Obstructive sleep apnea, hypertension and erectile dysfunction

Authors: M. Pohanka 1;  P. Kaňovský 2
Authors‘ workplace: Sexuologické oddělení FN u sv. Anny, Brno, přednosta prim. MUDr. R. Hajnová 1;  Neurologická klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. P. Kaňovský, CSc. 2
Published in: Vnitř Lék 2005; 51(5): 578-582
Category: Reviews


Erectile dysfunction and obstructive sleep apnea represent frequent, but generally underestimated phenomenon in clinical practice. Despite significant progress in understanding of erectile dysfunction pathophysiology, the mechanisms triggering onset and progression of organic erectile dysfunction are not completely known yet. Obstructive sleep apnea has several negative effects on the organism, causing autonomic, neurohumoral and endothelial dysfunction. There is an increased number of evidence that patients with obstructive sleep apnea may have increased risk for development of erectile dysfunction. This review will discuss potential pathophysiologic links between obstructive sleep apnea and erectile dysfunction.

Key words:
erectile dysfunction – sleep apnea


1. Peppard PE, Young T, Palta M et al. Prospective study of the association between sleep–disordered breathing and hypertension. N Engl J Med 2000; 342: 1378–1384.

2. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. Jama 1993; 270: 83–90.

3. Garban H, Marquez D, Cai L et al. Restoration of normal adult penile erectile response in aged rats by long–term treatment with androgens. Biol Reprod 1995; 53: 1365–1372.

4. Dahiya R, Lin A, Bakircioglu ME et al. mRNA and protein expression of nitric oxide synthase and adrenoceptor alpha 1 in young and old rat penile tissues. Br J Urol 1997; 80: 300–306.

5. Carrier S, Nagaraju P, Morgan DM, Baba K, Nunes L, Lue TF. Age decreases nitric oxide synthase-containing nerve fibers in the rat penis. J Urol 1997; 157: 1088–1092.

6. Haas CA, Seftel AD, Razmjouei K et al. Erectile dysfunction in aging: upregulation of endothelial nitric oxide synthase. Urology 1998; 51: 516–522.

7. Johannes CB, Araujo AB, Feldman HA et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 2000; 163: 460–463.

8. Melman A, Gingell JC. The epidemiology and pathophysiology of erectile dysfunction. J Urol 1999; 161: 5–11.

9. Saenz de Tejada I, Goldstein I. Diabetic penile neuropathy. Urol Clin North Am 1988; 15: 17–22.

10. Saenz de Tejada I, Goldstein I, Azadzoi K et al. Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl J Med 1989; 320: 1025–1030.

11. Azadzoi KM, Saenz de Tejada I. Diabetes mellitus impairs neurogenic and endothelium-dependent relaxation of rabbit corpus cavernosum smooth muscle. J Urol 1992; 148: 1587–1591.

12. Vernet D, Cai L, Garban H et al. Reduction of penile nitric oxide synthase in diabetic BB/WORdp (type I) and BBZ/WORdp (type II) rats with erectile dysfunction. Endocrinology 1995; 136: 5709–5717.

13. Sullivan ME, Bell CR, Dashwood MR et al. Autoradiographic localization of nitric oxide synthase binding sites in normal and diabetic rat corpus cavernosum. Eur Urol 1996; 30: 506–511.

14. Elabbady AA, Gagnon C, Hassouna MM et al. Diabetes mellitus increases nitric oxide synthase in penises but not in major pelvic ganglia of rats. Br J Urol 1995; 76: 196–202.

15. Seftel AD, Vaziri ND, Ni Z et al. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology 1997; 50: 1016–1026.

16. Azadzoi KM, Goldstein I. Erectile dysfunction due to atherosclerotic vascular disease: the development of an animal model. J Urol 1992; 147: 1675–1681.

17. Azadzoi KM, Park K, Andry C et al. Relationship between cavernosal ischemia and corporal veno-occlusive dysfunction in an animal model. J Urol 1997; 157: 1011–1017.

18. Azadzoi KM, Goldstein I, Siroky MB et al. Mechanisms of ischemia-induced cavernosal smooth muscle relaxation impairment in a rabbit model of vasculogenic erectile dysfunction. J Urol 1998; 160: 2216–2222.

19. Mannino DM, Klevens RM, Flanders WD. Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol 1994; 140: 1003–1008.

20. Xie Y, Garban H, Ng C et al. Effect of long–term passive smoking on erectile function and penile nitric oxide synthase in the rat. J Urol 1997; 157: 1121–1126.

21. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–1235.

22. Tishler PV, Larkin EK, Schluchter MD et al. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003; 289: 2230–2237.

23. Kára T, Souček M. Autonomní nervový systém. In: Souček M, Kára T. Klinická patofyziologie hypertenze. Praha: Grada 2002: 37–99.

24. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

25. Kára T, Souček M, Kárová Š et al. Metabolický kardiovaskulární syndrom a sympatický nervový systém: je obstrukční spánková apnoe klíčem k pochopení? Vnitř Lék 2005; 51(1): 53–61.

26. Arruda–Olson AM, Olson LJ, Nehra A et al. Sleep apnea and cardiovascular disease. Implications for understanding erectile dysfunction. Herz 2003; 28: 298–303.

27. Hirshkowitz M, Karacan I, Arcasoy MO et al. Prevalence of sleep apnea in men with erectile dysfunction. Urology 1990; 36: 232–234.

28. Bassiri A, Guillerminault C. Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome. In: Kriger M, Roth T, Dement W. Principles and practice of sleep medicine. Philadelphia:

Saunders 2000: 869–878.

29. Schmidt HS, Wise HA. Significance of impaired penile tumescence and associated polysomnographic abnormalities in the impotent patient. J Urol 1981; 126: 348–352.

30. Fanfulla F, Malaguti S, Montagna T et al. Erectile dysfunction in men with obstructive sleep apnea: an early sign of nerve involvement. Sleep 2000; 23: 775–781.

31. Luboshitzky R, Herer P, Levi M et al. Relationship between rapid eye movement sleep and testosterone secretion in normal men. J Androl 1999; 20: 731–737.

32. Phillips BG, Narkiewicz K, Pesek CA et al. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens 1999; 17: 61–66.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 5

2005 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account