[Case Sharing
Example 1: Mr. Liu, 43 years old, has been in the workplace for more than 20 years and is the financial director of a large company. However, in the past 5 years, he has become more and more fat, and now he is 3 feet 4 in the waist of his pants, weighing 190 pounds, snoring at night and getting sleepy during the day, and his work is becoming more and more incompetent, and what makes it difficult for him to say is that in the past 1 year, he has done nothing in terms of sex life, becoming “sexually impotent”. Finally, he was reminded that his distressing disease might be related to snoring, so he went to the hospital for sleep respiratory monitoring and was diagnosed with severe obstructive sleep apnea hypoventilation syndrome, and after wearing a non-invasive ventilator, he no longer snored and became sleepy, and worked with energy and competence. After 1 month, the “note” of discord in the couple’s life was eliminated, and the feeling of a strong man and a good man was regained.
Example 2: Ms. Qian, 48 years old, snoring for 15 years, accompanied by daytime sleepiness for 5 years, came to the hospital respiratory department and was diagnosed with severe obstructive sleep apnea hypoventilation syndrome by sleep respiratory monitoring, and after treatment with non-invasive ventilator, she gladly told the female doctor treating her at the follow-up that not only her snoring and sleepiness had completely disappeared, but also the coldness, reluctance and numbness to conjugal life in the past 2 years no longer existed. Marital life was back to being harmonious, beautiful and full of passion.
The story]
A study in the United States reported that 270 men and 30 women suffering from obstructive sleep apnea-hypopnea syndrome (OSAHS) conducted a questionnaire survey, the results showed that these patients and their sexual partners are generally dissatisfied with their sex life, manifested as low libido, short sex life, weakened orgasm, less frequent, etc.. This study suggests that OSAHS is harmful not only to male but also to female sexual function, reducing the quality of sexual life. It has been reported that OSAHS-related sexual dysfunction can lead to divorce in severe cases, and U.S. studies have reported that OSAHS is the third leading cause of divorce. Therefore, understanding the causes of OSAHS affecting male and female sexual function and providing effective treatment is important to improve the quality of life of patients, their marital status, and to promote family harmony and social cohesion.
Causes of OSAHS affecting male sexual function
About 30-50% of men with OSAHS suffer from sexual dysfunction, and OSAHS leads to a decrease in male sexual function in the form of partial or complete loss of erectile function. the decrease in male sexual function associated with OSAHS is related to intermittent hypoxemia caused by OSAHS resulting in nerve damage, vascular endothelial system dysfunction and endocrine abnormalities. First, OSAHS-induced intermittent hypoxia causes abnormalities in the nerves and neurotransmitters innervating the penis to trigger reduced sexual function in men with OSAHS. The penis is innervated by both somatic and autonomic nerves. The autonomic nervous system has the basic function of regulating erection, and the autonomic nerve innervation includes sympathetic and parasympathetic nerves. The intermittent hypoxia during sleep in OSAHS patients increases sympathetic excitability both during waking and sleep, with the strongest excitability during REM sleep, and increases in plasma catecholamine levels along with increased sympathetic excitability, especially at night when plasma catecholamine levels increase more significantly. These changes in sympathetic excitability and its transmitters weaken the physiological mechanisms that maintain normal erectile function. Another neurological mechanism may be the abnormal function of the sacral spinal cord. Applying the sacral spinal cord reflex arc function measurement technique, which quantifies the function of the somatic and autonomic pathways involved in the control of erectile function, the penile bulbocavernosal reflex reaction time was used to determine erectile function in OSAHS patients, and the results showed that 44% of OSAHS patients had prolonged reaction time of the penile bulbocavernosal reflex and 24% had no reaction time of the reflex. The reflex was absent. The abnormal sacral spinal cord function may be due to peripheral axonal and myelin lesions caused by nocturnal intermittent hypoxemia induced by OSAHS. Second, impaired penile vascular endothelial function due to intermittent hypoxia in OSAHS patients can also be involved in the development of sexual dysfunction in OSAHS patients. Penile erection is the end result of smooth muscle relaxation, a process that is neurally regulated by cholinergic, non-adrenergic, non-cholinergic, vasoactive intestinal peptidergic, and calcium gene-related peptides. Nitric oxide (NO), derived from non-adrenergic and non-cholinergic sources, mediates penile spiral artery and smooth muscle diastole via a cyclic guanosine-dependent pathway to trigger erection. Acetylcholine also promotes penile erection via presynaptic inhibition of adrenergic neurons and stimulation of NO release from vascular endothelial cells. Catecholamines and endothelial cell vasoconstrictor factors (e.g., prostacyclin F2α and endothelin) act together to inhibit erection and cause the penis to soften and shrink. NO produced by vascular endothelial cells plays an important physiological role in the erection process, while in contrast endothelin produced by endothelial cells has an erection-inhibiting effect. Studies have shown reduced intra-arterial NO synthesis and increased acetylcholine levels in OSAHS patients, and a significantly delayed vasodilatory response, indicating impaired vascular endothelial function in OSAHS patients. Vascular endothelial cell dysfunction is also manifested by increased levels of endothelin, which has a strong vasoconstrictive function, and decreased levels of NO, which has a diastolic function. This suggests that the inhibition of erectile function due to elevated plasma endothelin levels and reduced NO levels caused by vascular endothelial cell dysfunction is one of the pathogenic mechanisms of reduced male sexual function associated with OSAHS. Third, endocrine abnormalities also induce reduced sexual function in OSAHS patients. Sleep-related elevated blood testosterone levels exist during REM sleep in normal young men. However, this sleep-related blood testosterone secretion rhythm is disrupted in OSAHS patients due to sleep disruption, resulting in a significant decrease in the elevated blood testosterone levels at night. In addition, OSAHS causes pituitary-gonadal axis dysfunction, resulting in significantly lower nocturnal blood testosterone levels in OSAHS patients than in normal controls of the same age and weight. Therefore, reduced blood testosterone levels are one of the important pathogenic mechanisms of reduced male sexual function associated with OSAHS.
