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Cojocaru C, Cojocaru E, Pohaci-Antonesei LS, Pohaci-Antonesei CA, Dumitrache-Rujinski S. Sleep apnea syndrome associated with gonadal hormone imbalance (Review). Biomed Rep 2023; 19:101. [PMID: 38025832 PMCID: PMC10646762 DOI: 10.3892/br.2023.1683] [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: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Patients with obstructive sleep apnea exhibit an increased risk of developing gonadal disorders. Because a notable number of people worldwide have sleep respiratory and reproductive disorders, it is essential to recognize the association between local upper airway dysfunction and its gonadal effects. Repeated breathing pauses cause sleep fragmentation, disorganization of sleep cycles and stages, sympathetic activation, intermittent hypoxemia and systemic inflammation. Nocturnal intermittent hypoxemia has a direct central effect on neurotransmitters, with disturbances in the normal production of hypothalamic-pituitary hormones. Awakenings and micro-awakenings at the end of apneic episodes produce a central stress responsible for hormonal changes and subsequent endocrine imbalances. The aim of the present study was to investigate the impact of obstructive sleep apnea syndrome (OSAS) on gonadal hormonal homeostasis and its consequences. Recognizing and understanding how local upper airway dysfunction causes gonadal imbalance may facilitate better care for patients with OSAS. Although there may be a direct relationship between sleep-disordered breathing and gonadal function mediated by hormones via the hypothalamic-pituitary-gonadal axis, to date, current therapies have not been effective.
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Affiliation(s)
- Cristian Cojocaru
- Department of Medical III, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Morpho-Functional Sciences II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Luiza-Simona Pohaci-Antonesei
- Department of Morpho-Functional Sciences II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Stefan Dumitrache-Rujinski
- Department of Cardiothoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania
- Department of Pneumology, Marius Nasta Institute of Pneumophtisiology, 050159 Bucharest, Romania
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Ali MM, Ellison M, Iweala OI, Spector AR. A sleep clinician's guide to runny noses: evaluation and management of chronic rhinosinusitis to improve sleep apnea care in adults. J Clin Sleep Med 2023; 19:1545-1552. [PMID: 37082825 PMCID: PMC10394352 DOI: 10.5664/jcsm.10608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
STUDY OBJECTIVES The treatment of obstructive sleep apnea is often impeded by intolerance of positive airway pressure therapy, which is frequently attributed to the inability to breathe through the nose. Providers caring for patients with sleep apnea need a working knowledge of nasal passage disease and available treatments to better manage this common comorbidity. METHODS This review examines the literature connecting rhinosinusitis to adverse sleep and sleep apnea outcomes. It explores the different types of nasal and sinus diseases a sleep apnea provider might encounter, focusing on the medications used to treat them and indications for referral to otolaryngology. RESULTS Chronic rhinosinusitis can be either allergic or nonallergic. Both types can interfere with sleep and sleep apnea therapy. The successful management of chronic rhinosinusitis can improve positive airway pressure tolerance and adherence. A wide range of over-the-counter and prescription pharmacotherapy is available, with data supporting intranasal over oral treatment. Surgical treatment for chronic rhinosinusitis in obstructive sleep apnea addresses nasal obstruction, often with inferior turbinate reduction and septoplasty. CONCLUSIONS Sleep specialists should have a working knowledge of the available options to treat chronic rhinosinusitis. These options are often safe, effective, and readily accessible. Otolaryngologists and allergists/immunologists provide additional treatment options for more complicated patients. Providing treatment for chronic rhinosinusitis should be included as part of comprehensive sleep apnea care. CITATION Ali MM, Ellison M, Iweala OI, Spector AR. A sleep clinician's guide to runny noses: evaluation and management of chronic rhinosinusitis to improve sleep apnea care in adults. J Clin Sleep Med. 2023;19(8):1545-1552.
