University College London Hospitals, London, UK.
Int J Impot Res. 2022 Sep;34(6):603-609. doi: 10.1038/s41443-021-00462-3. Epub 2021 Aug 13.
Men with Stuttering Priapism (SP) and sleep-related painful erections (SRPE) experience bothersome nocturnal painful erections resulting in poor sleep. The aim of this study is to observe common features and differences between men with SP and SRPE based on polysomnography, nocturnal penile tumescence (NPT), and penile doppler ultrasound (PDU). This is a prospective cohort study of 20 participants divided into two groups (Group 1 = SP [n = 12]; Group 2 = SRPE [n = 8]) with bothersome painful nocturnal erections. All participants were referred to the sleep disorder clinic to be assessed and consented for overnight polysomnography with simultaneous NPT recording and to complete validated sleep, sexual dysfunction and health-related quality of life questionnaires. Unstimulated PDU was also performed. Abnormal Polysomnographic findings (reduced sleep efficiency, total sleep time, and awake after sleep onset) were identified in both groups suggesting poor sleep. Men with SP had significantly longer erections (60.0 vs 18.5; p = 0.002) and took longer to detumesce once awake (25.7 vs 5.4 min; p = 0.001) than men with SRPE. They also had significantly higher peak systolic and end diastolic velocities on unstimulated PDU with an abnormal low resistance waveform identified. No sleep pathology was identified in men with SP. This implies a local (penile) etiology in men with SP. Men with SRPE had a normal resting PDU and abnormal sleep architecture with REM awakenings and significantly more Periodic limb movements (p = 0.04) than men with SP suggesting a central (sleep-related) cause in men with SRPE. Sexual dysfunction and poor HR-QoL was identified on validated questionnaires in both groups. SP and SRPE are rare entities that share similar symptoms (painful nocturnal erections and poor sleep) but dissimilar features of nocturnal erection onset, duration and resolution with different polysomnographic features which may allude to a different pathophysiology.
患有口吃性阴茎勃起（SP）和与睡眠相关的疼痛性勃起（SRPE）的男性会经历夜间疼痛性勃起，导致睡眠质量差。本研究的目的是通过多导睡眠图、夜间阴茎勃起（NPT）和阴茎多普勒超声（PDU）观察 SP 和 SRPE 男性的常见特征和差异。这是一项前瞻性队列研究，共纳入 20 名参与者，分为两组（SP 组 [n=12]；SRPE 组 [n=8]），均有夜间疼痛性勃起。所有参与者均被转介至睡眠障碍诊所进行评估，并同意进行整夜多导睡眠图检查，同时记录 NPT，并完成经证实的睡眠、性功能障碍和健康相关生活质量问卷。还进行了未受刺激的 PDU。两组均存在异常的多导睡眠图发现（睡眠效率、总睡眠时间和入睡后觉醒时间减少），提示睡眠质量差。与 SRPE 组相比，SP 组的勃起时间显著更长（60.0 分钟 vs. 18.5 分钟；p=0.002），且一旦醒来，勃起消退时间也更长（25.7 分钟 vs. 5.4 分钟；p=0.001）。SP 组的未受刺激 PDU 峰值收缩期和舒张末期速度也显著较高，且识别到异常低阻力波形。SP 组的男性未发现睡眠病理学。这意味着 SP 组的男性存在局部（阴茎）病因。SRPE 组的男性 PDU 基础状态正常，睡眠结构异常，有 REM 觉醒，周期性肢体运动明显增多（p=0.04），这表明 SRPE 组的男性存在中枢（与睡眠相关）病因。两组均通过经证实的问卷识别出性功能障碍和较差的 HR-QoL。SP 和 SRPE 是罕见的实体，它们具有相似的症状（夜间疼痛性勃起和睡眠质量差），但夜间勃起发作、持续时间和消退的特征不同，多导睡眠图特征也不同，这可能提示不同的病理生理学。
