The association between obstructive sleep apnoea and erectile dysfunction: a systematic review and meta-analysis

While a link between obstructive sleep apnoea and erectile dysfunction is recognised, the correlation between their respective severities remains inadequately quantified. This systematic review and meta-analysis aimed to determine the correlation between markers of obstructive sleep apnoea and erectile dysfunction. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search was performed on PubMed, Embase, and Scopus for studies reporting correlations between the apnoea-hypopnea index or minimum oxygen saturation and validated versions of the International Index of Erectile Function (IIEF-5, IIEF-15, and IIEF-EF) scores. Eight studies met the pre-specified population, exposure, comparator, outcome, and study-design (PECOS) criteria. Meta-analysis of seven studies, with a pooled population of 594 patients, revealed a significant, moderate negative correlation between apnoea-hypopnoea index and International Index of Erectile Function scores (pooled Fisher's Z = - 0.43 ; 95% CI: -0.66 to -0.19). An analysis of three studies, comprising a pooled population of 513 patients, demonstrated a significant positive correlation between minimum oxygen saturation and International Index of Erectile Function scores (pooled Fisher's Z = 0.36 ; 95% CI: 0.04 to 0.69). Secondary findings highlighted a high prevalence of erectile dysfunction in patients with obstructive sleep apnoea, ranging from 59.0% to 69.0% across studied populations. Age was a significant confounding factor, and continuous Positive Airway Pressure was associated with reported improvements in erectile function in the included studies, although the magnitude of improvement varied according to the International Index of Erectile Function instrument used. These findings underscore the importance of screening for obstructive sleep apnoea in men presenting with erectile dysfunction, while recognizing that the pooled estimates are limited by high heterogeneity and variation in erectile-function instruments.