Effects of Surgical vs. Nonsurgical Therapy on Erectile Dysfunction and Quality of Life in Obstructive Sleep Apnea Syndrome: A Pilot Study

Abstract

Introduction Obstructive sleep apnea syndrome (OSAS) is associated with erectile dysfunction (ED). The improvement of ED after medical therapy including continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is still controversial. Furthermore, the efficacy of surgical treatment has been little investigated. Aim The aim of this nonrandomized prospective study was to evaluate the effects of surgical (uvulopalatopharyngoplasty [UPPP]) and nonsurgical approaches (CPAP and MAD) on ED and quality of life (QOL) in OSAS. Methods OSAS patients underwent UPPP (N = 30), CPAP (N = 16), or MAD (N = 10) and completed the Korean versions of the International Index of Erectile Function questionnaire (KIIEF-5) and the Calgary Sleep Apnea Quality of Life Index (SAQLI) before and after a median of 7 months of treatment (interquartile range, 4–15 months). All patients underwent a full-night in-laboratory polysomnography at baseline and follow-up. Main Outcome Measure The main outcome measures are the KIIEF-5 and SAQLI scores. Results CPAP group showed older age, higher body mass index, and more severe OSAS than other groups. Apnea–hypopnea index and lowest oxygen saturation level improved significantly in all groups, but Epworth Sleepiness Scale score decreased significantly in UPPP and MAD groups. Significant increase of KIIEF-5 was observed in patients who underwent UPPP (P = 0.039, paired t-test), but not in nonsurgical treatment group. All groups had the tendency of better QOL after treatment, but statistical significance was found only in MAD group. Neck circumference (r = 0.360, P = 0.006) and KIIEF-5 score (r = −0.484, P < 0.001) at baseline were significantly related to the improvement of KIIEF-5. Conclusions This study demonstrated that ED in OSAS may improve following UPPP. Better disease-specific QOL was observed after both surgical and nonsurgical therapies in OSAS. These findings suggest that interventions for OSAS can provide the alleviation of ED and increase QOL in OSAS patients with ED, especially if they had pronounced complaints of ED and wide neck circumferences.

Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review

“…Shin et al compared CPAP to patients using an oral appliance or surgery with UPPP. There were mixed results with the surgical group as the only group with increased erectile function scores, while the oral appliance group had better quality of life, and all study groups had improved SaO 2 .…”

Effects of obstructive sleep apnea and its treatment over the erectile function: a systematic review

“…developed a comparative study between OSA surgical treatment with UPP and medical therapies, including CPAP and mandibular advancement devices (MADs) 77. They reported a significant improvement in the erectile function of the UPP group ( P = 0.039), but not in CPAP or MAD groups.…”

“…The three treatment arms evidenced benefit regarding the quality of life tests outcomes, but only reached statistical significance ( P = 0.040) in the MAD treated group. This paper presents important limitations, such a small sample of patients in each group (MAD: 10; CPAP: 16; UPP: 30), and bias due to the lack of randomization, which led to a different profile of severity of OSA and ED in each group with the conclusion of the relationship between the severity of ED and a better response to the treatment77 being controversial.…”

Urological Manifestations of Obstructive Sleep Apnea Syndrome: A Review of Current Literature

“…Inflammatory cytokines, chemokines, and adhesion molecules induce endothelial dysfunction [74]. Surgical and nonsurgical treatment of OSA is correlated with alleviating sexual dysfunction [75]. ED patients that were treated with continuous positive airway pressure (CPAP) saw positive improvements after three months [76].…”

“…Mandibular advancement is another surgical procedure that seems to be effective in treating OSA [75]. Surgery improves clinical outcomes, systolic blood pressure, lipid profile, and increases the number of endothelial progenitor cells, which are correlated with endothelial impairment [114].…”