Sleep Apnea is an Independent Correlate of Erectile and Sexual Dysfunction

Abstract

Introduction Obstructive sleep apnea (OSA) has been linked with erectile dysfunction (ED), but it is unknown whether this association is maintained in the presence of other risk factors for ED. Aim The aim of this study was to evaluate the relationship between ED/sexual dysfunction and polysomnographic measures of sleep apnea in patients with known risk factors for ED. Methods Prospective cross-sectional analysis of 401 male patients undergoing in-lab polysomnography for suspected OSA. Erectile (EF) and sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire. Main Outcome Measures Severity of OSA via apnea–hypopnea index (AHI) and mean/lowest nocturnal oxygen saturation (SaO2). The IIEF-15 including the sexual domains: EF, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Results OSA (AHI > 5/h) was diagnosed in 92% of patients. ED (EF subdomain ≤ 25) was present in 69% of patients with, and 34% of patients without OSA (P < 0.001). Multivariate stepwise regression analyses including known risk factors for ED, such as age, obesity, coronary heart disease, peripheral occlusive disease, hypertension, diabetes, prostate surgery, and β-blocker treatment, and measures of sleep apnea identified mean nocturnal SaO2 as independently associated with ED (P = 0.002; mean [95% CI] normalized slope 0.126 [0.047; 0.205]). Age (P < 0.001), peripheral occlusive disease (P = 0.001), prostate surgery (P = 0.018), and hypertension (P = 0.021) were confirmed as risk factors for ED, but did not abolish the sleep apnea-associated risk. Similar results were obtained for sexual dysfunction. Logistic regression analysis using the diagnosis of ED (EF subdomain ≤ 25) as binary dependent variable confirmed that mean nocturnal SaO2 (P = 0.012), as well as age (P < 0.001) were independently associated with ED. Conclusions ED and overall sexual dysfunction were highly prevalent in patients with suspected OSA. Irrespective of known risk factors, mean nocturnal SaO2 was an additional, independent correlate of these dysfunctions, suggesting that OSA-related intermittent nocturnal hypoxemia specifically contributes to their development.

Sleep-Disordered Breathing and Coronary Artery Disease

“…19 One clinical manifestation of endothelial dysfunction is erectile dysfunction, which is present in the majority (69%) of sleep clinic populations with OSA. 20 In patients with acute MI, the prevalence of erectile dysfunction is significantly higher in those with versus without suspected OSA (74% vs 41%). 21 Endothelial dysfunction can be triggered by oxidative stress, 22 systemic inflammation 23,24 and activation of the sympathetic nervous system.…”

“…10 All of these factors are promoted in the presence of SDB, especially OSA, via repetitive hypoxia and arousals from sleep ( Figure 1B). 20 Oxidative stress is characterized by an imbalance of reactive oxygen species (ROS) and antioxidants in favor of ROS. Leucocytes from patients with severe OSA release more ROS in vitro compared with cells from individuals without OSA.…”

Nocturnal Hypoxemia is Associated With Low Testosterone Levels in Overweight Males and Older Men With Normal Weight

“…18 Although some studies report that the low sex hormone levels in patients with OSA are mostly due to obesity, 19,20 others indicate that sleep apnea negatively affects testosterone level 21,22 independent of BMI. [23][24][25][26] Overall, the research results on the relationship between OSA and the level of this sex hormone are inconsistent and thus require further investigation; therefore, the objective of this study was to evaluate the association between the TT levels in nonobese patients with OSA, as determined by different overnight polysomnography parameters.…”

Obstructive sleep apnea, atrial fibrillation, and erectile dysfunction: are they only coexisting conditions or a new clinical syndrome? The concept of the OSAFED syndrome

“…Almost 70% of male patients with OSA suffer from ED. 43 The odds for ED, in patients who are at high risk of OSA according to the Berlin Questionnaire and the Epworth Sleepiness Scale are 55.71 (95% CI, 3.36-923.81; P = 0.005). 44 AF, besides having a negative impact Erectile dysfunction ED is the inability to achieve or maintain an erection long enough to engage in sexual intercourse.…”

“…After performing a transesophageal echocardiography (which did not reveal any thrombi in the left atrial appendage, but showed an enlargement of the left atrium, confirmed also later with transthoracic echocardiography with the following results: left atrium, 5.9 × 6.8 cm; area, 33.7 cm 2 ; volume 135 cm 3 ); the pulmonary vein was isolated. Polysomnography showed an apnea-hypopnea index (AHI) of 43.8/h and a mean night-time blood oxygen saturation of 91.3%. After the diagnosis of severe…”