Low Quality of Life and Depressive Symptoms as an Independent Risk Factor for Erectile Dysfunction in Patients with Obstructive Sleep Apnea

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.

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

“…On the other hand, some studies reported that OSA or nocturnal hypoxemia was not associated with ED. 25,46 Yung et al 25 analyzed data from 713 male patients who underwent full-night PSG monitoring and found that the frequency of ED did not differ significantly according to OSA severity and there was no significant association of ED with either the AHI or lowest SaO2. The possible reasons for the discrepancies between our findings and some previous studies are as follows: (i) The exclusion criteria were different.…”

“…The results of the study by Yung Jin Jeon et al showed that the frequency of ED did not differ significantly according to OSA severity, and there was no significant association of ED with either the respiratory disorder index (RDI) or lowest SaO 2 . 25 Based on these considerations, we used comprehensive PSG data in a large sample of patients suspected to have OSA to assess whether those parameters including RDI (or AHI), lowest SaO2, mean SaO2, SIT90%, ODI, obstructive apnea index (OAI), maximum apnea time, microarousal index, oxygen reduction frequency (ORF), maximum oxygen reduction (MOR), longest oxygen reduction time (LORT), central apnea frequency, and obstructive apnea frequency were related to ED. In addition, we propose a new calculation method, the blood oxygen accumulation distribution area index (BOADAI), which integrates the information of apnea events and nocturnal hypoxemia to evaluate the association between OSA and ED.…”

Sleep, Sleep Disorders, and Sexual Dysfunction

“…Several studies have shown a high incidence of ED among male OSA patients, ranging from 47.1% to 80.0% [2021222324]. The severity of OSA is considered to be an important factor in the development of ED [2526], however, this finding is not consistent [27]. A Korean study by Shin et al [28] showed that ED is associated with decreased minimum oxygen saturation, not with AHI.…”

Chronic intermittent hypoxia induces hormonal and male sexual behavioral changes: Hypoxia as an advancer of aging

“…The risk for sleep apnea increases with age and occurs at a higher frequency in men than women [4–6]. Male sexual dysfunction is commonly associated with sleep apnea and can greatly lower quality of life [7, 8].…”