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Affiliation(s)
- Mir M. Ali
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Ellison
- Department of Otolaryngology, Duke University School of Medicine, Durham, North Carolina
| | - Onyinye I. Iweala
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
| | - Andrew R. Spector
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
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Dilixiati D, Kadier K, Laihaiti D, Lu JD, Rezhake R, Azhati B, Rexiati M. The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis. J Sex Med 2023:7143630. [PMID: 37186140 DOI: 10.1093/jsxmed/qdad054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The associations between sexual dysfunction (SD) and sleep disorders, sleep quality, and sleep duration remain unclear. AIM To assess the relationship between sleep and SD through a literature review and meta-analysis. METHODS The PubMed, Scopus, Embase, Ovid MEDLINE, and Cochrane Library databases were systematically searched from inception to November 10, 2022. OUTCOMES Pooled relative risks and 95% CIs were used to examine the association of sleep disorders with SD in longitudinal studies. Pooled odds ratios (ORs) and 95% CIs were used to examine the associations between SD and sleep disorders, sleep quality, and sleep duration in cross-sectional studies. RESULTS Forty-three articles, including 11 longitudinal studies and 32 cross-sectional studies, were included in the quantitative analysis. The pooled relative risk of SD in patients with sleep disorders was 1.97 in longitudinal studies (95% CI, 1.46-2.67, P < .001; heterogeneity: I2 = 95.0%, P < .001), while the pooled OR of SD in patients with sleep disorders was 2.05 in cross-sectional studies (95% CI, 1.76-2.39, P < .001; heterogeneity: I2 = 91.4%, P < .001). When compared with controls, subjects with poor sleep quality had a 1.49-fold increased risk of SD (OR, 1.49; 95% CI, 1.31-1.71, P < .001; heterogeneity: I2 = 73.4%, P < .001). In addition, short sleep duration was associated with the risk of SD (OR, 1.14; 95% CI, 1.06-1.22, P < .001; heterogeneity: I2 = 0.0%, P = .849). CLINICAL IMPLICATIONS The risk of SD is significantly increased in patients with sleep disorders and poor sleep quality, indicating that clinicians should monitor sleep among patients with SD. STRENGTHS AND LIMITATIONS This study is the most comprehensive meta-analysis of the association between sleep and SD to date. However, different sleep disorders may have varying associations with sleep duration and sleep quality; thus, we could not identify the independent effects across the studies. CONCLUSION Our systematic review and meta-analysis results suggest that sleep disorders, especially obstructive sleep apnea, increase the risk of SD in men and women. Poor sleep quality is significantly associated with SD. Short sleep duration is associated with an increased risk of SD.
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Affiliation(s)
- Diliyaer Dilixiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Kaisaierjiang Kadier
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Duolikun Laihaiti
- Department of Joint Surgery, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Changji 831199, China
| | - Jian-De Lu
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Remila Rezhake
- Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830017, China
| | - Baihetiya Azhati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
| | - Mulati Rexiati
- Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
- Xinjiang Clinical Medical Research Center of Urogenital Diseases, Urumqi 830054, China
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Schlafbezogene Atmungsstörungen und Gynäkologie – Teil 2. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lew-Starowicz M. Sexuality and Sleep Disorders. J Sex Med 2022; 19:890-894. [DOI: 10.1016/j.jsxm.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
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Rosa D, Amigoni C, Rimoldi E, Ripa P, Ligorio A, Fracchiolla M, Lombardi C, Parati G, Perger E. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let's Talk about Partners! Healthcare (Basel) 2022; 10:943. [PMID: 35628081 PMCID: PMC9141202 DOI: 10.3390/healthcare10050943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). The benefits of this therapy were studied and analyzed over time; patient adherence is often poor, as many factors negatively influence it. A topic that needs clarification is whether adherence to CPAP treatment in a patient with OSA is influenced by the behavior of a partner or spouse. METHODS A scoping review was conducted to evaluate the role of partner involvement in the CPAP treatment management in a patient with OSA. The research project was performed between August and September 2021 by consulting the main biomedical databases: CINHAL, Embase, PsycINFO, and PubMed. RESULTS Among 21 articles considered valid for our aim, 15 are qualitative studies, 5 are quantitative and 1 presents a mixed method. We identified several thematic areas and "key" elements, which are prevalent in the studies evaluated. CONCLUSIONS The presence of a partner promotes adherence to CPAP therapy in patients with OSA, resulting in ameliorating their overall quality of life. To increase CPAP adherence, a trained nurse could represent a reference figure to technically and emotionally support couples during the adaptation period and in the long term.
