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Abstract

Obstructive sleep apnea is highly prevalent in patients with erectile dysfunction, and the mechanisms implicated in this association appear to be very complex. The causation and the dose-response manner of the relationship between severity of obstructive sleep apnea and known risk factors predisposing to the development of erectile dysfunction has been suggested in multiple studies. Line of evidence linked OSA to obesity, hypertension, type 2 diabetes, and cerebrovascular and coronary diseases, all of which are tightly related to the aggravated erectile function. However, a direct negative influence of unhandled sleep-disordered breathing on ED should not be disregarded. Since these data are further enhanced by evidence showing advantageous effects of CPAP therapy on erectile performance in patients with OSA, the elimination of sleep apnea may constitute an important strategy in the management of these patients.

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References

  1. 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

    Article  CAS  PubMed  Google Scholar 

  2. American Academy of Sleep Medicine (2005) International classification of sleep disorders, 2nd edn. Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine

    Google Scholar 

  3. Young T, Palta M, Dempsey J et al (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  4. Logan AG, Perlikowski SM, Mente A et al (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001(19):2271–2277

    Article  Google Scholar 

  5. Grote L, Hedner J, Grunstein R et al (2000) Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder. Eur Respir J 16:921–927

    Article  CAS  PubMed  Google Scholar 

  6. Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF, Sleep Heart Health Study Research Group (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 154:50–59

    Article  CAS  PubMed  Google Scholar 

  7. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, McKinlay JB (2000) Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 30:328–338

    Article  CAS  PubMed  Google Scholar 

  8. Hammoud AO, Gibson M, Peterson CM, Hamilton BD, Carrell DT (2006) Obesity and male reproductive potential. J Androl 27:619–626

    Article  PubMed  Google Scholar 

  9. Wolk R, Shamsuzzaman AS, Somers VK (2003) Obesity, sleep apnea, and hypertension. Hypertension 42:1067–1074

    Article  CAS  PubMed  Google Scholar 

  10. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  CAS  PubMed  Google Scholar 

  11. Baud MO, Magistretti PJ, Petit JM (2013) Sustained sleep fragmentation affects brain temperature, food intake and glucose tolerance in mice. J Sleep Res 22:3–12

    Article  PubMed  Google Scholar 

  12. Calvin AD, Carter RE, Adachi T, Macedo PG, Albuquerque FN, van der Walt C, Bukartyk J, Davison DE, Levine JA, Somers VK (2013) Effects of experimental sleep restriction on caloric intake and activity energy expenditure. Chest 144:79–86

    Article  PubMed Central  PubMed  Google Scholar 

  13. Phillips BG, Kato M, Narkiewicz K et al (2000) Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol 279:H234–H237

    CAS  Google Scholar 

  14. Patel SR, Palmer LJ, Larkin EK et al (2004) Relationship between obstructive sleep apnea and diurnal leptin rhythms. Sleep 27:206–210

    Google Scholar 

  15. Sánchez-de-la-Torre M, Mediano O, Barceló A, Piérola J, de la Peña M, Esquinas C, Miro A, Durán-Cantolla J, Agustí AG, Capote F, Marin JM, Montserrat JM, García-Río F, Barbé F (2012) The influence of obesity and obstructive sleep apnea on metabolic hormones. Sleep Breath 16:649–656

    Article  PubMed  Google Scholar 

  16. Dobrosielski DA, Patil SP (2013) Weight loss and obstructive sleep apnea: what lies AHEAD? SLEEP 36:627–629

    PubMed Central  PubMed  Google Scholar 

  17. Esposito KG, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F, D’Armiento M, Giugliano D (2004) Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 291:2978–2984

    Article  CAS  PubMed  Google Scholar 

  18. Despres JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444:881–887

    Article  CAS  PubMed  Google Scholar 

  19. Hermans MP, Ahn SA, Rousseau MF (2009) Erectile dysfunction, microangiopathy and UKPDS risk in type 2 diabetes. Diabetes Metab 35:484–489

    Article  PubMed  Google Scholar 

  20. Resnick HE, Redline S, Shahar E, Gilpin A, Newman A, Walter R, Ewy GA, Howard BV, Punjabi NM, Sleep Heart Health Study (2003) Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 26:702–709

    Article  PubMed  Google Scholar 

  21. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FX, Darcey V, Kuna ST, Sleep AHEAD Research Group (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019

    Article  PubMed Central  PubMed  Google Scholar 

  22. Pillai A, Warren G, Gunathilake W, Idris I (2011) Effects of sleep apnea severity on glycemic control in patients with type 2 diabetes prior to continuous positive airway pressure treatment. Diabetes Technol Ther 13:945–949

