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1.
J Sex Med ; 12(2): 405-15, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25496437

RESUMO

INTRODUCTION: Erectile dysfunction (ED) is frequent in patients with obstructive sleep apnea (OSA) and may act as a surrogate of endothelial dysfunction. Furthermore, impairments of vigilance and sustained attention are also commonly associated with OSA. AIM: The purpose of this study was to evaluate whether there is an association between ED and sustained attention deficits. METHODS: A prospective cross-sectional cohort of 401 male in-patients undergoing diagnostic polysomnography for suspected OSA and a 25-minute sustained attention test was analyzed. ED was assessed using the 15-item International Index of Erectile Function (IIEF-15) questionnaire. The Epworth Sleepiness Scale (ESS) served as a measure of daytime sleepiness. MAIN OUTCOME MEASURE: Severity of impaired erectile function (EF) assessed by the IIEF-15, core task parameters of the sustained attention test (i.e., CR: correct reactions; V-CR: variation of correct reactions, CE: commission errors, RT: reaction time; V-RT: variation of reaction times). RESULTS: Three hundred eighty-one consecutive patients presenting for in-lab polysomnography were included in the analysis. Impaired EF was diagnosed in 246 patients (65%). With increasing impairment of EF, patients scored significantly worse in all vigilance test parameters and demonstrated more severely diminished vigilance (normal EF: 11.9%, moderately impaired EF: 24.1%, and severely impaired EF: 34.9%). Multivariate regression analyses including established risk factors for ED, OSA, or sleepiness revealed a significant independent association between lower scores for EF and impairments on the following vigilance test variables: odds ratio (95% confidence interval) for V-CR: 0.52 (0.34-0.81), CE: 0.87 (0.80-0.95), and V-RT: 0.91 (0.87-0.96). The ESS was independently associated with both measures of performance instability: odds ratio for V-CR: 6.94 (2.97-16.23) and V-RT: 1.28 (1.14-1.44). CONCLUSIONS: In OSA patients, the severity of impaired EF was associated with impaired vigilance performance, independent of other known risk factors for ED or OSA and not mediated by sleepiness. Potentially, the findings suggest a direct relationship between vascular or endothelial dysfunction and impairments in both EF and neurobehavioral cognitive function.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Distúrbios do Sono por Sonolência Excessiva/complicações , Disfunção Erétil/etiologia , Apneia Obstrutiva do Sono/complicações , Idoso , Atenção , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Estudos Transversais , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polissonografia , Estudos Prospectivos , Tempo de Reação , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/fisiopatologia , Inquéritos e Questionários
2.
J Sex Med ; 10(2): 524-31, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23088487

RESUMO

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 (apnea-hypopnea 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.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Disfunção Erétil/terapia , Comportamento Sexual , Disfunções Sexuais Fisiológicas/terapia , Apneia Obstrutiva do Sono/terapia , Idoso , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/psicologia , Estudos Transversais , Disfunção Erétil/epidemiologia , Disfunção Erétil/psicologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/psicologia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/psicologia , Estatística como Assunto , Inquéritos e Questionários , Resultado do Tratamento
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