Erectile dysfunction in men with obstructive sleep apnea syndrome: a randomized study of the efficacy of sildenafil and continuous positive airway pressure

Abstract

The aim of this study was to compare the efficacy of sildenafil and continuous positive airway pressure (CPAP) in men with erectile dysfunction (ED) and obstructive sleep apnea syndrome (OSAS). In all, 30 men were randomly treated for 12 weeks either with sildenafil 100 mg before intercourse (15 men) or CPAP during night time sleep (15 men). Under sildenafil, 97/180 (53.9%) of attempted intercourses were successful compared to 33/138 (23.9%) under CPAP. The mean IIEF (erectile function domain score) was 12.9 and 9.3 after sildenafil and CPAP treatment, respectively (P ¼ 0.007), compared to 7.9 and 7 at baseline. In all, 53.3% of patients were satisfied with sildenafil and 20% with CPAP for ED treatment (P ¼ 0.058). Although sildenafil was superior to CPAP, comorbidities and OSAS per se possibly resulted in a lower effectiveness of sildenafil compared to that in the general population of ED men. While about half of the patients were not satisfied even with the more effective treatment, we conclude that a combination of the two therapeutic tools or a different therapeutic mode should be studied further.

Predictors of erectile function improvement in obstructive sleep apnea patients with long-term CPAP treatment

“…20 Our findings of ED improvement with OSAS treatment are in concurrence with Karacan and Karatas', 13 which reported an improvement in a third of his patients with impaired NPT after a single night of CPAP treatment. Our findings are also in agreement with the recently published study by Perimenis et al 14 The primary outcome in their The most important finding of our study is that in 20% of patient's, long-term CPAP treatment alone helped to alleviate ED. Interestingly, the same efficacy rates were reported by Perimenis et al 14 When considering these results clinically, it becomes apparent that one of every five patients with OSAS and ED will respond to CPAP therapy.…”

“…Our findings are also in agreement with the recently published study by Perimenis et al 14 The primary outcome in their The most important finding of our study is that in 20% of patient's, long-term CPAP treatment alone helped to alleviate ED. Interestingly, the same efficacy rates were reported by Perimenis et al 14 When considering these results clinically, it becomes apparent that one of every five patients with OSAS and ED will respond to CPAP therapy. Owing to the apparently low response rate, the identification of clinically useful predictors of improvement is essential.…”

“…11,12 The treatment of OSAS by continuous positive airway pressure (CPAP) is well established. To the best of our knowledge, there are only two studies addressing the effect of CPAP on ED in patients with OSAS, 13,14 both focused only on the acute, shortterm outcome. Karacan and Karatas, 13 reported that one-third of their subjects with ED showed improved results on nocturnal penile tumescence (NPT) after a single night of treatment with CPAP.…”

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

“…However, RCTs comparing the effect of CPAP to sildenafil showed that both improved erectile function but sildenafil was superior. 147,[149][150][151] There are no RCTs that assessed the impact of CPAP on erectile dysfunction in patients with T2D but one uncontrolled study showed that CPAP for 3 months had no effect on sexual function in 35 men with T2D.…”

Obstructive sleep apnoea: a diabetologist’s perspective

“…85 Other uncontrolled/observational studies suggested beneficial effects of CPAP on ED, and RCTs showed that sildenafil was superior to CPAP for managing ED. 84,[86][87][88] Impact of CPAP on glucose metabolism, CVD and QoL CPAP improved insulin sensitivity in patients with and without T2D in non-randomised trials 89,90 and in meta-analyses, 89,91,92 especially for patients using CPAP >4 hours/night. 93 Uncontrolled studies in patients with T2D89, [94][95][96][97] showed that CPAP improves postprandial hyperglycaemia, 94 glycaemic variability 95 and/or HbA1c .…”