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Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano, IRCCS, SITR Lombardia, 20149 Milan, Italy;
| | - Elisa Rimoldi
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Paola Ripa
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Antonella Ligorio
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Miriam Fracchiolla
- Multimedica, IRCCS, Emergency Department, 20099 Sesto San Giovanni, Italy;
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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Depression and obesity, but not mild obstructive sleep apnea, are associated factors for female sexual dysfunction. Sleep Breath 2021; 26:697-705. [PMID: 34318402 DOI: 10.1007/s11325-021-02433-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/07/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Mild obstructive sleep apnea (OSA) is more prevalent than moderate and severe OSA and is more frequent in men than women. The association between OSA and female sexual dysfunction (FSD) is still poorly explored in published studies. Our aim was to investigate the prevalence of FSD in women with mild OSA and assess the impact of OSA on FSD, as well as to determine the predictors for FSD risk. METHODS The sample comprised 70 women aged 26-65 years: a control group (N = 28) with no sleep complaints, and a group with mild OSA (an apnea-hypopnea index of 5 or more and less than 15 events/hour, N = 42), who had been diagnosed using polysomnography performed in the sleep laboratory of a sleep research institute. All participants volunteered to take part in the study and completed the female sexual function index (FSFI), the Beck depression index (BDI), the Kupperman menopausal index (KMI), and the Epworth sleepiness scale (ESS). Their socioeconomic group was assessed using the Brazilian Economic Classification Criterion. Polysomnography and serum levels of free testosterone and total testosterone were analyzed. RESULTS We found low FSFI scores (< 26.55) in the mild OSA (18.1) and control (21.7) groups (p = 0.97). There was no statistically significant difference between the mild OSA group and the control group. However, a higher BMI (p = 0.04), a higher BDI (p = 0.02), and being sexuality inactive (p = 0.001) were risk factors for FSD. CONCLUSION There was a high prevalence of FSD in the entire sample. The presence of mild OSA did not affect sexual function in this sample. Depressive symptoms and a high BMI were associated risk factors for FSD. Being sexually active may protect female sexual function.
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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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Skoczyński S, Nowosielski K, Minarowski Ł, Brożek G, Oraczewska A, Glinka K, Ficek K, Kotulska B, Tobiczyk E, Skomro R, Mróz R, Barczyk A. Sexual disorders and dyspnoea among women with obstructive sleep apnea. Adv Med Sci 2020; 65:189-196. [PMID: 32000113 DOI: 10.1016/j.advms.2019.12.003] [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: 12/21/2018] [Revised: 09/10/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE We aimed to assess sexual function, sexual distress and the prevalence of female sexual dysfunction (FSD) among women with obstructive sleep apnea syndrome (OSA), and to assess if the presence of OSA and dyspnea influences the prevalence of FSD, body image during sexual activity and sexual function. METHODS We assessed 23 women with new OSA diagnosis and 23 healthy age and body mass index (BMI) matched controls. Sexual functions were evaluated by Changes in Sexual Functioning Questionnaire (CSFQ), sexual dysfunction was diagnosed based on DSM-5 criteria during the semi-structured sexual interview, whereas body image was evaluated by Body Exposure during Sexual Activities Questionnaire (BESAQ). New York Heart Association score (NYHA) and Visual Analogue Scale (VAS) were used to assess dyspnea. RESULTS OSA women had worse general sexual function and lower frequency of desire assessed by CSFQ (37.0 vs. 42 and 5 vs. 6), were at higher risk for FSD (CSFQ; 80% vs. 48%) and had a higher NYHA score (II vs. I). The prevalence of FSD did not differ in both groups, nor did sexual dysfunctions or body image (BESAQ). The multiple regression analysis revealed that OSA was associated with lower desire/frequency, higher NYHA scores with decreased desire/interest and worse body image during sexual activity, whereas higher VAS scores with worse desire/frequency. CONCLUSIONS OSA probably does not influence the prevalence of sexual dysfunction in females. However, OSA, as well as the higher level of dyspnea assessed by NYHA, may decrease sexual body image and sexual performance in females.
