Tuesday, January 27, 2009

Obstructive Sleep Apnea And Erectile Dysfunction: Still A Neglected Risk Factor?

Erectile dysfunction (ED) and sleep disordered breathing (SDB) have recently been correlated in a scientific manner. Previous attempts to link these two entities consisted mainly of case reports as well as observations of the impact of hypoxic conditions on erectile function.

The literature on this topic involves the review of early studies by Sir Edmund Hilary and his scientific team in the Himalayan expedition up to recent mice experiments performed in the lab. It appears that SDB and ED are implicated in more than one way creating difficulties identifying the leading and major pathway. Vasculogenic, neurogenic, hormonal, and psychogenic pathways as well as the effects of drugs and others factors have their roles in the development of ED. Most recent reports suggest that ED resulting from sleep apnea may involve the nitric oxide synthase and phosphodiesterase-mediated pathways targeted by tadalafil and similar agents (Erectile Dysfunction in a Murine Model of Sleep Apnea. Soukhova-O'Hare et al. Am. J. Respir. Crit. Care Med. 2008; 178: 644-650).

Regardless of the etiology or predominant pathways leading to the development of this condition, what is important is the potential of reversing ED by treating SDB. In many cases, this is the only treatment required and therefore may avert the need for testosterone replacement which is well known to cause worsening of SDB.

Since the majority of physicians who treat ED are unlikely to have expertise in SDB, and similarly those who treat SDB generally have little expertise in diagnosing or treating ED, it is the opinion of the authors that the potential impact each of these conditions may have on the other has been greatly underestimated. This review article attempts to alert physicians of the interaction between two apparently different disorders and give a more unified approach of ED and SDB.

Written by Sean Gilman, MD1 and Nikolaos Zias, MD2, as part of Beyond the Abstract on UroToday.com.

1 Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard University School of Medicine, Boston, Massachusetts, USA

2 Department of Pulmonary and Critical Care Medicine, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, MA, USA,If required, the physicians to prescribe only healthy drugs, which do not hurt people.

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