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Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor?

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Abstract

Introduction

Erectile dysfunction (ED) is a well-known entity with determined risk factors, which generally has a negative impact on quality of life. Obstructive sleep-disordered breathing (SDB), often referred to as obstructive sleep apnea, stands among the possible risk factors for ED.

Discussion

Literature review suggests that SDB induces a spectrum of abnormalities in neural, hormonal, and vascular regulation that may contribute to the development of ED. While more studies are required to imply SDB as a risk factor for ED, several case series and expert opinion have contributed evidence for a causal relationship.

Conclusion

In clinical practice, men presenting with symptoms of sexual dysfunction often have concomitant sleep disorders requiring treatment. There is now evidence to suggest that treating SDB may be an effective treatment for ED. It is the authors’ opinion that patients with erectile dysfunction would benefit from a sleep evaluation.

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References

  1. Kochar MS, Mazur LI, Patel A (1999) What is causing your patient’s sexual dysfunction? Uncovering a connection with hypertension and antihypertensive therapy. Postgrad Med 106:149–152, 155–147

    CAS  PubMed  Google Scholar 

  2. Hirshkowitz M, Karacan I, Arcasoy MO, Acik G, Narter EM, Williams RL (1990) Prevalence of sleep apnea in men with erectile dysfunction. Urology 36:232–234 doi:10.1016/0090-4295(90)80262-L

    Article  CAS  PubMed  Google Scholar 

  3. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235 doi:10.1056/NEJM199304293281704

    Article  CAS  PubMed  Google Scholar 

  4. Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20:705–706

    CAS  PubMed  Google Scholar 

  5. Arruda-Olson AM, Olson LJ, Nehra A, Somers VK (2003) Sleep apnea and cardiovascular disease. Implications for understanding erectile dysfunction. Herz 28:298–303

    PubMed  Google Scholar 

  6. Impotence (1992) NIH Consens Statement 10:1–33

    Google Scholar 

  7. Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E (2004) Definitions, classification, and epidemiology of sexual dysfunction. In: Lue TF, Basson R, Rosen RC et al (eds) Sexual medicine. Health Publications, Paris, pp 37–72

    Google Scholar 

  8. Seftel AD, Strohl KP, Loye TL, Bayard D, Kress J, Netzer NC (2002) Erectile dysfunction and symptoms of sleep disorders. Sleep 25:643–647

    PubMed  Google Scholar 

  9. Shiri R, Koskimaki J, Hakama M, Hakkinen J, Tammela TL, Huhtala H et al (2003) Effect of chronic diseases on incidence of erectile dysfunction. Urology 62:1097–1102 doi:10.1016/j.urology.2003.07.001

    Article  PubMed  Google Scholar 

  10. Fedele D, Bortolotti A, Coscelli C, Santeusanio F, Chatenoud L, Colli E et al (2000) Erectile dysfunction in type 1 and type 2 diabetics in Italy. On behalf of Gruppo Italiano Studio Deficit Erettile nei Diabetici. Int J Epidemiol 29:524–531 doi:10.1093/ije/29.3.524

    Article  CAS  PubMed  Google Scholar 

  11. Klein R, Klein BE, Lee KE, Moss SE, Cruickshanks KJ (1996) Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 19:135–141 doi:10.2337/diacare.19.2.135

    Article  CAS  PubMed  Google Scholar 

  12. Jensen J, Lendorf A, Stimpel H, Frost J, Ibsen H, Rosenkilde P (1999) The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens 12:271–275 doi:10.1016/S0895-7061(98)00225-8

    Article  CAS  PubMed  Google Scholar 

  13. Karadag F, Ozcan H, Karul AB, Ceylan E, Cildag O (2007) Correlates of erectile dysfunction in moderate-to-severe chronic obstructive pulmonary disease patients. Respirology 12:248–253 doi:10.1111/j.1440-1843.2006.01042.x

    Article  PubMed  Google Scholar 

  14. Naya Y, Mizutani Y, Ochiai A, Soh J, Kawauchi A, Fujito A et al (2003) Preliminary report of association of chronic diseases and erectile dysfunction in middle-aged men in Japan. Urology 62:532–536 doi:10.1016/S0090-4295(03)00383-2

    Article  PubMed  Google Scholar 

  15. Karacan I, Karatas M (1995) Erectile dysfunction in sleep apnea and response to CPAP. J Sex Marital Ther 21:239–247

    CAS  PubMed  Google Scholar 

  16. Fanfulla F, Malaguti S, Montagna T, Salvini S, Bruschi C, Crotti P et al (2000) Erectile dysfunction in men with obstructive sleep apnea: an early sign of nerve involvement. Sleep 23:775–781

    CAS  PubMed  Google Scholar 

  17. Grunstein RR, Handelsman DJ, Lawrence SJ, Blackwell C, Caterson ID, Sullivan CE (1989) Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J Clin Endocrinol Metab 68:352–358

    Article  CAS  PubMed  Google Scholar 

  18. Hirshkowitz M, Karacan I, Gurakar A, Williams RL (1989) Hypertension, erectile dysfunction, and occult sleep apnea. Sleep 12:223–232

    CAS  PubMed  Google Scholar 

  19. Melman A, Gingell JC (1999) The epidemiology and pathophysiology of erectile dysfunction. J Urol 161:5–11 doi:10.1016/S0022-5347(01)62045-7

    Article  CAS  PubMed  Google Scholar 

  20. Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC (1977) Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern Med 137:296–300 doi:10.1001/archinte.137.3.296

    Article  CAS  PubMed  Google Scholar 

  21. Teloken PE, Smith EB, Lodowsky C, Freedom T, Mulhall JP (2006) Defining association between sleep apnea syndrome and erectile dysfunction. Urology 67:1033–1037 doi:10.1016/j.urology.2005.11.040

    Article  PubMed  Google Scholar 

  22. Schmidt HS, Wise HA 2nd (1981) Significance of impaired penile tumescence and associated polysomnographic abnormalities in the impotent patient. J Urol 126:348–352

    CAS  PubMed  Google Scholar 

  23. Bassiri AG, Guilleminault C (2000) Clinical features and evaluation of obstructive sleep apnea–hypopnea syndrome. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Saunders, Philadelphia, pp 869–878

    Google Scholar 

  24. Margel D, Cohen M, Livne PM, Pillar G (2004) Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology 63:545–549 doi:10.1016/j.urology.2003.10.016

    Article  PubMed  Google Scholar 

  25. Pressman MR, DiPhillipo MA, Kendrick JI, Conroy K, Fry JM (1986) Problems in the interpretation of nocturnal penile tumescence studies: disruption of sleep by occult sleep disorders. J Urol 136:595–598

    CAS  PubMed  Google Scholar 

  26. Levine FJ, Greenfield AJ, Goldstein I (1990) Arteriographically determined occlusive disease within the hypogastric-cavernous bed in impotent patients following blunt perineal and pelvic trauma. J Urol 144:1147–1153

    CAS  PubMed  Google Scholar 

  27. Aizenberg D, Zemishlany Z, Dorfman-Etrog P, Weizman A (1995) Sexual dysfunction in male schizophrenic patients. J Clin Psychiatry 56:137–141

    CAS  PubMed  Google Scholar 

  28. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB (1998) The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 60:458–465

    CAS  PubMed  Google Scholar 

  29. Rajfer J, Rosciszewski A, Mehringer M (1988) Prevalence of corporeal venous leakage in impotent men. J Urol 140:69–71

    CAS  PubMed  Google Scholar 

  30. Shabsigh R, Klein LT, Seidman S, Kaplan SA, Lehrhoff BJ, Ritter JS (1998) Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 52:848–852 doi:10.1016/S0090-4295(98)00292-1

    Article  CAS  PubMed  Google Scholar 

  31. Wolfe MM (1979) Impotence on cimetidine treatment. N Engl J Med 300:94

    CAS  PubMed  Google Scholar 

  32. Lue TF (2000) Erectile dysfunction. N Engl J Med 342:1802–1813 doi:10.1056/NEJM200006153422407

    Article  CAS  PubMed  Google Scholar 

  33. Rowland DL, Greenleaf W, Mas M, Myers L, Davidson JM (1989) Penile and finger sensory thresholds in young, aging, and diabetic males. Arch Sex Behav 18:1–12 doi:10.1007/BF01579287

    Article  CAS  PubMed  Google Scholar 

  34. Kaiser FE, Viosca SP, Morley JE, Mooradian AD, Davis SS, Korenman SG (1988) Impotence and aging: clinical and hormonal factors. J Am Geriatr Soc 36:511–519

    CAS  PubMed  Google Scholar 

  35. Christ GJ, Maayani S, Valcic M, Melman A (1990) Pharmacological studies of human erectile tissue: characteristics of spontaneous contractions and alterations in alpha-adrenoceptor responsiveness with age and disease in isolated tissues. Br J Pharmacol 101:375–381

    CAS  PubMed  Google Scholar 

  36. Larsen SH, Wagner G, Heitmann BL (2007) Sexual function and obesity. Int J Obes Lond 31:1189–1198 doi:10.1038/sj.ijo.0803604

    Article  CAS  PubMed  Google Scholar 

  37. Juenemann KP, Lue TF, Luo JA, Benowitz NL, Abozeid M, Tanagho EA (1987) The effect of cigarette smoking on penile erection. J Urol 138:438–441

    CAS  PubMed  Google Scholar 

  38. Rosen MP, Greenfield AJ, Walker TG, Grant P, Dubrow J, Bettmann MA et al (1991) Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastric-cavernous arterial bed of men with arteriogenic impotence. J Urol 145:759–763

    CAS  PubMed  Google Scholar 

  39. Miller NS, Gold MS (1988) The human sexual response and alcohol and drugs. J Subst Abuse Treat 5:171–177 doi:10.1016/0740-5472(88)90006-2

    Article  CAS  PubMed  Google Scholar 

  40. Saenz de Tejada I, Goldstein I, Azadzoi K, Krane RJ, Cohen RA (1989) Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl J Med 320:1025–1030

    Article  CAS  PubMed  Google Scholar 

  41. Nogues MA, Starkstein S, Davalos M, Berthier M, Leiguarda R, Garcia H (1991) Cardiovascular reflexes and pudendal evoked responses in chronic haemodialysis patients. Funct Neurol 6:359–365

    CAS  PubMed  Google Scholar 

  42. Pugh LG (1962) Physiological and medical aspects of the Himalayan scientific and mountaineering expedition, 1960–61. BMJ 2:621–627

    Article  CAS  PubMed  Google Scholar 

  43. Goncalves MA, Guilleminault C, Ramos E, Palha A, Paiva T (2005) Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment. Sleep Med 6:333–339 doi:10.1016/j.sleep.2005.03.001

    Article  CAS  PubMed  Google Scholar 

  44. Granata AR, Rochira V, Lerchl A, Marrama P, Carani C (1997) Relationship between sleep-related erections and testosterone levels in men. J Androl 18:522–527

    CAS  PubMed  Google Scholar 

  45. Gambineri A, Pelusi C, Pasquali R (2003) Testosterone levels in obese male patients with obstructive sleep apnea syndrome: relation to oxygen desaturation, body weight, fat distribution and the metabolic parameters. J Endocrinol Invest 26:493–498

    CAS  PubMed  Google Scholar 

  46. Lavie P, Herer P, Peled R, Berger I, Yoffe N, Zomer J et al (1995) Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 18:149–157

    CAS  PubMed  Google Scholar 

  47. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021 doi:10.1001/jama.284.23.3015

    Article  CAS  PubMed  Google Scholar 

  48. Luboshitzky R, Aviv A, Hefetz A, Herer P, Shen-Orr Z, Lavie L et al (2002) Decreased pituitary–gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab 87:3394–3398 doi:10.1210/jc.87.7.3394

    Article  CAS  PubMed  Google Scholar 

  49. Ware JC, Hirshkowitz M (1992) Characteristics of penile erections during sleep recorded from normal subjects. J Clin Neurophysiol 9:78–87 doi:10.1097/00004691-199201000-00009

    Article  CAS  PubMed  Google Scholar 

  50. Segraves KA, Segraves RT, Schoenberg HW (1987) Use of sexual history to differentiate organic from psychogenic impotence. Arch Sex Behav 16:125–137 doi:10.1007/BF01542066

    Article  CAS  PubMed  Google Scholar 

  51. Travison TG, Araujo AB, Kupelian V, O'Donnell AB, McKinlay JB (2007) The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab 92:549–555 doi:10.1210/jc.2006-1859

    Article  CAS  PubMed  Google Scholar 

  52. Semple PD, Beastall GH, Brown TM, Stirling KW, Mills RJ, Watson WS (1984) Sex hormone suppression and sexual impotence in hypoxic pulmonary fibrosis. Thorax 39:46–51

    Article  CAS  PubMed  Google Scholar 

  53. Semple PD, Beastall GH, Watson WS, Hume R (1981) Hypothalamic–pituitary dysfunction in respiratory hypoxia. Thorax 36:605–609

    Article  CAS  PubMed  Google Scholar 

  54. Semple PD, Beastall GH, Watson WS, Hume R (1980) Serum testosterone depression associated with hypoxia in respiratory failure. Clin Sci (Lond) 58:105–106

    CAS  Google Scholar 

  55. Mayer P, Dematteis M, Pepin JL, Wuyam B, Veale D, Vila A et al (1999) Peripheral neuropathy in sleep apnea. A tissue marker of the severity of nocturnal desaturation. Am J Respir Crit Care Med 159:213–219

    CAS  PubMed  Google Scholar 

  56. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904 doi:10.1172/JCI118235

    Article  CAS  PubMed  Google Scholar 

  57. Ziegler MG, Nelesen R, Mills P, Ancoli-Israel S, Kennedy B, Dimsdale JE (1997) Sleep apnea, norepinephrine-release rate, and daytime hypertension. Sleep 20:224–231

    CAS  PubMed  Google Scholar 

  58. Wolf J, Lewicka J, Narkiewicz K (2007) Obstructive sleep apnea: an update on mechanisms and cardiovascular consequences. Nutr Metab Cardiovasc Dis 17:233–240 doi:10.1016/j.numecd.2006.12.005

    Article  PubMed  Google Scholar 

  59. Levine L, Lenting E (1995) Use of nocturnal penile tumuscence and rigidity in the evaluation of male erectile dysfunction. In: Melman A (ed) The urologic clinics of North America. Impotence. Saunders, Philadelphia, pp 775–788

    Google Scholar 

  60. Kribbs NB, Getsy JE, Dinges DF (1994) Investigations and management of daytime sleepiness in sleep apnea. In: Saunders NA, Sullivan CE (eds) Sleep and breathing. Dekker, New York, pp 575–603

    Google Scholar 

  61. Schroder CM, O'Hara R (2005) Depression and obstructive sleep apnea (OSA). Ann Gen Psychiatry 4:13 doi:10.1186/1744-859X-4-13

    Article  PubMed  Google Scholar 

  62. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V et al (2000) Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102:2607–2610

    CAS  PubMed  Google Scholar 

  63. Christou K, Markoulis N, Moulas AN, Pastaka C, Gourgoulianis KI (2003) Reactive oxygen metabolites (ROMs) as an index of oxidative stress in obstructive sleep apnea patients. Sleep Breath 7:105–110 doi:10.1007/s11325-003-0105-9

    Article  PubMed  Google Scholar 

  64. Ip MS, Lam B, Chan LY, Zheng L, Tsang KW, Fung PC et al (2000) Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med 162:2166–2171

    CAS  PubMed  Google Scholar 

  65. Schulz R, Schmidt D, Blum A, Lopes-Ribeiro X, Lucke C, Mayer K et al (2000) Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea: response to CPAP therapy. Thorax 55:1046–1051 doi:10.1136/thorax.55.12.1046

    Article  CAS  PubMed  Google Scholar 

  66. Rakugi H, Tabuchi Y, Nakamaru M, Nagano M, Higashimori K, Mikami H et al (1990) Evidence for endothelin-1 release from resistance vessels of rats in response to hypoxia. Biochem Biophys Res Commun 169:973–977 doi:10.1016/0006-291X(90)91989-6

    Article  CAS  PubMed  Google Scholar 

  67. Santamaria JD, Prior JC, Fleetham JA (1988) Reversible reproductive dysfunction in men with obstructive sleep apnoea. Clin Endocrinol (Oxf) 28:461–470 doi:10.1111/j.1365-2265.1988.tb03680.x

    Article  CAS  Google Scholar 

  68. Yee B, Liu P, Phillips C, Grunstein R (2004) Neuroendocrine changes in sleep apnea. Curr Opin Pulm Med 10:475–481 doi:10.1097/01.mcp.0000143967.34079.27

    Article  PubMed  Google Scholar 

  69. Li F, Feng Q, Zhang X, Liu Q (2004) Treatment for erectile dysfunction patients with obstructive sleep apnea syndrome by nasal continual positive airway pressure. Zhonghua Nan Ke Xue 10:355–357

    PubMed  Google Scholar 

  70. Meston N, Davies RJ, Mullins R, Jenkinson C, Wass JA, Stradling JR (2003) Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med 254:447–454 doi:10.1046/j.1365-2796.2003.01212.x

    Article  CAS  PubMed  Google Scholar 

  71. Luboshitzky R, Lavie L, Shen-Orr Z, Lavie P (2003) Pituitary–gonadal function in men with obstructive sleep apnea. The effect of continuous positive airways pressure treatment. Neuroendocrinol Lett 24:463–467

    PubMed  Google Scholar 

  72. Margel D, Tal R, Livne PM, Pillar G (2005) Predictors of erectile function improvement in obstructive sleep apnea patients with long-term CPAP treatment. Int J Impot Res 17:186–190 doi:10.1038/sj.ijir.3901268

    Article  CAS  PubMed  Google Scholar 

  73. Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF et al (2007) Sexual function and obstructive sleep apnea–hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med 4:1153–1162 doi:10.1111/j.1743-6109.2006.00341.x

    Article  PubMed  Google Scholar 

  74. Sajkov D, Wang T, Saunders NA, Bune AJ, McEvoy RD (2002) Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med 165:152–158

    PubMed  Google Scholar 

  75. Fletcher EC (2003) Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea. Sleep 26:15–19

    PubMed  Google Scholar 

  76. Perimenis P, Karkoulias K, Konstantinopoulos A, Perimeni PP, Katsenis G, Athanasopoulos A et al (2007) Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a comparative study of their efficacy and safety and the patient’s satisfaction with treatment. Asian J Androl 9:259–264 doi:10.1111/j.1745-7262.2007.00085.x

    Article  CAS  PubMed  Google Scholar 

  77. Perimenis P, Konstantinopoulos A, Karkoulias K, Markou S, Perimeni P, Spyropoulos K (2007) Sildenafil combined with continuous positive airway pressure for treatment of erectile dysfunction in men with obstructive sleep apnea. Int Urol Nephrol 39:547–552 doi:10.1007/s11255-006-9079-4

    Article  PubMed  Google Scholar 

  78. Kiroglu AF, Bayrakli H, Yuca K, Cankaya H, Kiris M (2006) Nasal obstruction as a common side-effect of sildenafil citrate. Tohoku J Exp Med 208:251–254 doi:10.1620/tjem.208.251

    Article  CAS  PubMed  Google Scholar 

  79. Motamed M, Sandhu D, Murty GE (2003) Sildenafil and nasal obstruction. J Otolaryngol 32:259–261 doi:10.2310/7070.2003.41631

    Article  PubMed  Google Scholar 

  80. Roizenblatt S, Guilleminault C, Poyares D, Cintra F, Kauati A, Tufik S (2006) A double-blind, placebo-controlled, crossover study of sildenafil in obstructive sleep apnea. Arch Intern Med 166:1763–1767 doi:10.1001/archinte.166.16.1763

    Article  CAS  PubMed  Google Scholar 

  81. Matsumoto AM, Sandblom RE, Schoene RB, Lee KA, Giblin EC, Pierson DJ et al (1985) Testosterone replacement in hypogonadal men: effects on obstructive sleep apnoea, respiratory drives, and sleep. Clin Endocrinol (Oxf) 22:713–721 doi:10.1111/j.1365-2265.1985.tb00161.x

    Article  CAS  Google Scholar 

  82. Fink G, Sumner B, Rosie R, Wilson H, McQueen J (1999) Androgen actions on central serotonin neurotransmission: relevance for mood, mental state and memory. Behav Brain Res 105:53–68 doi:10.1016/S0166-4328(99)00082-0

    Article  CAS  PubMed  Google Scholar 

  83. Bonnet MH, Arand DL (1995) 24-Hour metabolic rate in insomniacs and matched normal sleepers. Sleep 18:581–588

    CAS  PubMed  Google Scholar 

  84. Cistulli PA, Grunstein RR, Sullivan CE (1994) Effect of testosterone administration on upper airway collapsibility during sleep. Am J Respir Crit Care Med 149:530–532

    CAS  PubMed  Google Scholar 

  85. Zhou XS, Rowley JA, Demirovic F, Diamond MP, Badr MS (2003) Effect of testosterone on the apneic threshold in women during NREM sleep. J Appl Physiol 94:101–107

    CAS  PubMed  Google Scholar 

  86. Knuth UA, Hano R, Nieschlag E (1984) Effect of flutamide or cyproterone acetate on pituitary and testicular hormones in normal men. J Clin Endocrinol Metab 59:963–969

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pulmonary and Critical Care Medicine, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, MA, USA

    Nikolaos Zias, Vishnu Bezwada & Alexandra Chroneou

  2. Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard University School of Medicine, Boston, MA, USA

    Sean Gilman

  3. Department of Pulmonary and Critical Care Medicine, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    Nikolaos Zias

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  1. Nikolaos Zias
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Correspondence to Nikolaos Zias.

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Zias, N., Bezwada, V., Gilman, S. et al. Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor?. Sleep Breath 13, 3–10 (2009). https://doi.org/10.1007/s11325-008-0212-8

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