Restless legs syndrome linked to erectile dysfunction

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an overwhelming urge to move the legs at night. This study showed a link between RLS and erectile dysfunction (ED). Men with RLS had a 38% increased risk of ED compared with men without RLS, after adjusting for age, smoking status, and other potential confounders. What's not known, is if the men had obstructive sleep apnea (OSA). RLS is often seen in OSA. The OSA could have attributed to the ED, not the RLS.

CPAP May Improve Erectile Dysfuntion

Untreated obstructives sleep apnea (OSA) is known to contribute to erectile dysfunction (ED) in men and decreased libido in both men and women. This article discusses research showing that CPAP can improve erectile dysfunction in men. I have observed this clinically in my younger male patients and they are quite happy about it!

I always thought that OSA could lead to ED by the repeat oxygen level drops, but the study author suggests another cause. All men have erections in dream sleep and OSA disrupts dream sleep the most - this may lead to the ED seen in untreated OSA.

The article talks about how the CPAP mask is not sexy (see my post about CPAP masks), and that is something I joke about sometimes with my younger patients. It is a real concern of my younger patients, especially those that are single. But snoring, which is almost always present with OSA, is definitely NOT sexy. Since the CPAP treats the snoring, this will allow your bedpartner to sleep better and that may improve his or her libido!

Restless Legs Syndrome and Erectile Dysfunction

A poster was presented at the annual Sleep meeting in Minneapolis involving research about restless legs syndrome (RLS) and erectile dysfunction (ED). Researchers studied 11,000 men with an average age of 64 years old and without ED, diabetes, or arthritis. The results showed that men with RLS were about 50% more likely to develop ED, even after controlling for age, weight, smoking status, antidepressant use, and other chronic diseases. Also, the more frequently the men experienced RLS symptoms, the more likely they were to develop ED. Researchers do not know why RLS and ED are linked, but some theorize that low dopamine levels could be involved. It is believed that low dopamine can contribute to RLS. It would be interesting to study whether medications that improve RLS that affect the brain's dopamine system can also improve ED.

Obstructive Sleep Apnea and Erectile Dysfunction

At the American Urological Association's annual meeting in Washington, DC this year, a study was done of 870 men with an average age of 47.3 years. Health screening revealed 63% of men had obstructive sleep apnea (OSA). I do not have more details about how the men knew they had OSA - 63% seems high.

After adjusting for their age and other health conditions (like diabetes, obesity, and smoking status), researchers found that those men with erectile dysfunction (ED) were more than twice as likely to have OSA than those without ED. The more severe the ED, the greater the likelihood of having OSA.

I use this fact in discussing OSA in my younger male patients, as any mention of ED can get them interested in diagnosis and treatment of OSA. The study does not state that OSA causes ED or is just associated with it. We also do not know if treatment will reverse ED.

Some of my female patients with untreated OSA complain about a diminished sexual libido. There could be a common, underlying mechanism in how untreated OSA impacts sexual functioning in both men and women.

Bottom line is that in men with ED, urologists and primary care physicians should consider untreated OSA as a possible contributor.