title: Effects of surgical vs. nonsurgical therapy on erectile dysfunction and quality of life in obstructive sleep apnea syndrome: a pilot study.
abstract: BACKGROUND
  Obstructive sleep apnea syndrome (OSAS) is associated with erectile dysfunction (ED). The improvement of ED after medical therapy including continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is still controversial. Furthermore, the efficacy of surgical treatment has been little investigated.
  
  
  OBJECTIVE
  The aim of this nonrandomized prospective study was to evaluate the effects of surgical (uvulopalatopharyngoplasty [UPPP]) and nonsurgical approaches (CPAP and MAD) on ED and quality of life (QOL) in OSAS.
  
  
  METHODS
  OSAS patients underwent UPPP (N = 30), CPAP (N = 16), or MAD (N = 10) and completed the Korean versions of the International Index of Erectile Function questionnaire (KIIEF-5) and the Calgary Sleep Apnea Quality of Life Index (SAQLI) before and after a median of 7 months of treatment (interquartile range, 4-15 months). All patients underwent a full-night in-laboratory polysomnography at baseline and follow-up.
  
  
  METHODS
  The main outcome measures are the KIIEF-5 and SAQLI scores.
  
  
  RESULTS
  CPAP group showed older age, higher body mass index, and more severe OSAS than other groups. Apnea-hypopnea index and lowest oxygen saturation level improved significantly in all groups, but Epworth Sleepiness Scale score decreased significantly in UPPP and MAD groups. Significant increase of KIIEF-5 was observed in patients who underwent UPPP (P = 0.039, paired t-test), but not in nonsurgical treatment group. All groups had the tendency of better QOL after treatment, but statistical significance was found only in MAD group. Neck circumference (r = 0.360, P = 0.006) and KIIEF-5 score (r = -0.484, P < 0.001) at baseline were significantly related to the improvement of KIIEF-5.
  
  
  CONCLUSIONS
  This study demonstrated that ED in OSAS may improve following UPPP. Better disease-specific QOL was observed after both surgical and nonsurgical therapies in OSAS. These findings suggest that interventions for OSAS can provide the alleviation of ED and increase QOL in OSAS patients with ED, especially if they had pronounced complaints of ED and wide neck circumferences.
authors.affiliation: Department of Otorhinolaryngology, Seoul National University College of Medicine and Sensory Organ Research Institute, Seoul, Korea.
authors.forename: Hyun-Woo
authors.initials: HW
authors.lastname: Shin
authors.forename: Ju-Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Jong-Wan
authors.initials: JW
authors.lastname: Park
authors.forename: Chae-Seo
authors.initials: CS
authors.lastname: Rhee
authors.forename: Chul Hee
authors.initials: CH
authors.lastname: Lee
authors.forename: Yang-Gi
authors.initials: YG
authors.lastname: Min
authors.forename: Dong-Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure; D007172:Erectile Dysfunction / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017286:Polysomnography; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Erectile Dysfunction; Obstructive Sleep Apnea Syndrome; Quality of Life; Sexual Function Improvement after Surgical and Nonsurgical Treatments; Treatment