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Zheng W, Chen X, Huang J, Zhang S, Chen T, Zhang L, Li X, Li Q, Dai J. Blood Oxygen Accumulation Distribution Area Index Is Associated With Erectile Dysfunction in Patients With Sleep Apnea-Results From a Cross-sectional Study. Sex Med 2020; 8:36-44. [PMID: 32008979 PMCID: PMC7042163 DOI: 10.1016/j.esxm.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/16/2019] [Accepted: 11/11/2019] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Wenzhong Zheng
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Chen
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingwen Huang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengxiong Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Respiratory and Critical Care Medicine, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Yunnan, China
| | - Tao Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Guanzhou Medical University, Guanzhou Medical University, Guanzhou, China
| | - Liu Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xianxin Li
- Department of Surgery, Shenzhen Sun Yat-Sen Cardiovascular Hospital, Shenzhen, China
| | - Qingyun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jican Dai
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Pallesen S, Waage S, Thun E, Andreassen CS, Bjorvatn B. A national survey on how sexual activity is perceived to be associated with sleep. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00246-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ruchała M, Bromińska B, Cyrańska-Chyrek E, Kuźnar-Kamińska B, Kostrzewska M, Batura-Gabryel H. Obstructive sleep apnea and hormones - a novel insight. Arch Med Sci 2017; 13:875-884. [PMID: 28721156 PMCID: PMC5507108 DOI: 10.5114/aoms.2016.61499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), a disorder characterized by repetitive collapse of the upper respiratory tract during sleep, occurs in about 4% of middle-aged men and 2% of women. The incidence of the disorder is rising due to an increase in obesity and ageing of the population. Patients with obstructive sleep apnea are at elevated risk of some endocrinal and metabolic disorders, which may lead to serious consequences including shortening of life expectancy. The recognition and understanding of interactions between local upper airway dysfunction and its endocrinal consequences is therefore vital. In this review we will focus on the influence of OSA on bone metabolism and endocrine homeostasis.
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Affiliation(s)
- Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Bromińska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Cyrańska-Chyrek
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Kostrzewska
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Halina Batura-Gabryel
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
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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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Effects of low sleep quality on sexual function, in women with fibromyalgia. Int J Impot Res 2015; 28:46-9. [PMID: 26581913 DOI: 10.1038/ijir.2015.31] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/23/2015] [Accepted: 10/19/2015] [Indexed: 12/24/2022]
Abstract
Sexual dysfunction is a common experience in women with fibromyalgia. However, the physiopathology of this association is unclear. We aimed to evaluate whether sleep disturbance has an influence on sexual function in women with fibromyalgia. Fifty-four sexually active premenopausal women with fibromyalgia were enrolled in the study. The following questionnaires were used: the Female Sexual Function Index (FSFI), the Pittsburgh Sleep Quality Index (PSQI), the Fibromyalgia Impact Questionnaire (FIQ) and the Beck Depression Inventory (BDI). Appropriate statistical analyses were used by using SPSS 18. The mean FSFI score was 25.344 ± 6.52 and showed no correlation with age, body mass index, BDI or duration of fibromyalgia. However, a positive correlation between sexual dysfunction and low sleep quality was found (r=0.43; P=0.001). In addition, the median FSFI score was 29.2 (27.2-32.4) in patients with higher sleep quality (PSQI⩽5), whereas it was 21.4 (18.9-25.3) in patients with lower sleep quality (PSQI>5) (P<0.001). There was a positive correlation between sexual dysfunction and symptoms of fibromyalgia as indicated by a higher FIQ score (r=0.37; P=0.006). Sexual dysfunction in female patients with fibromyalgia may be due to low sleep quality. Treatment of the sleep disorder may improve female sexual function.
