CPAP Versus Positional Therapy for Sleep Apnea

I just finished another article in the June 2010 issue of the Journal of Clinical Sleep Medicine. It was a study about patients with mild to moderate positional obstructive sleep apnea (OSA) - in this case, the patients only had OSA on their backs, and not on their sides.

I see this type of OSA less often. It usually is in patients who have a normal body weight or only mildly overweight. However, OSA is often worse when patients sleep on their back, but they usually have it on their sides as well. Those patients were not the focus of this study.

CPAP was tested against a device worn at night to keep people on their sides - the Zzoma . The authors found that the Zzoma was just as effective as CPAP in treating position-dependent mild to moderate OSA. This is good news, as sometimes patients with this type of OSA do not want or do not tolerate CPAP. I usually tell patients with this type of OSA to use a wall of pillows to keep them off of their back when they sleep. Some of these patients also respond better to an oral appliance worn at night. Now, they have another option.

Sleep Apnea, Sexual Health, and CPAP Treatment

I did not plan for my first post to be out sex, but this was the first article in the June 2010 issue of the Journal of Clinical Sleep Medicine (JCSM), entitled “Outcome of CPAP Treatment on Intimate and Sexual Relationships in Men with Obstructive Sleep Apnea.”

To begin with, the authors explain that 30% to 68% of men with obstructive sleep apnea (OSA) suf­fer from some level of sexual dysfunction. Loss of interest in sex has been associated with the number of apneas and how low a patient’s oxygen level goes when asleep. They warn us that CPAP treatment has not definitively been shown to improve sexual function.

The authors designed the study to look at OSA patients’ perceptions of their intimate and sexual relationships, the as­sociation with daytime sleepiness, and degree of impairment compared to normal values, and to document if there was any improvement with CPAP treatment.

They studied 123 men, with most of the patients being middle-aged, obese, and with severe sleep apnea. The patients rated their intimate and sexual relationships with a questionnaire that asked about sexual desire, ability to become sexually aroused, and ability to have an orgasm.

The results showed that men with OSA have worse intimate and sexual relationships and this is related to daytime sleepiness. Following treatment with CPAP, intimate and sexual functioning improved, with the most severe amount of OSA showing the largest improvement. This im­provement was related to improvement in daytime sleepiness.

Why would men with OSA have worse intimate and sexual relationships? Being tired may mean men are less interested and have more difficulty with sexual activity. OSA can affect certain hormones like testosterone, which could then impact sexual interest and performance. Finally, low oxygen levels have been associated with impotence. The authors also point out that, although regular CPAP use did improve sexual functioning, 43% of those OSA patients using CPAP for 3 months did not improve to a level seen in men who do not have OSA at all.