madman
Super Moderator
Abstract
Background: Erectile dysfunction (ED) with obstructive sleep apnea (OSA) is a relatively common issue for men. A number of clinical studies have demonstrated that continuous positive airway pressure (CPAP) therapy may effectively alleviate ED symptoms in patients with OSA.
Methods: PubMed, MEDLINE, EMBASE, and Cochrane Library databases were utilized and searched for the relevant studies up to September 2, 2019. The International Index of Erectile Function 5 (IIEF-5) scoring system from the patients before and after receiving their CPAP therapy was collected according to the strict inclusion and exclusion criteria. REVMEN 5.3 software was applied for the meta-analysis.
Results: A total of seven publications consisting of 206 ED patients with OSA were included in the study. ED patients with OSA received CPAP treatment were significantly improved based on the IIEF-5 scores [Weighted Mean Difference (WMD) = 1.14, 95% confidence interval (CI) = 0.89 – 1.38, z =9.09, p < 0.0001].Our research found that high heterogeneity is mainly due to Zhang's research because his patient's AHI is much higher than other patients. We removed Zhang’s study, and a moderate heterogeneity (I2 = 54%, P = 0.05) was found in this study.
Conclusion: The results suggest that continuous positive airway pressure therapy improves erectile dysfunction in patients with obstructive sleep apnea. However, further evidence is needed due to the insufficient number of included patients and high heterogeneity.
1. Introduction
Obstructive Sleep Apnea (OSA) is a chronic respiratory condition leading to intermittent hypoxia and disturbances of sleep structure, resulting in partial or complete obstruction of the upper airways [1,2]. Epidemiological survey shows that approximately 3%-9% of women and 10%-17% of men have OSA in the United States [3], and around 4.1% of people aged 14 or over have OSA in Guangxi province, China [4]. OSA is an important predisposing risk factor for primary hypertension, atherosclerosis, myocardial infarction, cerebral infarction, and stroke. It also significantly affects the quality of life due to its prevalence and severity and is linked to Erectile Dysfunction (ED). Previous studies indicated that patients with OSA have a higher risk of ED, and nearly half of OSA male patients may already have ED [5-8]. The causative factors of ED in the setting of OSA are hypoxemia, hypercapnia, and acid-base decompensation [9,10]. Reductions of serum testosterone and prolactin levels in patients with OSA are associated with the severity of OSA, and sexual dysfunction is caused mainly by the changes in sex hormones [11]. Patients with ED usually receive drug treatments such as Sildenafil, Vardenafil, and Tadalafil, however, the ED symptoms may not be able to fully recover [12], and the treatment itself is expensive[13]. Instead of medications, continuous positive airway pressure (CPAP) therapy has been utilized as and widely accepted treatment strategy for OSA patients [14,15,16]. There are a number of clinical trials that have shown that CPAP therapy may relieve ED symptoms in men with OSA, but its efficacy has not yet been discussed. Therefore, this meta-analysis aims to collect the International Index of Erectile Function 5 (IIEF-5) data and systematically evaluate the effect of CPAP therapy on male OSA patients with ED symptoms.
4. Discussion
The responses of CPAP treatment can be considered to be immediate and continuous, and the treatment for 1-month to 3-month is a short period. After the patients received their CPAP treatments, Perimenis et al. [17,18] noticed that OSA symptoms, including snoring and daytime sleepiness, were relieved, and the sleeping quality was improved. They also observed that the clinical indicators, including AHI, sleep structure, and sleep hypoxia, were well-recovered. This finding was confirmed by Grunstein et al. [29] and demonstrated that a 3-month or longer CPAP therapy, could maximize the treatment benefits, and improve the levels of testosterone and sex hormone-binding proteins in male OSA patients.
Conclusion
Previously, a number of researchers paid attention to studying the relationship between OSA and ED while a small number of participants from each study were not able to draw a conclusive conclusion. Utilizing the IIEF-5 scoring system in this meta-analysis found that CPAP therapy is effective in relieving the ED symptoms for male OSA patients with ED in a 3-month length setting. Long-term CPAP therapy may be needed for further evaluation.