    Article  PubMed  Google Scholar 

  23. Dawson A, Abel SL, Loving RT, Dailey G, Shadan FF, Cronin JW, Kripke DF, Kline LE (2008) CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med 4:538–542

    PubMed Central  PubMed  Google Scholar 

  24. Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T (2005) Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 165:447–452

    Google Scholar 

  25. Lavie P, Herer P, Hoffstein V (2000) Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 320:479–482

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Peppard PE, Young T, Palta M et al (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1784

    Article  CAS  PubMed  Google Scholar 

  27. Nieto FJ, Young TB, Lind BK et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283:1829–1836

    Article  CAS  PubMed  Google Scholar 

  28. Calhoun DA (2010) Obstructive sleep apnea and hypertension. Curr Hypertens Rep 12:189–195

    Article  PubMed  Google Scholar 

  29. Logan AG, Perlikowski SM, Mente A et al (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 19:2271–2277

    Article  CAS  PubMed  Google Scholar 

  30. Lloberes P, Lozano L, Sampol G et al (2010) Obstructive sleep apnoea and 24-h blood pressure in patients with resistant hypertension. J Sleep Res 19:597–602

    Article  PubMed  Google Scholar 

  31. Pedrosa RP, Drager LF, Gonzaga CC et al (2011) Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 58:811–817

    Article  CAS  PubMed  Google Scholar 

  32. Brooks D, Horner RL, Kozar LF et al (1997) Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. J Clin Invest 99:106–109

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, Narkiewicz K, Minuz P (2013) Effect of continuous positive airway pressure (CPAP) on blood pressure in patients with obstructive sleep apnea/hypopnea. A systematic review and meta-analysis (2014). Chest 145:762–771

    Google Scholar 

  34. Wilcox I, Grunstein RR, Hedner JA et al (1993) Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea. Sleep 16:539–544

    CAS  PubMed  Google Scholar 

  35. Faccenda JF, Mackay TW, Boon NA et al (2001) Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 163:344–348

    Article  CAS  PubMed  Google Scholar 

  36. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N et al (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359:204–210

    Article  PubMed  Google Scholar 

  37. Shahar E, Whitney CW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    Article  CAS  PubMed  Google Scholar 

  38. Peker Y, Kraiczi H, Hedner J et al (1999) An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J 13:179–184

    Article  Google Scholar 

  39. Peker Y, Hedner J, Kraiczi H et al (2000) Respiratory disturbance index – an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med 162:81–86

    Article  CAS  PubMed  Google Scholar 

  40. Guilleminault C, Connolly SJ, Winkle RA (1983) Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 52:490–494

    Article  CAS  PubMed  Google Scholar 

  41. Gami AS, Pressman G, Caples SM et al (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110:364–367

    Article  PubMed  Google Scholar 

  42. Mehra R, Benjamin EJ, Sahar E et al (2006) Association of nocturnal arrhythmias with sleep-disordered breathing. The Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–916

    Article  PubMed Central  PubMed  Google Scholar 

  43. Kanagala R, Murali NS, Friedman PA et al (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107:2589–2594

    PubMed  Google Scholar 

  44. Szymański FM, Puchalski B, Filipiak KJ (2013) Obstructive sleep apnea, atrial fibrillation, and erectile dysfunction: are they only coexisting conditions or a new clinical syndrome? The concept of the OSAFED syndrome. Pol Arch Med Wewn 123:701–707

    PubMed  Google Scholar 

  45. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041

    Article  CAS  PubMed  Google Scholar 

  46. Martinez-Garcia MA, Galiano-Blancart R, Roman-Sanchez P et al (2005) Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest 128:2123–2129

    Article  PubMed  Google Scholar 

  47. Johnson CB, Beanlands RS, Yoshinaga K et al (2008) Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure. Can J Cardiol 24:697–704

    Article  PubMed Central  PubMed  Google Scholar 

  48. Wittert G (2014) The relationship between sleep disorders and testosterone in men. Asian J Androl 16:262–265

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, de Bont LG (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

    Article  PubMed  Google Scholar 

  50. Bratel T, Wennlund A, Carlström K (1999) Pituitary reactivity, androgens and catecholamines in obstructive sleep apnoea. Effects of continuous positive airway pressure treatment (CPAP). Respir Med 93:1–7

    Article  CAS  PubMed  Google Scholar 

  51. 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. Neuro Endocrinol Lett 24:463–467

    PubMed  Google Scholar 

  52. 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 

  53. Knapp A, Myhill PC, Davis WA, Peters KE, Hillman D, Hamilton EJ, Lim EM, Davis TM (2014) Effect of continuous positive airway pressure therapy on sexual function and serum testosterone in males with type 2 diabetes and obstructive sleep apnoea. Clin Endocrinol (Oxf) 81:254–258

