Is Continuous Positive Airway Pressure a Valid Alternative to Sildenafil in Treating Sexual Dysfunction among OSA Patients? A Systematic Review and Meta-Analysis.
[en] Background and Objectives: This study aimed to assess the comparative effectiveness of continuous positive airway pressure (CPAP) therapy and sildenafil pharmacological therapy in improving sexual function among patients with obstructive sleep apnea (OSA) and erectile dysfunction (ED). Materials and methods: Population: Patients affected by OSA and ED; Intervention: CPAP therapy vs. Comparison: Sildenafil pharmacological therapy; Outcomes: Improvement in erectile function, as measured by the International Index of Erectile Function 5 (IIEF-5) scoring system; Time: A systematic review of the literature from the past 20 years; Study Design: Observational studies comparing erectile function improvements after OSA treatment. Results: A total of eight papers were included in the qualitative summary, involving four hundred fifty-seven patients with ED and OSA. Erectile function improvements were observed in both treatment groups. After sildenafil and CPAP treatment, the mean IIEF-5 domain scores were 37.7 and 27.3, respectively (p < 0.001). Sildenafil 100 mg demonstrated a higher therapeutic impact compared to CPAP treatment. Conclusions: CPAP therapy significantly improved sexual parameters in most studies for OSA patients with ED. The findings suggest that CPAP therapy effectively alleviates erectile dysfunction symptoms, resulting in improved sexual performance in OSA patients. The comparison of the two treatments indicates that sildenafil has a more substantial therapeutic impact on erectile function than CPAP therapy; however, a combined treatment will provide a cumulative effect.
Disciplines :
Otolaryngology
Author, co-author :
Stilo, Giovanna; Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
Vicini, Claudio; Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy
Pollicina, Isabella; Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
Maniaci, Antonino ; Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy ; Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
Lechien, Jérome ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Educatio > Service de Métrologie et Sciences du langage
Calvo-Henríquez, Christian ; Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France ; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
Yáñez, Miguel Mayo ; Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France ; Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
Iannella, Giannicola ; Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France ; Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
Pace, Annalisa ; Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy
Cammaroto, Giovanni ; Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy ; Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
Meccariello, Giuseppe; Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy
Cannavicci, Angelo ; Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy ; Research Committee Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 75000 Paris, France
Moffa, Antonio ; Unit of Otolaryngology, University Campus Bio-Medico, 00185 Rome, Italy
Casale, Manuele; Unit of Otolaryngology, University Campus Bio-Medico, 00185 Rome, Italy
La Mantia, Ignazio; Department of Medical and Surgical Sciences and Advance and Echnologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
Is Continuous Positive Airway Pressure a Valid Alternative to Sildenafil in Treating Sexual Dysfunction among OSA Patients? A Systematic Review and Meta-Analysis.
Publication date :
17 July 2023
Journal title :
Medicina
ISSN :
1010-660X
eISSN :
1648-9144
Publisher :
Multidisciplinary Digital Publishing Institute (MDPI), Switzerland
Sforza E. Roche F. Chronic intermittent hypoxia and obstructive sleep apnea: An experimental and clinical approach Hypoxia 2016 4 99 108 10.2147/HP.S103091 27800512
May A.M. Van Wagoner D.R. Mehra R. OSA and Cardiac Arrhythmogenesis: Mechanistic Insights Chest 2017 151 225 241 10.1016/j.chest.2016.09.014 27693594
Ramar K. Caples S.M. Vascular changes, cardiovascular disease and obstructive sleep apnea Future Cardiol. 2011 7 241 249 10.2217/fca.10.123 21453030
Pollicina I. Maniaci A. Lechien J.R. Iannella G. Vicini C. Cammaroto G. Cannavicci A. Magliulo G. Pace A. Cocuzza S. et al. Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art Behav. Sci. 2021 11 180 10.3390/bs11120180
Lisan Q. van Sloten T. Boutouyrie P. Laurent S. Danchin N. Thomas F. Guibout C. Perier M.C. Dagnelie P. Henry R.M. et al. Sleep Apnea is Associated with Accelerated Vascular Aging: Results From 2 European Community-Based Cohort Studies J. Am. Heart Assoc. 2021 10 e021318 10.1161/JAHA.120.021318
Trzepizur W. Martinez M.C. Priou P. Andriantsitohaina R. Gagnadoux F. Microparticles and vascular dysfunction in obstructive sleep apnoea Eur. Respir. J. 2014 44 207 216 10.1183/09031936.00197413
Feldman H.A. Johannes C.B. Derby C.A. Kleinman K.P. Mohr B.A. Araujo A.B. McKinlay J.B. Erectile dysfunction and coronary risk factors: Prospective results from the Massachusetts male aging study Prev. Med. 2000 30 328 338 10.1006/pmed.2000.0643
