title: Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA), particularly intermittent nocturnal hypoxemia, is associated with erectile dysfunction (ED).
  
  
  OBJECTIVE
  We investigated in patients with OSA whether continuous positive airway pressure (CPAP) therapy has a long-term effect on sexual function, including ED, in the presence of other risk factors for ED.
  
  
  METHODS
  Within a long-term observational design, we reassessed 401 male patients who had been referred for polysomnography, with respect to erectile and overall sexual function. Mean ± standard deviation follow-up time was 36.5 ± 3.7 months. Patients with moderate to severe ED were stratified according to the regular use of CPAP.
  
  
  METHODS
  Changes of sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire, including the domains erectile function (EF), intercourse satisfaction, orgasmic function (OF), sexual desire (SD), and overall satisfaction (OS).
  
  
  RESULTS
  Of the 401 patients, 91 returned a valid IIEF-15 questionnaire at follow-up. Their baseline characteristics were not different from those of the total study group. OSA (apnea-hypopnea index >5/hour) had been diagnosed in 91.2% of patients. In patients with moderate to severe ED (EF domain <17), CPAP users (N = 21) experienced an improvement in overall sexual function (IIEF-15 summary score; P = 0.014) compared with CPAP non-users (N = 18), as well as in the subdomains OF (P = 0.012), SD (P = 0.007), and OS (P = 0.033). Similar results were obtained in patients with poor overall sexual dysfunction (IIEF-15 summary score <44). In patients with moderate to severe ED and low mean nocturnal oxygen saturation (≤93%, median), also the EF subdomain improved in CPAP users vs. non-users (P = 0.047).
  
  
  CONCLUSIONS
  These data indicate that long-term CPAP treatment of OSA and the related intermittent hypoxia can improve or preserve sexual function in men with OSA and moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA-induced sexual dysfunctions.
authors.affiliation: Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Center Rosenheim, Rosenheim, Germany. stephan.budweiser@ro-med.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Budweiser
authors.forename: Ruth
authors.initials: R
authors.lastname: Luigart
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
authors.forename: Florian
authors.initials: F
authors.lastname: Kollert
authors.forename: Yannick
authors.initials: Y
authors.lastname: Kleemann
authors.forename: Wolf F
authors.initials: WF
authors.lastname: Wieland
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
mesh_terms: D000368:Aged; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000523:psychology; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome