Hwang Juen-Haur, Ong Hueih-Ling, Chen Yi-Chun
Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Andrology. 2022 Mar;10(3):477-485. doi: 10.1111/andr.13126. Epub 2021 Nov 25.
It has been reported that the risk of erectile dysfunction (ED) is significantly higher in patients with obstructive sleep apnea (OSA), compared with patients without OSA. However, there is limited evidence on whether surgical treatments in patients with OSA could decrease ED risk.
To assess the impact of surgical treatments for OSA on the risk of ED by analysis of claims data from the Taiwan National Health Insurance Research Database between 1997 and 2012.
We identified 20,675 male adults with newly diagnosed OSA during the study period; 16,040 patients ever received surgical treatments (treated cohort) and 4635 patients never received surgical treatments (untreated cohort). According to 3:1 propensity score matching, we analyzed 8337 patients in the treated cohort and 2779 controls in the untreated cohort. We estimated the incidence rates (IRs) and hazard ratios (HRs) of incident ED in both cohorts through the end of 2012.
In a total study follow-up of 64,916 person-years, 396 (3.6%) patients developed impotence. The IRs of ED for the treated and untreated cohorts, respectively, were 55.8 (95% confidence interval [CI], 55.6-55.9) and 76.1 (95% CI, 76.0-76.3) per 1000 person-years. Multivariate Cox proportional hazard analysis showed that surgical treatments for OSA patients were associated with a lower risk for ED (adjusted HR, 0.79; 95% CI, 0.64-0.98). Multivariate stratified analysis further verified that significant risk reduction of ED was present in OSA patients without hypertension, diabetes, hyperlipidemia, hyperuricemia, obesity, chronic kidney disease, and chronic liver disease.
We found that OSA patients who received surgical treatments were associated with a lower risk for developing ED by 21%.
据报道，与无阻塞性睡眠呼吸暂停（OSA）的患者相比，OSA患者勃起功能障碍（ED）的风险显著更高。然而，关于OSA患者的手术治疗是否能降低ED风险的证据有限。
通过分析1997年至2012年台湾国民健康保险研究数据库中的理赔数据，评估OSA手术治疗对ED风险的影响。
我们确定了研究期间20675名新诊断为OSA的成年男性；16040例患者曾接受手术治疗（治疗队列），4635例患者从未接受手术治疗（未治疗队列）。根据3:1倾向评分匹配，我们分析了治疗队列中的8337例患者和未治疗队列中的2779例对照。我们估计了截至2012年底两个队列中ED的发病率（IR）和风险比（HR）。
在总共64916人年的研究随访中，396例（3.6%）患者出现阳痿。治疗队列和未治疗队列中ED的发病率分别为每1000人年55.8（95%置信区间[CI]，55.6 - 55.9）和76.1（95%CI，76.0 - 76.3）。多变量Cox比例风险分析表明，OSA患者的手术治疗与较低的ED风险相关（调整后HR，0.79；95%CI，0.64 - 0.98）。多变量分层分析进一步证实，在没有高血压、糖尿病、高脂血症、高尿酸血症、肥胖、慢性肾病和慢性肝病的OSA患者中，ED风险显著降低。
我们发现接受手术治疗的OSA患者发生ED的风险降低了21%。
