Pure Obstructive Sleep Apnea Syndrome and Erectile Dysfunction

Abstract

Objective: The aim of this study is to investigate the existence of erectile dysfunction in patients with obstructive sleep apnea syndrome (OSAS) in which the other possible causes of erectile dysfunction were eliminated. Material and Methods: The study group consisted of 24 patients diagnosed as OSAS with polysomnographic evaluation, and 15 non-apneic controls (mean age; 41.0±8.8 and 42.3±7.9 year respectively) whose comorbidities which might be associated with erectile dysfunction were excluded. Daytime sleepiness was evaluated by Epworth Sleepiness Scale (ESS) and measurement of erectile function was performed by International Index of Erectile Function. Results: The rate of erectile dysfunction in OSAS and control groups were 54.2% and 33.3% respectively (p=0.204). The difference between mean erectile function scores of patient and control groups was non-significant (26.1±4.5 and 26.3±4.3 respectively, p=0.900). There was no correlation between erectile function scores and apnea hypnoea index (r=-0.140; p=0.395). Conclusion: Findings obtained from this study suggest that the high incidence of erectile dysfunction reported in OSAS patients seems to be related with concomitant comorbidities such as diabetes, atherosclerosis and neuroendocrine disorders rather than sleep apnea.

Keywords

• Erectile dysfunction, sleep apnea, international index of erectile function, polysomnography

Pure Obstructive Sleep Apnea Syndrome and Erectile Dysfunction

Öz

Kaynakça

1. Malhotra A, White DP. Obstructive sleep apnea. Lancet 2002;360:237-45. [CrossRef]
2. Shin HW, Rha YC, Han DH, Chung S, Yoon IY, Rhee CS, et al. Erectile dysfunction and disease-specific quality of life in patients with ob- structive sleep apnea. Int J Impot Res 2008;20:549-53. [CrossRef]
3. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased in- cidence of cardiovascular disease in middle-aged men with ob- structive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 2002;166:159-65. [CrossRef]
4. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as risk factor for hypertension; population study. Br Med J 2000;320:479-82. [CrossRef]
5. Seftel AD, Strohl KP, Loye TL, Bayard D, Kress J, Netzer NC. Erectile dysfunction and symptoms of sleep disorders. Sleep 2002;25:643-7.
6. Hirshkowitz M, Karacan I, Arcasoy MO, Acik G, Narter EM, Wil- liams RL. Prevalence of sleep apnea in men with erectile dysfunc- tion. Urology 1990;36:232-4. [CrossRef]
7. Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC. Sleep apnea syndrome due to upper airway obstruction. A review of 25 cases. Arch Intern Med 1977;137:296-300. [CrossRef]
8. Taskin U, Yigit O, Acioglu E, Arıcıgil M, Toktas G, Guzelhan Y. Erectile dysfunction in severe sleep apnea patients and response to CPAP. Int J Impotence Res 2010;22:134-9. [CrossRef]

9. Arruda-Olson AM, Olson LJ, Nehra A, Somers VK. Sleep apnea and cardiovascular disease. Implications for understanding erec- tile dysfunction. Herz 2003;28:298-303. [CrossRef]
10. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5.
11. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.
12. Rechtschaffen A, Kales A. A Manual of Standardized Terminol- ogy, Technique, and Scoring System for Sleep Stages of Human Subjects, BIS/ BRI, UCLA, Los Angeles, 1968.
13. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidi- mensional scale for assessment of erectile dysfunction. Urology 1997;49:822-30. [CrossRef]
14. McHorney CA, Kosinski M, Ware JE Jr. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care 1994;32:551-67. [CrossRef]
15. Koçyigit H, Gülseren S, Erol A, Hizli N, Memis A. The reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Clin Rheumatol 2003;22:18-23. [CrossRef]
16. Akkus E, Kadioglu A, Esen A, Doran S, Ergen A, Anafarta K, et al. Prevalence and correlates of erectile dysfunction in Turkey: a population-based study. Eur Urol 2002;41:298-304. [CrossRef]
17. Physical status: the use and interpretation of anthropometry. Re- port of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452.
18. Budweiser S, Enderlein S, Jörres RA, Hitzl AP, Wieland WF, Pfeifer M, et al. Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med 2009;6:3147-57. [CrossRef]
19. Fanfulla F, Malaguti S, Montagna T, Salvini S, Bruschi C, Crotti P, et al. Erectile dysfunction in men with obstructive sleep apnea: an early sign of nerve involvement. Sleep 2000;23:775-81.
20. Zias N, Bezwada V, Gilman S, Chroneou A. Obstructive sleep ap- nea and erectile dysfunction: still a neglected risk factor? Sleep Breath 2009;13:3-10. [CrossRef]
21. Findley LJ, Wilhoit SC, Suratt PM. Apnea duration and hypox- emia during REM sleep in patients with obstructive sleep apnea. Chest 1985;87:432-6. [CrossRef]
22. Sériès F, Cormier Y, La Forge J. Influence of apnea type and sleep stage on nocturnal postapneic desaturation. Am Rev Respir Dis 1990;141:1522-6.
23. Cohen DB. Dysphoric affect and REM sleep. J Abnorm Psychol 1979;88:73-7. [CrossRef]
24. Giles DE, Roffwarg HP, Schlesser MA, Rush A. Which endogenous depressive symptoms relate to REM latency reduction? J Biol Psychiatry 1986;21:473-82. [CrossRef]
25. Ware JC, Hirshkowitz M. Characteristics of penile erections dur- ing sleep recorded from normal subjects. J Clin Neurophysiol 1992;9:78-87. [CrossRef]
26. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professional’s follow-up study. Ann Intern Med 2003:139:161-8.
27. Moore P, Bardwell WA, Ancoli-Israel S, Dimsdale JE. Associa- tion between polysomnographic sleep measures and health- related quality of life in obstructive sleep apnea. J Sleep Res 2001;10:303-8. [CrossRef]
28. Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea. Am J Respir Crit Care Med 1998;158:494-503.
29. Teloken PE, Smith EB, Lodowsky C, Freedom T, Mulhall JP. De- fining association between sleep apnea syndrome and erectile dysfunction. Urology 2006;67:1033-7. [CrossRef]
30. Margel D, Cohen M, Livne PM, Pillar G. Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dys- function. Urology 2004;63:545-9. [CrossRef]
31. Hanak V, Jacobson DJ, McGree ME, Sauver JS, Lieber MM, Olson EJ, et al. Snoring as a risk factor for sexual dysfunction in com- munity men. J Sex Med 2008;5:898-908. [CrossRef]