Budweiser, S; Luigart, R; Joerres, RA; Kollert, F; Kleemann, Y; Wieland, WF; Pfeifer, M; Arzt, M
Introduction. Obstructive sleep apnea (OSA), particularly
intermittent nocturnal hypoxemia, is associated with erectile dysfunction (ED). Aim. We
investigated in patients with OSA whether continuous positive airway pressure (CPAP) therapy has
a long-term effect on sexual function, including ED, in the presence of other risk factors for
ED. Methods. Within a long-term observational design, we reassessed 401 male patients who had
been referred for polysomnography, with respect to erectile and overall sexual function. Mean +/-
standard deviation follow-up time was 36.5 +/- 3.7 months. Patients with moderate to severe ED
were stratified according to the regular use of CPAP. Main Outcome Measure. Changes of sexual
function were assessed by the 15-item International Index of Erectile Function (IIEF-15)
questionnaire, including the domains erectile function (EF), intercourse satisfaction, orgasmic
function (OF), sexual desire (SD), and overall satisfaction (OS). Results. Of the 401 patients,
91 returned a valid IIEF-15 questionnaire at follow-up. Their baseline characteristics were not
different from those of the total study group. OSA (apneahypopnea index >5/hour) had been
diagnosed in 91.2% of patients. In patients with moderate to severe ED (EF domain <17), CPAP
users (N = 21) experienced an improvement in overall sexual function (IIEF-15 summary score; P =
0.014) compared with CPAP non-users (N = 18), as well as in the subdomains OF (P = 0.012), SD (P
= 0.007), and OS (P = 0.033). Similar results were obtained in patients with poor overall sexual
dysfunction (IIEF-15 summary score <44). In patients with moderate to severe ED and low mean
nocturnal oxygen saturation (=93%, median), also the EF subdomain improved in CPAP users vs.
non-users (P = 0.047). Conclusions. These data indicate that long-term CPAP treatment of OSA and
the related intermittent hypoxia can improve or preserve sexual function in men with OSA and
moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA-
induced sexual dysfunctions. Budweiser S, Luigart R, Jorres RA, Kollert F, Kleemann Y, Wieland
WF, Pfeifer M, and Arzt M. Long-term changes of sexual function in men with obstructive sleep
apnea after initiation of continuous positive airway pressure. J Sex Med 2013;10:524-531.