Background: Erectile dysfunction (ED) with obstructive sleep apnea (OSA) is a relatively common issue for men. A number of clinical studies have demonstrated that continuous positive airway pressure (CPAP) therapy may effectively alleviate ED symptoms in patients with OSA.
Methods: PubMed, MEDLINE, EMBASE, and Cochrane Library databases were utilized and searched for the relevant studies up to September 2, 2019. The International Index of Erectile Function 5 (IIEF-5) scoring system from the patients before and after receiving their CPAP therapy was collected according to the strict inclusion and exclusion criteria. REVMEN 5.3 software was applied for the meta-analysis.
Results: A total of seven publications consisting of 206 ED patients with OSA were included in the study. ED patients with OSA received CPAP treatment were significantly improved based on the IIEF-5 scores [Weighted Mean Difference (WMD) = 1.14, 95% confidence interval (CI) = 0.89 – 1.38, z =9.09, p < 0.0001].Our research found that high heterogeneity is mainly due to Zhang's research because his patient's AHI is much higher than other patients. We removed Zhang’s study, and a moderate heterogeneity (I2 = 54%, P = 0.05) was found in this study.
Conclusion: The results suggest that continuous positive airway pressure therapy improves erectile dysfunction in patients with obstructive sleep apnea. However, further evidence is needed due to the insufficient number of included patients and high heterogeneity.
1. Introduction
Obstructive Sleep Apnea (OSA) is a chronic respiratory condition leading to intermittent hypoxia and disturbances of sleep structure, resulting in partial or complete obstruction of the upper airways [1,2]. Epidemiological survey shows that approximately 3%-9% of women and 10%-17% of men have OSA in the United States [3], and around 4.1% of people aged 14 or over have OSA in Guangxi province, China [4]. OSA is an important predisposing risk factor for primary hypertension, atherosclerosis, myocardial infarction, cerebral infarction, and stroke. It also significantly affects the quality of life due to its prevalence and severity and is linked to Erectile Dysfunction (ED). Previous studies indicated that patients with OSA have a higher risk of ED, and nearly half of OSA male patients may already have ED [5-8]. The causative factors of ED in the setting of OSA are hypoxemia, hypercapnia, and acid-base decompensation [9,10]. Reductions of serum testosterone and prolactin levels in patients with OSA are associated with the severity of OSA, and sexual dysfunction is caused mainly by the changes in sex hormones [11]. Patients with ED usually receive drug treatments such as Sildenafil, Vardenafil, and Tadalafil, however, the ED symptoms may not be able to fully recover [12], and the treatment itself is expensive[13]. Instead of medications, continuous positive airway pressure (CPAP) therapy has been utilized as and widely accepted treatment strategy for OSA patients [14,15,16]. There are a number of clinical trials that have shown that CPAP therapy may relieve ED symptoms in men with OSA, but its efficacy has not yet been discussed. Therefore, this meta-analysis aims to collect the International Index of Erectile Function 5 (IIEF-5) data and systematically evaluate the effect of CPAP therapy on male OSA patients with ED symptoms.
4. Discussion
The responses of CPAP treatment can be considered to be immediate and continuous, and the treatment for 1-month to 3-month is a short period. After the patients received their CPAP treatments, Perimenis et al. [17,18] noticed that OSA symptoms, including snoring and daytime sleepiness, were relieved, and the sleeping quality was improved. They also observed that the clinical indicators, including AHI, sleep structure, and sleep hypoxia, were well-recovered. This finding was confirmed by Grunstein et al. [29] and demonstrated that a 3-month or longer CPAP therapy, could maximize the treatment benefits, and improve the levels of testosterone and sex hormone-binding proteins in male OSA patients.
Conclusion
Previously, a number of researchers paid attention to studying the relationship between OSA and ED while a small number of participants from each study were not able to draw a conclusive conclusion. Utilizing the IIEF-5 scoring system in this meta-analysis found that CPAP therapy is effective in relieving the ED symptoms for male OSA patients with ED in a 3-month length setting. Long-term CPAP therapy may be needed for further evaluation.
