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Most men with erectile dysfunction (ED) had undiagnosed sleep apnea in a single-center study from India.

Some 65% of men seeking treatment for erectile dysfunction also had obstructive sleep apnea (OSA), reported Sujith Jose, MBBS, MS, of the Government Medical College in Kozhikode, India, and colleagues.

Patients who had obstructive sleep apnea were more likely to have subthreshold or clinical insomnia, Jose said in a presentation at the .

Jose and colleagues also found that those in the sleep apnea group had worse average erectile function than patients who did not have sleep troubles.

"As erectile dysfunction and OAS share risk factors, the presence of ED should raise the suspicion of an undiagnosed sleep disorder," Jose said in a meeting presentation.

"As urologists, we are in a unique position to identify and refer men at risk of sleep disorders," he added. "We suggest that ED patients with high OSA scores be referred to a sleep specialist and be reassessed before proceeding with surgical treatment options, like penile implant."

Obstructive sleep apnea is a breathing disorder characterized by blockage in the upper airway, and can cause poor sleep, intermittent hypoxia, hypoxia-induced neurological issues, hormonal and psychological changes, and low nitric oxide production. Sleep apnea shares several risk factors with erectile dysfunction -- such as age, obesity and underlying cardiovascular conditions. Jose said this study is the second to examine the prevalence of sleep apnea in this population.

Jose and colleagues recruited patients who had complaints of erectile dysfunction and presented to an andrology clinic from May 2019 to May 2020. Patients received a series of questionnaires to assess erectile dysfunction and sleep disorders. They were then grouped into two categories: those who had sleep apnea and those who did not.

Information on age, BMI, serum testosterone, smoking habits and comorbidities was collected. Patients with neurological disorders, penile deformity, a history of pelvic trauma or surgery, or sexual function drug use were excluded.

Mean age among the 121 men included in the study was 49. Men with sleep apnea were more likely to be older (62 vs 43 years in the non-sleep apnea group; P<0.001), and had a higher BMI (26 vs 22, P=0.025).

Among all patients in the study, 78 scored high enough on the sleep apnea questionnaire to indicate need for a sleep specialist. In addition, patients with OAS scored an average of 10 on the International Index of Erectile Function diagnostic tool, compared to patients without sleep apnea that scored an average of 15, indicating better erectile function.

Jose's group noted increasing patient awareness of sleep apnea and erectile dysfunction may lead to better cardiac health outcomes. The researchers also suggested further studies that investigate whether continuous positive airway pressure (CPAP) can be used to manage erectile dysfunction patients with sleep apnea.

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