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Liu L, Kang R, Zhao S, Zhang T, Zhu W, Li E, Li F, Wan S, Zhao Z. Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Sex Med 2015; 12:1992-2003. [DOI: 10.1111/jsm.12983] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med 2015; 12:1221-32. [PMID: 25772315 DOI: 10.1111/jsm.12858] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The etiological role of sleep disturbance in sexual difficulties has been largely overlooked. Research suggests that short sleep duration and poor sleep quality lead to poor female sexual response. However, prior research consists of cross-sectional studies, and the influence of sleep on sexual functioning and behavior has not been prospectively examined. AIM We sought to examine the influence of nightly sleep duration, sleep quality, and sleep onset latency on daily female sexual response and activity. METHODS This study used a longitudinal design to study 171 women free of antidepressants and with reliable Internet access who were recruited from a university setting in the United States. Participants first completed baseline measures in a laboratory, and then completed web-delivered surveys at their habitual wake time for 14 consecutive days. MAIN OUTCOME MEASURES All outcome measures were modified for daily recall. Participants completed the Profile of Female Sexual Function's desire, subjective arousal, and orgasmic functioning scales and the Female Sexual Function Index's genital arousal scale, and indicated whether they engaged in partnered sexual activity or self-stimulation in response to dichotomous items. RESULTS Analyses revealed that longer sleep duration was related to greater next-day sexual desire (b = 0.32, P = 0.02), and that a 1-hour increase in sleep length corresponded to a 14% increase in odds of engaging in partnered sexual activity (odds ratio = 1.14, P < 0.05). In contrast, sleeping longer predicted poorer next-day genital arousal (b = -0.19, P < 0.01). However, results showed that women with longer average sleep duration reported better genital arousal than women with shorter average sleep length (b = 0.54, P = 0.03). CONCLUSIONS Obtaining sufficient sleep is important to the promotion of healthy sexual desire and genital response, as well as the likelihood of engaging in partnered sexual activity. These relationships were independent of daytime affect and fatigue. Future directions may investigate sleep disorders as risk factors for sexual dysfunction.
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Affiliation(s)
- David A Kalmbach
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Vivek Pillai
- Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Jeffrey A Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Baldassarre M, Alvisi S, Meriggiola MC. Reply to the letter to the editor: How does sleep relate to metabolic syndrome in women with sexual dysfunction? J Sex Med 2014; 11:3124. [PMID: 25471144 DOI: 10.1111/jsm.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maurizio Baldassarre
- Center for Applied Biomedical Research (CRBA), Department of Surgical and Medical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Petersen M, Kristensen E, Berg S, Midgren B. Long-term effects of continuous positive airway pressure treatment on sexuality in female patients with obstructive sleep apnea. Sex Med 2014; 1:62-8. [PMID: 25356289 PMCID: PMC4184499 DOI: 10.1002/sm2.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Results from a previous study showed that sexuality was negatively affected in females with untreated obstructive sleep apnea (OSA). Data are sparse on the long-term effects of nocturnal continuous positive airway pressure (CPAP) treatment on sexual difficulties and sexual distress in female patients with OSA. Aim The aim of the present study was to investigate the effects after 1 year of CPAP treatment on sexual difficulties, sexual distress, and manifest sexual dysfunction in female patients with OSA. The effect of CPAP on life satisfaction was also investigated. Methods Fifty-four therapy-compliant, female patients (age 22–71) received a survey before and after 1 year of nocturnal CPAP treatment. The questions on this survey were drawn from three self-administered questionnaires: two on sexuality and one on life satisfaction. The results were compared with a population sample. The Epworth Sleepiness Scale was used for assessment of daytime sleepiness. Main Outcome Measures The Female Sexual Function Index, Female Sexual Distress Scale, Manifest Female Sexual Dysfunction, four questions from Life Satisfaction 11, and the Epworth Sleepiness Scale were all used to measure outcome. Results In total, 44 patients responded to the survey (81% response rate). The results were a significant, positive change in manifest female sexual dysfunction, but no significant changes in isolated sexual difficulties or sexual distress. Daytime sleepiness significantly decreased after 1 year. The results from the Life Satisfaction 11 questionnaire remained unchanged after 1 year. Conclusions After 1 year of CPAP treatment, female patients with OSA reported reduced manifest sexual dysfunction. However, it cannot be concluded if this result is due to CPAP treatment alone. Furthermore, reduced daytime tiredness was found in the surveyed population. CPAP treatment, per se, does not seem to affect partner relationships. Petersen M, Kristensen E, Berg S, and Midgren B. Long-term effects of continuous positive airway pressure treatment on sexuality in female patients with obstructive sleep apnea. Sex Med 2013;1:62–68.
