Obstructive sleep apnoea and sexual function in men

Obstructive sleep apnoea (OSA) is associated with sexual dysfunction. Untreated OSA and erectile dysfunction (ED) have both been identified as being indicative of a high risk of developing cardiovascular disease. Treatments for ED, such as testosterone supplementation or PDE-5 inhibitors, and for OSA, such as Continuous Positive Airways Pressure (CPAP) are both readily available. The effects of these treatments on the other associated conditions have not been fully assessed. The efficacy of testosterone supplementation, in untreated OSA, on sexual function and quality of life has not been investigated. PDE-5 inhibitors are an established treatment for erectile dysfunction, however, there is a paucity of information regarding their efficacy in OSA, and there is a theoretical risk of worsening of OSA with their use. CPAP, in some observational and non-treatment or alternative treatment controlled studies, has been shown to improve erection function in men with OSA, however the majority of these studies have been in men with OSA, with and without ED. Two randomised controlled trials investigating the effects of testosterone in untreated OSA (n=67), and the effects of CPAP and a PDE-5 inhibitor in men with OSA and ED using a factorial design (n=61) were performed. Sleep, sexual function and quality of life was assessed. CPAP increased the quantity of nocturnal erections and a PDE-5 inhibitor improved their quality. However, neither CPAP use, exogenous testosterone nor a PDE-5 inhibitor improved subjective erectile function in men with OSA. Post-hoc analysis showed that adherent CPAP use (>4hours per night) increased subjective erectile function and sexual desire, as well as several parameters of quality of life in men with OSA and ED. Testosterone also increased sexual desire in men with OSA

High-intensity interval exercise induces greater acute changes in sleep, appetite-related hormones and free-living energy intake compared to moderate-intensity continuous exercise

Compare the effect of high-intensity interval and moderate-intensity continuous exercise on sleep characteristics, appetite-related hormones and eating behaviour. 11 overweight, inactive men completed two consecutive nights of sleep assessments to determine baseline (BASE) sleep stages and arousals recorded by polysomnography (PSG). On separate afternoons (1400-1600h), participants completed a 30min exercise bout: 1) moderate-intensity continuous exercise (MICE; 60% V̇O2peak) or 2) high-intensity interval exercise (HIIE; 60s work at 100% V̇O2peak: 240s rest at 50% V̇O2peak), in a randomised order. Measures included appetite-related hormones (acylated ghrelin, leptin, peptide tyrosine tyrosine) and glucose pre-exercise, 30min post-exercise, and the next morning post-exercise; PSG sleep stages, actigraphy (sleep quantity and quality), and self-reported sleep and food diaries were recorded until 48h post-exercise. There was no between-trial differences for time in bed (p=0.19) or total sleep time (p=0.99). For HIIE, stage N3 sleep was greater (21 ± 7%) compared to BASE (18 ± 7%; p=0.02). Also, number of arousals during rapid eye movement sleep were lower for HIIE (7 ± 5) compared to BASE (11 ± 7; p=0.05). Wake after sleep onset was lower following MICE (41min) compared to BASE (56min; p=0.02). Acylated ghrelin was lower and glucose higher at 30min post-exercise for HIIE compared to MICE (p≤0.05). There were no significant differences in total energy intake between conditions (p≥0.05). HIIE appears more beneficial than MICE for improving sleep quality and inducing favourable transient changes in appetite-related hormones in overweight, inactive men. However, energy intake was not altered regardless of exercise intensity.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Metabolic and hormonal effects of 'catch-up' sleep in men with chronic, repetitive, lifestyle-driven sleep restriction.

ObjectiveAcutely restricting sleep worsens insulin sensitivity in healthy individuals whose usual sleep is normal in duration and pattern. The effect of recovery or weekend 'catch-up' sleep on insulin sensitivity and metabolically active hormones in individuals with chronic sleep restriction who regularly 'catch-up' on sleep at weekends is as yet unstudied.Design19 men (mean ± SEM age 28·6 ± 2·0 years, BMI 26·0 ± 0·8 kg/m(2) ) with at least 6 months' history (5·1 ± 0·9 years) of lifestyle-driven, restricted sleep during the working week (373 ± 6·6 min/night) with regular weekend 'catch-up' sleep (weekend sleep extension 37·4 ± 2·3%) completed an in-laboratory, randomized, crossover study comprising two of three conditions, stratified by age. Conditions were 3 weekend nights of 10 hours, 6 hours or 10 hours time-in-bed with slow wave sleep (SWS) suppression using targeted acoustic stimuli.MeasurementsInsulin sensitivity was measured in the morning following the 3rd intervention night by minimal modelling of 19 samples collected during a 2-h oral glucose tolerance test. Glucose, insulin, c-peptide, leptin, peptide YY (PYY), ghrelin, cortisol, testosterone and luteinizing hormone (LH) were measured from daily fasting blood samples; HOMA-IR, HOMA-β and QUICKI were calculated.ResultsInsulin sensitivity was higher following three nights of sleep extension compared to sustained sleep restriction. Fasting insulin, c-peptide, HOMA-IR, HOMA-β, leptin and PYY decreased with 'catch-up' sleep, QUICKI and testosterone increased, while morning cortisol and LH did not change. Targeted acoustic stimuli reduced SWS by 23%, but did not alter insulin sensitivity.ConclusionsThree nights of 'catch-up' sleep improved insulin sensitivity in men with chronic, repetitive sleep restriction. Methods to improve metabolic health by optimizing sleep are plausible

The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods: Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results: We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions: Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).</p

Randomized Trial of CPAP and Vardenafil on Erectile and Arterial Function in Men with Obstructive Sleep Apnea and Erectile Dysfunction

Context Erectile function is important for life satisfaction and often impaired in men with obstructive sleep apnea (OSA). Uncontrolled studies show that treating OSA with continuous positive airway pressure (CPAP) improves erectile function. Phosphodiesterase type 5 inhibitors (e.g., vardenafil) are the first-line therapy for erectile dysfunction (ED), but may worsen OSA. Objective To assess the effects of CPAP and vardenafil on ED. Design Sixty-one men with moderate-to-severe OSA and ED were randomized to 12 weeks of CPAP or sham CPAP, and 10 mg daily vardenafil or placebo in a two-by-two factorial design. Main Outcome Measures International Index of Erectile Function (primary end point), treatment and relationship satisfaction, sleep-related erections, sexual function, endothelial function, arterial stiffness, quality of life, and sleep-disordered breathing. Results CPAP increased the frequency of sleep-related erections, overall sexual satisfaction, and arterial stiffness but did not change erectile function or treatment or relationship satisfaction. Vardenafil did not alter erectile function, endothelial function, arterial stiffness, or sleep-disordered breathing, but did improve overall self-esteem and relationship satisfaction, other aspects of sexual function, and treatment satisfaction. Adherent CPAP improved erectile function, sexual desire, overall sexual, self-esteem, relationship, and treatment satisfaction, as well as sleepiness, and quality of life. Adherent vardenafil use did not consistently change nocturnal erection quality. Conclusion CPAP improves overall sexual satisfaction, sleep-related erections, and arterial stiffness. Low-dose daily vardenafil improves certain aspects of sexual function and did not worsen OSA. Adherent CPAP or vardenafil use further improves ED and quality of life.</p