. Low Quality of Life and Depressive Symptoms as an Independent Risk Factor for Erectile Dysfunction in Patients with Obstructive Sleep Apnea. J Sex Med 2015; 12:2168-77. [PMID: 26477542 DOI: 10.1111/jsm.13021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Accumulating evidence indicates that obstructive sleep apnea (OSA) is associated with a high prevalence of erectile dysfunction (ED), but the factors that predict the risk of ED in OSA patients have yet to be defined clearly. AIMS The aims of the present study were to investigate the clinical characteristics of OSA patients with ED and to identify plausible predictors of ED. METHODS The present cross-sectional analysis included 713 male patients who visited Seoul National University Hospital for snoring and/or daytime sleepiness from 2006 to 2014. An in-laboratory polysomnography procedure was conducted to obtain objective recordings of OSA and other sleep parameters. MAIN OUTCOME MEASURES The demographic data of all patients were obtained, and each patient completed all requirements of the following questionnaires: the Calgary Sleep Apnea Quality of Life Index (SAQLI), the Korean version of the International Index of Erectile Function (KIIEF-5), the Beck Depression Inventory (BDI), and the Epworth Sleepiness Scale (ESS). ED and OSA were defined as a KIIEF-5 < 21 and a respiratory disturbance index (RDI) ≥ 5, respectively. Depressive symptoms were defined as a BDI ≥ 10. RESULTS The frequency of ED did not differ significantly according to OSA severity. In Spearman's correlation analysis, the BDI and the ESS were inversely correlated with the KIIEF-5, whereas the SAQLI was positively correlated with the KIIEF-5. The RDI and the lowest oxygen saturation (SaO2 ) did not exhibit significant correlations with the KIIEF-5. A multivariate logistic regression analysis adjusted for possible confounding factors showed that ED was independently associated with the SAQLI and depressive symptoms, but there was no significant association of ED with either the RDI or the lowest SaO2 . CONCLUSIONS The present study demonstrated that depressive symptoms and a low quality of life specific to sleep apnea are independent risk factors for ED in OSA patients.
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Affiliation(s)
- Yung Jin Jeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dae Wui Yoon
- Obstructive Upper airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Woo Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.,Obstructive Upper airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
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Dong JQ, Chen X, Xiao Y, Zhang R, Niu X, Kong WJ. Serum sex hormone levels in different severity of male adult obstructive sleep apnea-hypopnea syndrome in East Asians. ACTA ACUST UNITED AC 2015. [PMID: 26223926 DOI: 10.1007/s11596-015-1469-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious health issue, which can impact the hormone secretion. The aim of this study is to analyze the relationship between serum sex hormone concentrations and different severity degree of OSAHS, and to evaluate the influence of OSAHS on sex hormone levels. We enrolled 116 subjects who were subjected to polysomnography (PSG). They were divided into three groups: control group (n=10) [apnea hypopnea index (AHI) <5/h], mild-moderate OSAHS group (n=15) (5≤AHI<30/h), and severe OSAHS group (n=91) (AHI≥30/h). The patients in OSAHS group were subdivided into obesity and non-obesity subgroups. The parameters such as AHI, body mass index (BMI), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) were recorded. Serum levels of testosterone, polactin, estradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH) were determined in the morning immediately after waking up. Mean levels of hormones were compared among groups. The correlation between hormone levels and sleep-breathing parameters was analyzed. No significant differences in serum sex hormone levels were found among control, mild-moderate OSAHS, and severe OSAHS groups (P>0.05). There was no correlation between AHI and sex hormone levels (P>0.05). Testosterone was significantly negatively correlated with BMI (P<0.05). These results suggested that BMI might have a direct effect on testosterone level, and it might be an important factor affecting testosterone level in male OSAHS patients, and there may be no correlation between severity of OSAHS and sex hormones levels.
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Affiliation(s)
- Jia-Qi Dong
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiong Chen
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ying Xiao
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Rui Zhang
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xun Niu
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei-Jia Kong
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Chen CM, Tsai MJ, Wei PJ, Su YC, Yang CJ, Wu MN, Hsu CY, Hwang SJ, Chong IW, Huang MS. Erectile Dysfunction in Patients with Sleep Apnea--A Nationwide Population-Based Study. PLoS One 2015; 10:e0132510. [PMID: 26177206 PMCID: PMC4503619 DOI: 10.1371/journal.pone.0132510] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/15/2015] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Chia-Min Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Ju Wei
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chung Su
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Inn-Wen Chong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Shyan Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
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26
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Hoyos CM, Melehan KL, Phillips CL, Grunstein RR, Liu PY. To ED or not to ED – Is erectile dysfunction in obstructive sleep apnea related to endothelial dysfunction? Sleep Med Rev 2015; 20:5-14. [DOI: 10.1016/j.smrv.2014.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/07/2014] [Accepted: 03/10/2014] [Indexed: 01/23/2023]
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Effects of nasal continuous positive airway pressure therapy on partners' sexual lives. Eur Arch Otorhinolaryngol 2015; 273:133-7. [PMID: 25876002 DOI: 10.1007/s00405-015-3546-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
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.
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28
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Miner M, Nehra A, Jackson G, Bhasin S, Billups K, Burnett AL, Buvat J, Carson C, Cunningham G, Ganz P, Goldstein I, Guay A, Hackett G, Kloner RA, Kostis JB, LaFlamme KE, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel A, Shabsigh R, Vlachopoulos C, Wu F. All men with vasculogenic erectile dysfunction require a cardiovascular workup. Am J Med 2014; 127:174-82. [PMID: 24423973 DOI: 10.1016/j.amjmed.2013.10.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/18/2022]
Abstract
An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
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Affiliation(s)
- Martin Miner
- Departments of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI.
| | - Ajay Nehra
- Department of Urology, Rush University, Chicago, Ill
| | | | - Shalender Bhasin
- Department of Medicine, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Mass
| | - Kevin Billups
- Department of Urologic Surgery, University of Minnesota, Minneapolis; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
| | - Jacques Buvat
- Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
| | - Culley Carson
- Department of Surgery, Division of Urologic Surgery, University of North Carolina, Chapel Hill
| | - Glenn Cunningham
- Departments of Medicine, and Molecular & Cellular Biology, Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Tex
| | - Peter Ganz
- Division of Cardiology, San Francisco General Hospital and University of California, San Francisco, Calif
| | | | - Andre Guay
- Center For Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Mass, Tufts University School of Medicine, Boston, Mass
| | | | - Robert A Kloner
- Heart Institute, Good Samaritan Hospital and Keck School of Medicine at University of Southern California, Los Angeles
| | - John B Kostis
- Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Institute of Cardiology University of Milan, Italy
| | - Melinda Ramsey
- Complete Healthcare Communications, Inc., Chadds Ford, Pa
| | - Raymond Rosen
- New England Research Institutes, Inc., Watertown, Mass
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Allen Seftel
- Department of Urology, Cooper University Hospital, Camden, NJ
| | - Ridwan Shabsigh
- Division of Urology, Maimonides Medical Center, Brooklyn, NY, and College of Physicians and Surgeons of Columbia University, New York, NY
| | | | - Frederick Wu
- Andrology Research Unit, Developmental & Regenerative Biomedicine Research Group, University of Manchester, Manchester Academic Health Science Centre, Manchester Royal Infirmary, UK
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