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Affiliation(s)
- Marian Petersen
- The Neuroscience Centre, Rigshospital Copenhagen, Denmark ; Department of Respiratory Medicine and Allergology, Lund University Lund, Sweden
| | - Ellids Kristensen
- Sexological Clinic, Psychiatric Centre Copenhagen, University Hospital of Copenhagen Copenhagen, Denmark ; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen Copenhagen, Denmark
| | - Søren Berg
- Department of ENT, Head and Neck Cancer, Lund University Lund, Sweden
| | - Bengt Midgren
- Department of Respiratory Medicine and Allergology, Lund University Lund, Sweden
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Shin HW, Park JH, Park JW, Rhee CS, Lee CH, Min YG, Kim DY. Effects of surgical vs. nonsurgical therapy on erectile dysfunction and quality of life in obstructive sleep apnea syndrome: a pilot study. J Sex Med 2013; 10:2053-9. [PMID: 23534383 DOI: 10.1111/jsm.12128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is associated with erectile dysfunction (ED). The improvement of ED after medical therapy including continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is still controversial. Furthermore, the efficacy of surgical treatment has been little investigated. AIM The aim of this nonrandomized prospective study was to evaluate the effects of surgical (uvulopalatopharyngoplasty [UPPP]) and nonsurgical approaches (CPAP and MAD) on ED and quality of life (QOL) in OSAS. METHODS OSAS patients underwent UPPP (N = 30), CPAP (N = 16), or MAD (N = 10) and completed the Korean versions of the International Index of Erectile Function questionnaire (KIIEF-5) and the Calgary Sleep Apnea Quality of Life Index (SAQLI) before and after a median of 7 months of treatment (interquartile range, 4-15 months). All patients underwent a full-night in-laboratory polysomnography at baseline and follow-up. MAIN OUTCOME MEASURE The main outcome measures are the KIIEF-5 and SAQLI scores. RESULTS CPAP group showed older age, higher body mass index, and more severe OSAS than other groups. Apnea-hypopnea index and lowest oxygen saturation level improved significantly in all groups, but Epworth Sleepiness Scale score decreased significantly in UPPP and MAD groups. Significant increase of KIIEF-5 was observed in patients who underwent UPPP (P = 0.039, paired t-test), but not in nonsurgical treatment group. All groups had the tendency of better QOL after treatment, but statistical significance was found only in MAD group. Neck circumference (r = 0.360, P = 0.006) and KIIEF-5 score (r = -0.484, P < 0.001) at baseline were significantly related to the improvement of KIIEF-5. CONCLUSIONS This study demonstrated that ED in OSAS may improve following UPPP. Better disease-specific QOL was observed after both surgical and nonsurgical therapies in OSAS. These findings suggest that interventions for OSAS can provide the alleviation of ED and increase QOL in OSAS patients with ED, especially if they had pronounced complaints of ED and wide neck circumferences.
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Affiliation(s)
- Hyun-Woo Shin
- Department of Otorhinolaryngology, Seoul National University College of Medicine and Sensory Organ Research Institute, Seoul, Korea
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Sexual dysfunction in obese women: Does obstructive sleep apnea play a role? Sleep Med 2013; 14:252-6. [DOI: 10.1016/j.sleep.2012.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/22/2012] [Accepted: 11/27/2012] [Indexed: 01/07/2023]
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Current World Literature. Curr Opin Obstet Gynecol 2012; 24:265-72. [DOI: 10.1097/gco.0b013e3283564f02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome. Int J Impot Res 2012; 24:228-33. [PMID: 22673583 DOI: 10.1038/ijir.2012.20] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1±4.9) and 58 postmenopausal (mean age 59.9±4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea-Hypopnea Index (AHI) 10-30) and a severe OSA group (AHI >30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5±4.0 and 16.9±4.7, respectively) compared with not-severe OSA (23.4±5.5, P<0.01 and 21.8±7.5, P<0.05) and control subjects (27.0±5.5, P<0.01 and 24.0±6.7, P<0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26±0.2) compared with not-severe OSA (0.55±0.14, P<0.01) and control group (0.62±0.16, P<0.01), correlated significantly with FSFI (r=0.39, P<0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction.
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