Suffering from sleep problems? Go to a urologist.

Problems with sexual functioning? Go to a sleep laboratory.

This advice might sound mixed up, but it is what Israeli researchers are recommending following the findings of their study that has found a direct link between obstructive sleep apnea (OSAS) and erectile dysfunction (ED).

The study will be published soon in the medical journal Urology, and was conducted by Dr. David Margel, from the Rabin Medical Center in Petah Tikva, and Dr. Giora Pillar from the Technion. They found that the more severe the apnea the more acute the impotence problems, and vice versa.

Obstructive Sleep Apnea is a common condition defined as frequent episodes of long pauses in breathing during sleep. Four percent of all American men suffer from the syndrome. Overweight men have the highest risk of developing this condition, however, 30-40% of people suffering from this disorder are not overweight.

When a man has erectile dysfunction (ED), he cannot achieve or maintain a firm erection. ED also is called “impotence.” About one in every ten American men has impotence or some degree of impotence.

The most commonly known causes of ED are health problems like prostate cancer treatments (surgery and radiation), heart disease, diabetes, and high blood pressure, as well as smoking and alcoholism.

“Our study was designed to see if there’s a connection between OSAS and ED,” Margel told ISRAEL21c. “There have been studies conducted in the past, but with no conviction – some say yes and some say no. We wanted to confirm or reject this connection.”

Margel, a doctor of urology at Rabin, and Pillar, a sleep specialist at the Technion, took 209 male patients who were referred to the sleep laboratory at the Technion because they displayed symptoms of OSAS. They were given a sleep questionnaire, and a revised IIEF questionnaire comprised of three main questions about the following subjects: sexual satisfaction, erection during intercourse and morning erection.

“Before their full sleep tests in the lab, we interviewed them about their erectile functioning using a validated standard questionnaire. We divided the patients into two categories – those with severe OSAS symptoms, and those without,” said Margel.

The participants then underwent a full night in-lab polysomnography (PSG).

“Our findings showed that the more severe the OSAS, the more frequent the problems with erectile functioning,” said Margel.

There was a decrease in erectile function among all OSAS groups as compared to those without OSAS. However Margel pointed out that the only group that this reduction was statistically significant in all ED dimensions was the severe OSAS. Furthermore, the patients complaining of severe ED had the highest Respiratory Disturbance Index (RDI).

According to Margel, subsequent multiple logistic regression analyses revealed that the primary predicting factors for ED in OSAS patients were age, morning tiredness and RDI.

It’s still not clear why such a strong a connection between the two medical conditions exists, although the researchers surmise that the fatigue caused by the apnea can lessen the desire for sex. Another theory is connected to small blood vessels that cause the slowing down of the flow of blood during sleep that also affect sexual functioning.

“We think there’s a mechanism connecting OSAS and erectile disfunctioning. OSAS is caused by a disruption of small vessels – the same kind of vessels which are used in an erection,” said Margel. “Another reason could be hormonal. Some studies say that men suffering from OSAS secrete less testosterone. Lastly, patients with OSAS are generally more tired and their daily functioning is deteriorated, an their libido is also lessened. All of these can cause the erectile dysfunctioning, The study did not assess causality, but we can assume all these mechanisms together can cause this syndrome.”

The researchers’ study was presented at a urological conference in Eilat in Israel recently and won an award of excellence. According to Margel, a new study is underway to see if the standard treatment for OSAS – called Nasal Continuous Positive Airway Pressure (CPAP) will help alleviate the problems with erectile function.

But Margel says that the connection between the two health problems has been firmly established.

“According to the findings, I recommend that everyone who suffers from sleep apnea see a urologist to check their sexual functioning, and for everyone who suffers from erectile dysfunctioning to attend a sleep lab to check on apnea. For both conditions there are treatment and solutions, and early detection will improve the quality of life of the sufferer,” said Margel.