Surgical treatments for obstructive sleep apnea decrease the risk of erectile dysfunction: A nationwide cohort study

Hwang, Juen-Haur; Ong, Hueih-Ling; Chen, Yi‐Chun

doi:10.1111/andr.13126

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…It has been proved that CPAP therapy significantly improves erectile function of OSA patients, and a combined treatment with sildenafil provides a cumulative effect [36]. In addition, a large and long-term cohort study which included 11,116 OSA patients has shown that surgical treatments for OSA could reduce the risk for developing ED by 21% [37]. In P r e p r i n t 11 our research, we have not identified genetic evidence of a causal relationship between OSA and ED.…”

Section: Discussionmentioning

confidence: 99%

Causal relationship between sleep traits and erectile dysfunction: Evidence from Mendelian Randomization analysis

Zhu,

Gao,

Guo

et al. 2024

Arch Med Sci

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IntroductionAlthough several observational studies have explored the association between sleep traits and the risk of erectile dysfunction (ED), it remains controversial. In the present study, we included a wide range of sleep traits that are commonly observed in clinical practice. We investigated the causal relationship between these sleep traits and ED using univariate and multivariate Mendelian randomization (MR) methods.Material and methodsInstrumental variables (IVs) for eight sleep traits (insomnia, sleep duration, chronotype, and sleep apnea syndrome), five confounders (depression, body mass index, smoking initiation, alcohol consumption, and type 2 diabetes), and ED were derived from genome-wide association study (GWAS) data of individuals of European ancestry. The primary analysis technique used was the inverse-variance weighted (IVW) approach. Furthermore, several sensitivity analyses were conducted to evaluate heterogeneity, horizontal pleiotropy, and stability.ResultsMR analysis revealed that increased snoring, short sleep, and frequent insomnia, were associated with a higher risk of ED. Furthermore, we found evidence of a significant association between being a morning person and the risk of developing ED. This association persisted in multivariable MR analyses after adjusting for potential confounding factors. Sensitivity analysis suggested that the results were robust with no evidence of pleiotropy or heterogeneity.ConclusionsThis study provides further evidence supporting the association between genetically predicted snoring, insomnia, and an increased risk of ED. Additionally, the study highlights the causal relationship of short sleep duration and chronotype with ED.

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Section: Discussionmentioning

confidence: 99%

Causal relationship between sleep traits and erectile dysfunction: Evidence from Mendelian Randomization analysis

Zhu,

Gao,

Guo

et al. 2024

Arch Med Sci

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“…Moreover, surgical treatment may reduce the risk of primary brain cancers in subjects with OSA [ 3 ]. Recently, we found that surgical treatments could reduce the risk of erectile dysfunction in OSA patients by a large-scale cohort study [ 5 ]. This study showed that surgical treatment for OSA in CKD patients could decrease ESRD risk, but increase mortality risk, especially for non-cardiovascular mortality and within 3 months after surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded 19,510 CKD patients who were aged < 18 years, had missing data, had a diagnosis of ESRD or OSA before the CKD inception date, and expired or dropped out before the CKD inception date; we obtained 357,299 CKD patients without OSA. We further identified 32,220 incident OSA patients after the CKD inception date and divided them into two groups according to exposure to surgical treatment for OSA, which was defined as ever admission due to OSA or the presence of ICD-9/10 surgical procedure codes for OSA [ 5 ]. CKD patients who ever received surgical treatments for OSA between 2001(1 year after the start of the LGTD2005 inclusion period) and 2015 (1 year before the end of the LGTD2005 inclusion period) were designated as the treated cohort ( n = 1171).…”

Section: Methodsmentioning

confidence: 99%

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Effects of Surgical Treatment for Obstructive Sleep Apnea on Renal and Survival Outcomes in Patients with Chronic Kidney Disease: A Taiwanese Nationwide Cohort Study

Hwang

Yu²,

Chen

2022

JCM

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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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Chronic sleep deprivation induces erectile dysfunction through increased oxidative stress, apoptosis, endothelial dysfunction, and corporal fibrosis in a rat model

Zhang,

Su,

Liu

et al. 2024

The Journal of Sexual Medicine

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Background Sleep is foundational for nocturnal erections, facilitating nutrient exchange and waste removal, which has brought widespread attention to the relationship between sleep and erectile dysfunction (ED). However, there is currently a lack of basic research confirming whether chronic sleep deprivation (CSD) leads to erectile impairment and its underlying pathological mechanisms. Aim The study sought to investigate whether CSD impairs erectile function in rats and the potential tissue damage it may cause in rats. Methods The modified multiple platform method was employed to induce CSD in 14 rats, randomly divided into a platform control group and a CSD group. After 3 weeks, erectile function was evaluated by measuring intracavernosal pressure following cavernous nerve stimulation. Outcomes Arterial blood samples were then analyzed for testosterone levels, and cavernous tissues were processed for advanced molecular biology assays, including Western blotting and immunofluorescence. Results After inducing CSD, rats exhibited a marked reduction in erectile function, yet their serum testosterone levels remained statistically unchanged when compared with the control group. More importantly, rats in the CSD group exhibited a significant increase in oxidative stress levels, accompanied by low expression of HO-1 and high expression of NOX1 and NOX4. Subsequently, elevated oxidative stress induced increased apoptosis in smooth muscle and endothelial cells, as evidenced by significant decreases in CD31 and α-smooth muscle actin expression in the CSD group, demonstrated through Western blotting and immunofluorescence assays. Endothelial cell apoptosis led to a significant decrease in endothelial nitric oxide synthase, resulting in lowered levels of nitric oxide and cyclic guanosine monophosphate, which severely impaired the erectile mechanism. Additionally, activation of the transforming growth factor β1 fibrotic pathway led to increased levels of tissue fibrosis, resulting in irreversible damage to the penile tissue in the CSD group. Clinical implications Our study lacks further exploration of the molecular mechanisms linking CSD and ED, representing a future research focus for potential targeted therapies. Strengths and limitations Our findings demonstrated that CSD significantly impairs erectile function in rats. Conclusion CSD severely impairs erectile function in rats. When exposed to CSD, rats exhibit significantly elevated oxidative stress levels, which lead to increased tissue apoptosis, endothelial dysfunction, and ultimately irreversible fibrotic changes in the tissues. Further researches into the potential molecular mechanisms are needed to identify possible therapeutic targets for ED related to CSD.

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Surgical treatments for obstructive sleep apnea decrease the risk of erectile dysfunction: A nationwide cohort study

Cited by 4 publications

References 31 publications

Causal relationship between sleep traits and erectile dysfunction: Evidence from Mendelian Randomization analysis

Causal relationship between sleep traits and erectile dysfunction: Evidence from Mendelian Randomization analysis

Effects of Surgical Treatment for Obstructive Sleep Apnea on Renal and Survival Outcomes in Patients with Chronic Kidney Disease: A Taiwanese Nationwide Cohort Study

Chronic sleep deprivation induces erectile dysfunction through increased oxidative stress, apoptosis, endothelial dysfunction, and corporal fibrosis in a rat model

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