Obstructive sleep apnoea and sexual function in men

Abstract

Obstructive sleep apnoea (OSA) is associated with sexual dysfunction. Untreated OSA and erectile dysfunction (ED) have both been identified as being indicative of a high risk of developing cardiovascular disease. Treatments for ED, such as testosterone supplementation or PDE-5 inhibitors, and for OSA, such as Continuous Positive Airways Pressure (CPAP) are both readily available. The effects of these treatments on the other associated conditions have not been fully assessed. The efficacy of testosterone supplementation, in untreated OSA, on sexual function and quality of life has not been investigated. PDE-5 inhibitors are an established treatment for erectile dysfunction, however, there is a paucity of information regarding their efficacy in OSA, and there is a theoretical risk of worsening of OSA with their use. CPAP, in some observational and non-treatment or alternative treatment controlled studies, has been shown to improve erection function in men with OSA, however the majority of these studies have been in men with OSA, with and without ED. Two randomised controlled trials investigating the effects of testosterone in untreated OSA (n=67), and the effects of CPAP and a PDE-5 inhibitor in men with OSA and ED using a factorial design (n=61) were performed. Sleep, sexual function and quality of life was assessed. CPAP increased the quantity of nocturnal erections and a PDE-5 inhibitor improved their quality. However, neither CPAP use, exogenous testosterone nor a PDE-5 inhibitor improved subjective erectile function in men with OSA. Post-hoc analysis showed that adherent CPAP use (>4hours per night) increased subjective erectile function and sexual desire, as well as several parameters of quality of life in men with OSA and ED. Testosterone also increased sexual desire in men with OSA.