Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, and Malcom-Randall VAMC, Gainesville, Florida.
Department of Medicine, and Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, Veterans Affairs Health System, Minneapolis, Minnesota; Geriatric Research Education and Clinical Center, Veterans Affairs Health System, Minneapolis, Minnesota.
J Urol. 2017 Mar;197(3 Pt 1):776-782. doi: 10.1016/j.juro.2016.09.089. Epub 2016 Sep 30.
We investigated the association between sleep disordered breathing and erectile dysfunction in older men.
We performed a cross-sectional analysis of community dwelling men age 67 years or older enrolled in the Osteoporotic Fractures in Men Sleep Study. Participants underwent overnight polysomnography (2003 to 2005) and completed sexual health questionnaires (2005 to 2006). We defined sleep disordered breathing using the apnea-hypopnea index or nocturnal hypoxemia. Erectile dysfunction was defined using the MMAS (Massachusetts Male Aging Study) scale and, in sexually active men, the International Index of Erectile Function. We used logistic regression to examine the association between sleep disordered breathing and erectile dysfunction.
Mean participant age was 76±5 years. Of the 2,676 men completing the MMAS, 70% had moderate to complete erectile dysfunction. Among 1,099 sexually active men completing the IIEF-5 (5-item International Index of Erectile Function), 26% had moderate to severe erectile dysfunction. A higher apnea-hypopnea index was associated with greater odds of MMAS defined moderate to complete erectile dysfunction after adjusting for age and study site (OR 1.39, 95% CI 1.00-1.92 for severe sleep disordered breathing vs none, p trend=0.008), but not after further adjustment for body mass index, socioeconomic status and comorbidities (OR 1.05, 95% CI 0.75-1.49, p trend=0.452). Greater nocturnal hypoxemia was associated with increased odds of MMAS defined moderate to complete erectile dysfunction (unadjusted OR 1.36, 95% Cl 1.04-1.80 vs none) but this was attenuated after adjustment for age and study site (OR 1.24, 95% CI 0.92-1.66). Sleep disordered breathing was not associated with erectile dysfunction by 5-item International Index of Erectile Function.
In this cross-sectional analysis in older men sleep disordered breathing was associated with higher odds of erectile dysfunction in unadjusted analyses that was largely explained by higher body mass index and increased comorbidity among men with sleep disordered breathing. Prospective studies accounting for obesity and multimorbidity would further clarify the association of sleep disordered breathing and erectile dysfunction.
我们研究了老年男性睡眠呼吸障碍与勃起功能障碍之间的关系。
我们对参加男性骨质疏松性骨折睡眠研究的年龄在 67 岁或以上的社区居民男性进行了横断面分析。参与者接受了整夜多导睡眠图（2003 年至 2005 年）和性健康问卷（2005 年至 2006 年）的检查。我们使用呼吸暂停低通气指数或夜间低氧血症来定义睡眠呼吸障碍。勃起功能障碍使用 MMAS（马萨诸塞州男性衰老研究）量表来定义，对于有性行为的男性，则使用 IIEF-5（5 项国际勃起功能指数）来定义。我们使用逻辑回归来检查睡眠呼吸障碍与勃起功能障碍之间的关联。
参与者的平均年龄为 76±5 岁。在完成 MMAS 的 2676 名男性中，70%有中度至完全的勃起功能障碍。在完成 IIEF-5（5 项国际勃起功能指数）的 1099 名有性行为的男性中，26%有中度至严重的勃起功能障碍。调整年龄和研究地点后，呼吸暂停低通气指数越高，MMAS 定义的中度至完全勃起功能障碍的可能性就越大（严重睡眠呼吸障碍与无睡眠呼吸障碍相比，比值比为 1.39，95%置信区间为 1.00-1.92，p 趋势=0.008），但进一步调整体重指数、社会经济地位和合并症后，这种关联就不存在了（比值比为 1.05，95%置信区间为 0.75-1.49，p 趋势=0.452）。夜间低氧血症越严重，MMAS 定义的中度至完全勃起功能障碍的可能性就越大（未经调整的比值比为 1.36，95%置信区间为 1.04-1.80 与无睡眠呼吸障碍相比），但在调整年龄和研究地点后，这种关联就减弱了（比值比为 1.24，95%置信区间为 0.92-1.66）。5 项国际勃起功能指数并未显示睡眠呼吸障碍与勃起功能障碍之间存在关联。
在这项对老年男性的横断面分析中，未经调整的分析显示，睡眠呼吸障碍与勃起功能障碍的几率增加有关，而在睡眠呼吸障碍患者中，这主要与体重指数增加和合并症增加有关。考虑肥胖和多种合并症的前瞻性研究将进一步阐明睡眠呼吸障碍与勃起功能障碍之间的关联。
