title: Sexual function and obstructive sleep apnea-hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy.
abstract: BACKGROUND
  The obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with sexual dysfunction. Although successful treatment with continuous positive airway pressure (CPAP) has been demonstrated to improve sexual function, the effects of oral-appliance therapy are unknown.
  
  
  OBJECTIVE
  The aims of this study were to determine to what extent untreated male OSAHS patients experience sexual dysfunctions compared with control subjects, and second, to evaluate the effects of oral-appliance and CPAP therapy on sexual functioning.
  
  
  METHODS
  Sexual functioning was determined in 48 OSAHS patients with the Golombok Rust inventory of sexual satisfaction (GRISS) and a testosterone measurement. GRISS outcomes were compared with 48 age-matched male controls without any sexual problems. Patients were randomized for either oral-appliance or CPAP therapy. After 2-3 months of treatment, the GRISS and testosterone measurements were repeated.
  
  
  METHODS
  The outcomes on the GRISS were used as the main outcome measure.
  
  
  RESULTS
  Compared with controls, OSAHS patients had significantly more erectile dysfunction (mean +/- standard deviation; OSAHS 8.7 +/- 3.8 vs. controls 6.8 +/- 2.6) and sexual dissatisfaction (mean +/- standard deviation; OSAHS 9.7 +/- 4.2 vs. controls 8.1 +/- 2.6) as indicated by the GRISS. No significant changes in the GRISS or testosterone levels were observed in the 20 and 27 patients completing the follow-up review for oral-appliance and CPAP therapy. A correlation was demonstrated between the extent of erectile dysfunction at baseline and improvements in erectile function following treatment (r = -0.547, P = 0.000).
  
  
  CONCLUSIONS
  This study confirms that male OSAHS patients show more sexual dysfunctions compared with age-matched control subjects. Although significant improvements in sexual functioning in neither the oral-appliance nor CPAP-treated group could be established, our findings suggest that untreated OSAHS patients with pronounced erectile dysfunction experience some improvement following treatment.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.hoekema@kchir.umcg.nl
authors.forename: Aarnoud
authors.initials: A
authors.lastname: Hoekema
authors.forename: Anna-Lucia
authors.initials: AL
authors.lastname: Stel
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Stegenga
authors.forename: Johannes H
authors.initials: JH
authors.lastname: van der Hoeven
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Wijkstra
authors.forename: Mels F
authors.initials: MF
authors.lastname: van Driel
authors.forename: Lambert G M
authors.initials: LG
authors.lastname: de Bont
mesh_terms: D000328:Adult; D003075:Coitus; D045422:Continuous Positive Airway Pressure; D007172:Erectile Dysfunction / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017286:Polysomnography / Q000295:instrumentation; D012107:Research Design; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome