title: Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review.
abstract: OBJECTIVE
  Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.
  
  
  METHODS
  A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.
  
  
  RESULTS
  Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.
  
  
  CONCLUSIONS
  The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.
authors.affiliation: School of Nursing, Wichita State University, Wichita, KS, USA.
authors.forename: E
authors.initials: E
authors.lastname: Steinke
authors.affiliation: Department of Cardiology, Copenhagen University Hospital, Bispebjerg Hospital, and The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Palm Johansen
authors.affiliation: Department of Nursing Science, School of Health & Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Fridlund
authors.affiliation: Department of Nursing Science, School of Health & Welfare, Jönköping University, Jönköping, Sweden.|Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Broström
mesh_terms: D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008593:Menopause / Q000502:physiology; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D000068677:Sildenafil Citrate / Q000627:therapeutic use; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*
chemical_list: D006728:Hormones; D058986:Phosphodiesterase 5 Inhibitors; D000068677:Sildenafil Citrate