    Google Scholar 

  54. Budweiser S, Enderlein S, Jörres RA, Hitzl AP, Wieland WF, Pfeifer M, Arzt M (2009) Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med 6:3147–3157

    Article  PubMed  Google Scholar 

  55. Taskin U, Yigit O, Acioglu E, Aricigil M, Toktas G, Guzelhan Y (2010) Erectile dysfunction in severe sleep apnea patients and response to CPAP. Int J Impot Res 22:134–139

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  57. Reishtein JL, Maislin G, Weaver TE, Multisite Study group (2010) Outcome of CPAP treatment on intimate and sexual relationships in men with obstructive sleep apnea. J Clin Sleep Med 6:221–226

    PubMed Central  PubMed  Google Scholar 

  58. 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

    Article  PubMed  Google Scholar 

  59. Gonçalves 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

    Article  PubMed  Google Scholar 

  60. Carlson JT, Rangemark C, Hedner JA (1996) Attenuated endothelium-dependent vascular relaxation in patients with sleep apnoea. J Hypertens 14:577–584

    Article  CAS  PubMed  Google Scholar 

  61. Kraiczi H, Caidahl K, Samuelsson A et al (2001) Impairment of vascular endothelial function and left ventricular filling. Association with the severity of apnea-induced hypoxemia during sleep. Chest 119:1085–1091

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  63. Bayram NA, Ciftci B, Keles T et al (2009) Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment. Sleep 32:1257–1263

    PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  65. Phillips BG, Narkiewicz K, Pesek CA et al (1999) Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens 17:61–66

    Article  CAS  PubMed  Google Scholar 

  66. Jordan W, Reinbacher A, Cohrs S et al (2005) Obstructive sleep apnea: Plasma endothelin-1 precursor but not endothelin-1 levels are elevated and decline with nasal continuous positive airway pressure. Peptides 26:1654–1660

    Article  CAS  PubMed  Google Scholar 

  67. Gjørup PH, Sadauskiene L, Wessels J et al (2007) Abnormally increased endothelin-1 in plasma during the night in obstructive sleep apnea: relation to blood pressure and severity of disease. Am J Hypertens 20:44–52

    Article  PubMed  Google Scholar 

  68. Moller DS, Lind P, Strunge B et al (2003) Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens 16:274–280

    Article  CAS  PubMed  Google Scholar 

  69. Calhoun DA, Nishizaka MK, Zaman MA et al (2004) Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest 125:112–117

    Article  CAS  PubMed  Google Scholar 

  70. Shamsuzzaman AS, Winnicki M, Lanfranchi P et al (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464

    Article  CAS  PubMed  Google Scholar 

  71. Kokturk O, Ciftci TU, Mollarecep E et al (2005) Elevated C-reactive protein levels and increased cardiovascular risk in patients with obstructive sleep apnea syndrome. Int Heart J 46:801–809

    Article  CAS  PubMed  Google Scholar 

  72. Yokoe T, Minoguchi K, Matsuo H et al (2003) Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 107:1129–1134

    Article  CAS  PubMed  Google Scholar 

  73. Budweiser S, Luigart R, Jörres RA, Kollert F, Kleemann Y, Wieland WF, Pfeifer M, Arzt M (2013) Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. J Sex Med 10:524–531

    Article  PubMed  Google Scholar 

  74. 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

    Article  CAS  PubMed  Google Scholar 

  75. Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA): how many adhere to treatment? (2013) Harefuah 152:140–144. Abstract

    Google Scholar 

  76. Bostrom KB, Hedner J, Melander O et al (2007) Interaction between the angiotensin-converting enzyme gene insertion/deletion polymorphism and obstructive sleep apnoea as a mechanism for hypertension. J Hypertens 25:779–783

    Article  PubMed  Google Scholar 

  77. Younes M, Ostrowski M, Thompson W et al (2001) Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 163:1181–1190

    Article  CAS  PubMed  Google Scholar 

  78. Xie A, Bedekar A, Skatrud JB et al (2011) The heterogeneity of obstructive sleep apnea (predominant obstructive vs pure obstructive apnea). Sleep 34:745–750

    PubMed Central  PubMed  Google Scholar 

  79. Kapur VK, Resnick HE, Gottlieb DJ (2008) Sleep disordered breathing and hypertension: does self-reported sleepiness modify the association? Sleep 31:1127–1132

    PubMed Central  PubMed  Google Scholar 

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Wolf, J., Narkiewicz, K. (2015). Erectile Dysfunction and Sleep Apnea. In: Viigimaa, M., Vlachopoulos, C., Doumas, M. (eds) Erectile Dysfunction in Hypertension and Cardiovascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-08272-1_11

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