Abstract
Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients.
Highlights
Sleep apnea (SA) is the most common form of sleep disordered breathing characterized by repetitive cessation of breathing during sleep, usually associated with intermittent hypoxia and sleep fragmentation [1,2,3]
The diagnosis of SA is usually made by frequent apnea/hypopnea events during sleep, i.e. increased apnea-hypopnea index (AHI), on nocturnal polysomnography (PSG) [5]
More than 90% of patients have obstructive sleep apnea (OSA), characterized by recurrent upper airway collapse, while less than 10% of patients have central sleep apnea (CSA), which is related to losing neurological drives of respiratory effort [1,2]
Summary
Sleep apnea (SA) is the most common form of sleep disordered breathing characterized by repetitive cessation of breathing during sleep, usually associated with intermittent hypoxia and sleep fragmentation [1,2,3]. Results from Wisconsin Sleep Cohort study estimate the prevalence of SA was 9% for women and 24% for men [4]. The diagnosis of SA is usually made by frequent apnea/hypopnea events during sleep, i.e. increased apnea-hypopnea index (AHI), on nocturnal polysomnography (PSG) [5]. Over 152 million men were estimated to have ED in 1995, and this prevalence was projected to an estimation of 322 million by 2025 [7]. Because sexual health is important for overall wellbeing, ED is associated with significantly lower quality of life [8]. ED has been recognized as an important sentinel event for peripheral artery disease, coronary artery disease (CAD), stroke and even all cause-mortality [9,10,11]
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