Erectile Dysfunction and Sleep Apnea

According to a new study reported in the peer reviewed journal Erectile Dysfunction in Hypertension and Cardiovascular Disease (1), investigators suggested that obstructive sleep apnea should be suspected in males complaining of erectile dysfunction. Based on the results of the comprehensive study conducted on 870 males, it was observed that males with known history of ED were twice as likely to be diagnosed with obstructive sleep apnea as their normal counterparts.

Sleep Apnea and Erectile Dysfunction – What is the association?

Normal, uninterrupted and stress-free sleep is required for the optimal functioning of all major organ systems. Several research and clinical studies suggested that poor quality of sleep directly translates into deteriorating mental, physical and emotional health.

Sleep disordered breathing (also referred to as obstructive sleep apnea or OSA) is clinically defined as; difficulty in breathing due to partial or absolute obstruction (blockage) of the respiratory passageways during deep sleep. Classic symptoms of OSA are (2):

• Loud snoring
• Excessive daytime sleepiness
• Negative changes in mood and emotions
• Hypertension and other metabolic disorders
• High risk of getting into accidents due to fatigue
• Periods of brief respiratory pauses during deep sleep (often report by sleeping partners)
• Disturbed sleep (frequent episodes of awakening)

Unfortunately, OSA is fairly prevalent in the general population. According to latest statistics, at least one in four males and one in ten females experience obstructive sleep apnea, which may or may not be diagnosed clinically. According to another study, investigators reported that approximately 2-4% of the population experiences clinically overt (severe) sleep apnea that may require treatment (2).

It has been observed that individuals who experience moderate to severe obstructive sleep apnea, often complaints of low libido, lack of sexual vigor and poor performance. In fact, according to a study conducted by Hirshkowitz and associates (3), almost 9 of 10 males (91.3%) who complaints of ED have underlying sleep apnea.

Pathophysiology of Erectile Dysfunction in the setting of Sleep Apnea

Study reported in Sleep (2) suggested that chronic sleep apnea often leads to hormonal aberrations and dysregulation of metabolic functions; presenting as:

• Dysfunction of endothelium of blood vessels
• Neural dysregulation (that is responsible for the erection in response to neural mediators and chemicals like Nitric oxide)
• Impaired perfusion of blood vessels
• Poor tissue oxygenation (hypoxia) and low oxygen saturation

It is argued that the risk factors associated with erectile dysfunction are also statistically proven to play a role in the pathogenesis of sleep apnea. For example; obesity, chronic history of cigarette smoking, sleep fragmentation, advancing age and history of chronic medical/ metabolic ailments are some significant risk factors that may aggravate the risk of both conditions. In essence, research reveals that sleep fragmentation is almost always associated with decreased nocturnal erections; translating into moderate to severe erectile dysfunction and poor performance during the daytime.

How to address Erectile Dysfunction due to Sleep Apnea?

It is highly recommended to see a healthcare professional to address OSA as early as possible to minimize the risk of complications; because coexisting ED and sleep apnea has deleterious effects on the mood and overall well-being. Most frequently employed modality for long term management of OSA is continuous positive airway pressure (CPAP). In most cases, improvement of sleep apnea directly helps in improving the erectile dysfunction. According to the study conducted by Karacan and associates (4), CPAP improves erectile dysfunction in males by 40%. A number of studies also suggested that among anti-depressants and CPAP, later is associated with much more promising results (4).

Healthcare providers also believe that intervention with Sildenafil with CPAP can further improve the quality of results. Based on a meta-analysis, patient and partner satisfaction scores and number of successful intercourse attempts increases 3-fold with the use of Sildenafil (5).

Other popular options include;

• Uvulopalatopharyngoplasty
• Oral appliance therapy

If you are experiencing ED, it is highly recommended to evaluate the pathophysiology and possible causes, before employing any temporary remedy.

References:

1. Wolf, J., & Narkiewicz, K. (2015). Erectile Dysfunction and Sleep Apnea. In Erectile Dysfunction in Hypertension and Cardiovascular Disease (pp. 109-118). Springer International Publishing.

2. Seftel AD, Strohl KP, Loye TL, Bayard D, Kress J, Netzer NC. Erectile dysfunction and symptoms of sleep disorders. Sleep. 2002;25:643-647

3. Hirshkowitz M, Karacan I, Arcasoy MO, Acik G, Narter EM, Williams RL. Prevalence of sleep apnea in men with erectile dysfunction. Urology. 1990;36:232-234.

4. Karacan, I., & Karatas, M. (1995). Erectile dysfunction in sleep apnea and response to CPAP. Journal of sex & marital therapy, 21(4), 239-247.

5. Li, Xiaoming, Zhilong Dong, Yixin Wan, and Zhiping Wang. “Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a meta-analysis.” The Aging Male 13, no. 2 (2010): 82-