How Sleep Apnea Can Affect Erectile Function

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Sleep apnea is linked to a number of health concerns such as high blood pressure, heart disease, diabetes, and stroke. A number of studies have also suggested that those with sleep apnea have significant risk for erectile dysfunction (ED) — but this link was not confirmed in a large cohort study until 2015.

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Collecting sleep apnea data

The 2015 study published by the Public Library of Science collected data from a database that held information on medical reimbursement claims made against Taiwan’s national health insurance scheme. Researchers identified 1,946 men with probable sleep apnea and compared them to a control group of randomly selected men of the same age.

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The health problems linked to sleep apnea

Researchers found that, compared to the control group, men with sleep apnea had higher rates of underlying diseases such as high blood pressure (39 percent versus 19 percent), liver disease (25 percent versus 12 percent), diabetes (11 percent versus eight percent), heart disease (four percent versus two percent), cancer (four percent versus two percent), and congestive heart failure (three percent versus one percent).

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The effect of sleep apnea on erectile function

The study revealed that 2.67 percent of men with probable sleep apnea received an ED diagnosis compared to just 1.1 percent of men without the sleep disorder. After analyzing the data further and after adjusting for age and underlying diseases, researchers concluded that sleep apnea was an independent risk factor for developing ED.

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How does sleep apnea affect erectile function?

Although low testosterone is associated with ED, studies suggest that testosterone levels aren’t a factor when it comes to erectile function in men with sleep apnea. The authors of the study pointed to previous studies that found the oxygen deficiency associated with shallow or paused breathing is a possible cause of ED and decreased libido.

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The role of the nervous system

Obstructive sleep apnea is associated with increased sympathetic activation, part of the nervous system that is responsible for the body’s "fight-or-flight" response. Since increased sympathetic activation tends to inhibit erections, this may also explain the link between sleep apnea and erectile function.

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How to address ED caused by sleep apnea

In addition to CPAP treatment helping to increase libido and erectile function, researchers uncovered other studies that found oral appliances and tonsillectomy surgery may also improve ED. Studies have also suggested that sildenafil (Viagra) is more effective at treating ED in those with sleep apnea, but since this drug can lead to difficult or labored breathing it should be used carefully — and may be safer when used in conjunction with CPAP therapy.

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The different types of sleep apnea

The design of this study did not distinguish between obstructive sleep apnea and central sleep apnea so it was not possible to determine whether both types influenced the risk of ED in the same way. With that being said, since the majority of sleep apnea is obstructive sleep apnea, the authors of the study concluded that it is obstructive sleep apnea that might substantially increase the risk of ED.

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Additional risk factors for ED

It’s important to note that this study could not exclude participants based on well-known risk factors for ED since they were not available in the database used by researchers. These risk factors include smoking history, obesity, and alcoholism. With that being said, sleep apnea remained an independent risk factor for ED even after researchers adjusted for comorbid health conditions.