Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment

To evaluate the effect of one month of continuous positive airway pressure (CPAP) in a subgroup of obstructive sleep apnea (OSA) patients with erectile dysfunction (ED) and compare this subgroup with age- and body mass index (BMI)-matched OSA patients without ED.

Prospective general, sleep, psychiatric and sexologic evaluations were conducted. Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Sleep Disorders Questionnaire (SDQ), Quality of Life SF-36, and polysomnography were used. Seventeen OSA patients with ED were compared prior to CPAP treatment and during CPAP treatment with age- and BMI-matched OSA patients without ED. Parametric and non-parametric statistics, chi-square, Fisher exact test and multiple regression analyses were performed.

Ninety-eight men (BMI=28.8 kg/m2, apnea-hypopnea index (AHI)=49.6 events/h, ESS=14.8, BDI=8.4, and lowest SaO2=75.3%) were divided into subgroups of lowest SaO2>80% (A) and lowest SaO2< or =80% (B). (A) Forty-six men had a mean lowest SaO2 of 85.7%+/-2.9, AHI=29.5+/-17.6, age=46.3+/-9.3 years, ESS=13.6+/-4.2, BMI=25.8+/-4.8. Seven of the patients had ED. (B) Fifty-two men had a mean lowest SaO2=60.10+/-10.0%, AHI=67.4+/-24.5, BDI=9.0+/-6.9, age=47.4+/-9.4 years, ESS=16.2+/-4.4, BMI=31.4+/-5.1. Twenty-one of the patients had ED (chi2: P=0.006). Significant variables for ED were lowest SaO2 and age (r=0.17). CPAP-treated subgroup: ED subjects had significantly lower SaO2, ESS, BDI and SF-36 subscale scores than OSA controls. Nasal CPAP eliminated the differences between groups, and ED was resolved in 13 out of 17 cases.

ED in OSAS is related to nocturnal hypoxemia, and about 75% of OSAS patients with ED treated with nasal CPAP showed remission at one-month follow-up, resulting in significant improvement in quality of life.