Friday, July 19, 2013

CPAP Improves Sexual Function in Men With Sleep Apnea

June 18, 2012 (Boston, Massachusetts) — A new study confirms that erectile dysfunction (ED) is common in patients with obstructive sleep apnea (OSA) and indicates that continuous positive airway pressure (CPAP) therapy improves not only sexual function but satisfaction in many men.
Joseph W. Dombrowsky, MD, from the Sleep Disorders Center, Walter Reed National Military Medical Center in Bethesda, Maryland, reported the findings here at SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting.

The sample included 92 men newly diagnosed with OSA by in-lab polysomnography who were initiating CPAP therapy. The men had an average age of 45.8 years, mean body mass index (BMI) of 29 kg/m2, and average apnea hypopnea index (AHI) of 38 events per hour, indicating "pretty significant apnea," Dr. Dombrowsky noted in an interview with Medscape Medical News.

"Surprising" Data
At baseline, 43.5% of the men had ED, defined as an International Index of Erectile Function (IIEF) domain score of less than 25. ED was mild in 24% of the men, moderate in 8%, and severe in 12%.
"We were surprised at how many of these relatively young men had ED," Dr. Dombrowsky said. "We were similarly surprised at how robust a clinically significant response the men had with CPAP therapy."

CPAP therapy led to a positive minimal clinically important difference (MCID) in 54.4% of men with mild ED, in 28.6% of those with moderate ED, and in 27.3% of those with severe ED.

In addition, researchers noted a trend toward statistically significant improvement in the IIEF sexual desire domain in all men, with and without ED (+39; 95% confidence interval [CI], -0.01 to 0.79; P = .07). The improvement was greater in those with regular CPAP use (+68; 95% CI, 0.06-1.3; P = .05).
"We didn't have the power to break it down and truly relate the improvement to CPAP adherence," Dr. Dombrowsky said. "It would be great if we could say more is better, but we didn't have the power to do that."

Given the small sample size of 92 men, "we couldn't really control for hypertension, diabetes, and BMI. Only 3.3% of the cohort had diabetes, and about 33% had hypertension, which is about what you see in a national cohort, so the data have some real-world applicability,” Dr. Dombrowsky noted.

"Interesting Study"
Why does CPAP seem to help ED? "It's unclear," Dr. Dombrowsky said. "Nothing has been nailed down yet, but we can postulate that improving oxygenation at night or sleeping better improves your energy and libido," he commented.

Asked for his thoughts on the study, Clete Kushida, MD, PhD, professor and medical director of the Stanford Sleep Medicine Center in Palo Alto, California, and past president of the American Academy of Sleep Medicine, told Medscape Medical News, "The results are interesting, but with a sample size of 92, we definitely want to see more studies."

"I don't recall there being a study looking at the impact of CPAP on ED in a systematic way and one that also included things like quality of life," he added.

The authors and Dr. Kushida have disclosed no relevant financial relationships.
SLEEP 2012: Associated Professional Sleep Societies 26th Annual Meeting. Abstract #0574. Presented June 13, 2012.

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