Causes of OSAHS affecting female sexual function
Sexual dysfunction occurs in about 50% of female OSAHS patients, and sexual dysfunction in women due to OSAHS is characterized by (1) sexual demand disorder: low sexual desire, frequent or recurrent lack of sexual fantasy and or lack of desire to receive sexual activity; (2) sexual arousal disorder: lack of subjective stimulation, lubrication and enlargement of the genital tract or other physical responses, including reduced sensitivity and engorgement of the labia and clitoris, and lack of vaginal (iii) orgasmic disorders: as frequent or recurrent difficulties in obtaining orgasm after adequate sexual stimulation and arousal, delayed and lack of orgasm; (iv) painful intercourse: as recurrent or frequent genital pain during intercourse, including vaginal spasm, inadequate lubrication, atrophy and vulvar pain. female sexual dysfunction associated with OSAHS may also be associated with intermittent hypoxemia causing nerve damage, dysfunction of the vascular endothelial system and endocrine abnormalities. First, the female genital organs are innervated by the sympathetic infra-abdominal plexus, the parasympathetic pelvic plexus, and the somatic nerves of the pubic region. Therefore, peripheral nerve axonal and myelin lesions caused by OSAHS-induced intermittent hypoxemia may also be involved in the development of OSAHS-related female sexual dysfunction, resulting in impaired relaxation of clitoral and vaginal smooth muscle during sexual activity. Second, vascular endothelial dysfunction caused by OSAHS plays a key role in the pathogenesis of female sexual dysfunction like OSAHS, because vascular endothelial dysfunction can cause insufficient blood supply to the clitoris and vagina during sexual activity, and insufficient lubrication and expansion of the genital tract. Third, blood testosterone levels are reduced in female OSAHS patients. Low testosterone levels are associated with decreased libido, sexual arousal disorders, and orgasm disorders in women; therefore, reduced blood testosterone levels are involved in the pathogenesis of sexual dysfunction in female OSAHS patients.
Treatment of OSAHS-related male and female dysfunction
1.Non-invasive ventilator therapy
Studies have shown that non-invasive ventilator therapy can improve sexual dysfunction in 25-75% of male OSAHS patients while correcting sleep breathing disorders. It is suggested that non-invasive ventilator therapy can also improve sexual dysfunction in some female patients. Non-invasive ventilator may improve ED by correcting apnea while increasing plasma NO levels, improving vascular endothelial function, reducing sympathetic excitability and increasing plasma testosterone levels.
2.Sildenafil
Sildenafil is more effective than non-invasive ventilators in treating sexual dysfunction in OSAHS patients, improving sexual dysfunction in 54% of male patients and presumably in female patients as well. Sildenafil may correct male and female dysfunction associated with OSAHS by directly relaxing penile arteries and cavernous smooth muscle in men or clitoral and vaginal smooth muscle in women.
[Keyword].
The couple love each other deeply, but the sexual dysfunction is very urgent.
There are many causes of this disease, and snoring is also a root cause.
The treatment of snoring will be effective, and the pain will be relieved to benefit the marriage.
Scientific Tips]
OSAHS is a disease that affects the whole body and can also lead to male and female sexual dysfunction, which can seriously endanger the quality of life and even cause marriage breakup. Therefore, if you encounter patients who snore and have sexual dysfunction at the same time, you should clarify whether they have OSAHS or not.