By Alan Z. Segal, MD

Associate Professor of Clinical Neurology, Weill Cornell Medical College

Dr. Segal reports no financial relationships relevant to this field of study.

SOURCE: Jara SM, Hopp ML, Weaver EM. Association of continuous positive airway pressure treatment with sexual quality of life in patients with sleep apnea: Follow-up study of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2018;144:587-593.

When faced with the possibility of continuous positive airway treatment (CPAP) therapy for obstructive sleep apnea (OSA), patients commonly balk, especially if they fear that this potentially unromantic therapy will affect their sex life adversely. This report from Jara et al suggests otherwise. Data were derived from a 25-point Snore Outcome Scale (SOS), which included two sex-related options: “Because of medical problem, unable to have sexual relations” and “Lack of desire for sexual relations.” This was scored on a 0-5 scale (5 was the worst). Specifics regarding sexual function were limited, as data were derived from only these two points on a general scale (the SOS-25) rather than a predetermined sex-specific questionnaire. The cohort included 182 participants (63% men) with severe OSA. There was a significant improvement in SOS score of -0.7 among CPAP users compared with -0.1 among nonusers. This effect persisted in a multivariate analysis. However, in a specific subgroup analysis using only gender, the benefit was restricted to women. There was a 1.3-point improvement in women (95% confidence interval [CI], 0.5-2.18), but only a 0.16-point difference in men (95% CI, -0.26 to 0.58). The authors did not provide any theories to explain this sex difference.

COMMENTARY

Among men using CPAP, prior noncontrolled case series have suggested an improvement in sexual function, albeit primarily among subjects who reported prior sexual difficulties. Although hormonal effects have been implicated in OSA, no one has confirmed that low testosterone is a consequence of sleep-disordered breathing or that testosterone can rise with the use of CPAP. However, factors that clearly can improve with CPAP, such as weight gain and poor sleep quality, have shown a definite relationship to testosterone levels.

Among women, other researchers have contradicted this study, failing to show improvements in sexual function or distress with CPAP use. Taking a more granular approach than merely two questions from the SOS-25, other studies used detailed female-specific scales of sexual function, distress, and overall satisfaction.