Fanfulla F. Malaguti S. Montagna T. Salvini S. Bruschi C. Crotti P. Casale R. Rampulla C. Erectile dysfunction in men with obstructive sleep apnea: An early sign of nerve involvement Sleep 2000 23 775 781 10.1093/sleep/23.6.1e
Margel D. Cohen M. Livne P.M. Pillar G. Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction Urology 2004 63 545 549 10.1016/j.urology.2003.10.016
Maspero C. Giannini L. Galbiati G. Rosso G. Farronato G. Obstructive sleep apnea syndrome: A literature review Minerva Stomatol 2015 64 97 109
Arnaud C. Bochaton T. Pépin J.L. Belaidi E. Obstructive sleep apnoea and cardiovascular consequences: Pathophysiological mechanisms Arch. Cardiovasc. Dis. 2020 113 350 358 10.1016/j.acvd.2020.01.003 32224049
Peppard P.E. Young T. Palta M. Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension N. Engl. J. Med. 2000 342 1378 1384 10.1056/NEJM200005113421901
Yang E.H. Hla K.M. McHorney C.A. Havighurst T. Badr M.S. Weber S. Sleep apnea and quality of life Sleep 2000 23 535 541 10.1093/sleep/23.4.1g 10875560
İrer B. Çelikhisar A. Çelikhisar H. Bozkurt O. Demir Ö. Evaluation of Sexual Dysfunction, Lower Urinary Tract Symptoms and Quality of Life in Men with Obstructive Sleep Apnea Syndrome and the Efficacy of Continuous Positive Airway Pressure Therapy Urology 2018 121 86 92 10.1016/j.urology.2018.08.001
Mittleman M.A. Carrier S. Seftel A.D. Cardiovascular outcomes among sildenafil users: Results of the International Men’s Health Study J. Sex. Med. 2014 11 880 884 10.1111/jsm.12512 24697855
Li X. Dong Z. Wan Y. Wang Z. Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: A meta-analysis Aging Male 2010 13 82 86 10.3109/13685530903406789
Maniaci A. Di Luca M. Lechien J.R. Iannella G. Grillo C. Grillo C.M. Merlino F. Calvo-Henriquez C. De Vito A. Magliulo G. et al. Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: Systematic review and meta-analysis Sleep Breath. 2022 2022 1539 1550 10.1007/s11325-021-02520-y
Higgins J.P.T. Thomas J. Chandler J. Cumpston M. Li T. Page M.J. Welch V.A. Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 Cochrane Hoboken, NJ, USA 2021 Available online: www.training.cochrane.org/handbook (accessed on 1 June 2023)
Moola S. Munn Z. Sears K. Sfetcu R. Currie M. Lisy K. Tufanaru C. Qureshi R. Mattis P. Mu P. Conducting systematic reviews of association (etiology): The Joanna Briggs Institute’s approach Int. J. Evid. Based Healthc. 2015 13 163 169 10.1097/XEB.0000000000000064
Perimenis P. Karkoulias K. Konstantinopoulos A. Perimeni P.P. Katsenis G. Athanasopoulos A. Spyropoulos K. Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: A comparative study of their efficacy and safety and the patient’s satisfaction with treatment Asian J. Androl. 2007 9 259 264 10.1111/j.1745-7262.2007.00085.x
Perimenis P. Karkoulias K. Markou S. Gyftopoulos K. Athanasopoulos A. Barbalias G. Kiriazopoulou V. Spiropoulos K. Erectile dysfunction in men with obstructive sleep apnea syndrome: A randomized study of the efficacy of sildenafil and continuous positive airway pressure Int. J. Impot. Res. 2004 16 256 260 10.1038/sj.ijir.3901219
Khafagy A.H. Khafagy A.H. Treatment of obstructive sleep apnoea as a therapeutic modality for associated erectile dysfunction Int. J. Clin. Pract. 2012 66 1204 1208 10.1111/j.1742-1241.2012.02990.x 23163500
Taskin U. Yigit O. Acioglu E. Aricigil M. Toktas G. Guzelhan Y. Erectile dysfunction in severe sleep apnea patients and response to CPAP Int. J. Impot. Res. 2010 22 134 139 10.1038/ijir.2009.54 19940853
Pastore A.L. Palleschi G. Ripoli A. Silvestri L. Maggioni C. Pagliuca G. Nobili Benedetti F.M. Gallo A. Zucchi A. Maurizi A. et al. Severe obstructive sleep apnoea syndrome and erectile dysfunction: A prospective randomised study to compare sildenafil vs. nasal continuous positive airway pressure Int. J. Clin. Pract. 2014 68 995 1000 10.1111/ijcp.12463 24852701
Pascual M. de Batlle J. Barbé F. Castro-Grattoni A.L. Auguet J.M. Pascual L. Vilà M. Cortijo A. Sánchez-de-la-Torre M. Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of Continuous Positive Airway Pressure (CPAP) PLoS ONE 2018 13 e0201930 10.1371/journal.pone.0201930
Coban S. Gunes A. Gul A. Turkoglu A.R. Guzelsoy M. Ozturk M. Akyuz O. Ekici O. Can continuous positive airway pressure improve lower urinary tract symptoms and erectile dysfunction in male patients with severe obstructive sleep apnea syndrome? Investig. Clin. Urol. 2020 61 607 612 10.4111/icu.20200105
Husnu T. Ersoz A. Bulent E. Tacettin O. Remzi A. Bulent A. Aydin M. Obstructive sleep apnea syndrome and erectile dysfunction: Does long term continuous positive airway pressure therapy improve erections? Afr. Health Sci. 2015 15 171 179 10.4314/ahs.v15i1.23
Clerget A. Kanbar A. Abdessater M. Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review Prog. Urol. 2020 30 1069 1077 10.1016/j.purol.2020.07.244
Di Bello F. Napolitano L. Abate M. Ruvolo C.C. Morra S. Califano G. Capece M. Creta M. Scandurra C. Muzii B. et al. Nocturia and obstructive sleep apnea syndrome: A systematic review Sleep Med. Rev. 2023 69 101787 10.1016/j.smrv.2023.101787
