Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Luhao Liu MD; Ran Kang MD; Shankun Zhao MD; Tao Zhang MD; Wei Zhu MD; Ermao Li MD; Futian Li MD; Shawpong Wan MD, PhD; and ZhiGang Zhao MD, PhD

ONLINE: September 22, 2015 – The Journal of Sexual Medicine

DOI: 10.1111/jsm.12983


Introduction

Patients with obstructive sleep apnea (OSA) repeatedly stop breathing for short periods during sleep because of an obstruction in the upper airway. Affecting 5%-20% of adults, OSA impairs health-related quality of life, leading to poor sleep, fatigue, and possible sexual dysfunction.

Past studies of the relationship between OSA and sexual dysfunction have had mixed results. For example, some have found a link between OSA and erectile dysfunction (ED). Others suggest that there is no association. OSA’s effects on female sexual dysfunction (FSD) have not been widely researched.

This study is a meta-analysis intended to clarify the association of OSA and sexual dysfunction.

Materials and Methods

Pubmed, Embase, and the Cochrane Library databases were used to identify related studies published between the inception of the databases through March 2015. Sexual dysfunction was assessed using physical examinations, validated questionnaires, and clinical assessments.

After examination, nine studies were considered. In total, the studies included 1,275 participants – 681 OSA patients and 594 healthy subjects.

Five observational studies focused on the incidence of ED. The remaining four (two case-control and two cohort studies) reported incidence of FSD.

Results

Findings demonstrated that OSA was associated with ED, with an 82% increased risk of having ED if baseline OSA is present (pooled relative risk 1.82).  Similarly, FSD was two-times more likely to occur in women with OSA compared to those without. 

Discussion

This study found that rates of sexual dysfunction were higher in subjects with OSA when compared to controls. The finding was confirmed for both men and women.

Other important findings included the following:

 

They acknowledged the following limitations:

“While the current evidence was based on retrospective studies, our research strongly suggested that OSA increased the risk of sexual dysfunction in both genders,” the authors wrote.

They added, “CPAP therapy remains an important treatment modality for OSA. Given the lack of well-designed studies, larger and randomized trials with longer follow-up are warranted to further explore this relationship.”

  • Treatment with a continuous positive airway pressure (CPAP) device improved male sexual function in men with OSA. It’s possible that this treatment would have similar effects for women. One study found that men with OSA and ED treated with sildenafil were more satisfied than those treated with CPAP.
  • Psychologic, neural, hormonal, and vascular factors all contribute to sexual function. With this in mind, OSA’s effects are likely multifactorial. Potential mechanisms include:
    • Respiratory disturbances like OSA could reduce the amount of nitric oxide (NO) in the body, which may lead to sexual issues.
    • OSA, and resulting sleep interruption and sleep loss, may bring about changes in the secretory patterns of sex hormones, particularly testosterone in men.
    • Metabolic syndrome (insulin resistance, hypertension, dyslipidemia, and obesity) may also be involved in the relationship between OSA and sexual dysfunction.
  • In the future, researchers might investigate hormonal changes that might occur related to OSA.

“Our results suggest that it is important to recognize the adverse effects of OSA on the sexual function,” the authors noted.

  • There was an “unavoidable” heterogeneity between the different studies.
  • Confounding factors may influence the results.
  • This analysis was restricted to studies written in English. Works in other languages might provide different insights.

“While the current evidence was based on retrospective studies, our research strongly suggested that OSA increased the risk of sexual dysfunction in both genders,” the authors wrote.

They added, “CPAP therapy remains an important treatment modality for OSA. Given the lack of well-designed studies, larger and randomized trials with longer follow-up are warranted to further explore this relationship.”