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Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome

Abstract

The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1±4.9) and 58 postmenopausal (mean age 59.9±4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea–Hypopnea Index (AHI) 10–30) and a severe OSA group (AHI >30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5±4.0 and 16.9±4.7, respectively) compared with not-severe OSA (23.4±5.5, P<0.01 and 21.8±7.5, P<0.05) and control subjects (27.0±5.5, P<0.01 and 24.0±6.7, P<0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26±0.2) compared with not-severe OSA (0.55±0.14, P<0.01) and control group (0.62±0.16, P<0.01), correlated significantly with FSFI (r=0.39, P<0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction.

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References

  1. Guilleminault C, Tilkian A, Dement WC . The sleep apnea syndromes. Annu Rev Med 1976; 27: 465–484.

    Article  CAS  Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S . The occurrence of sleep-disordered breathing in middle-age adults. N Engl J Med 1993; 328: 1230–1235.

    Article  CAS  Google Scholar 

  3. Bixter E, Vgontzas A, Lin H, Ten Have T, Rein J, Vela-Bueno A et al. Prevalence of sleep-disordered breathing in women. Am J Respir Crit Care Med 2001; 163: 608–613.

    Article  Google Scholar 

  4. Durán J, Esnaola S, Rubio R, Iztueta A . Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J respir Crit Care Med 2001; 163: 685–689.

    Article  Google Scholar 

  5. Strohl K, Redline S . Recognition of obstructive sleep apnea. Am J Respir Crit Care Med 1996; 154: 274–289.

    Article  Google Scholar 

  6. Saaresranta T, Polo O . Sleep-disordered breathing and hormones. Eur Respir J 2003; 22: 161–172.

    Article  CAS  Google Scholar 

  7. Young T, Peppard PE, Gottlieb DJ . Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165: 1217–1239.

    Article  Google Scholar 

  8. Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC . Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern Med 1977; 137: 296–300.

    Article  CAS  Google Scholar 

  9. Teloken PE, Smith EB, Lodowsky C, Freedom T, Mulhall JP . Defining association between sleep apnea syndrome and erectile dysfunction. Urology 2006; 67: 1033–1037.

    Article  Google Scholar 

  10. Gonçalves MA, Guilleminault C, Ramos E, Palha A, Paiva T . Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment. Sleep Med 2005; 6: 333–339.

    Article  Google Scholar 

  11. Margel D, Cohen M, Livne PM, Pillar G . Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology 2004; 63: 545–549.

    Article  Google Scholar 

  12. Heruti R, Shochat T, Tekes-Manova D, Ashkenazi I, Justo D . Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men. J Sex Med 2005; 2: 543–550.

    Article  Google Scholar 

  13. Koseoglu N, Koseoglu H, Itil O, Oztura I, Baklan B, Ikiz AO et al. Sexual function status in women with obstructive sleep apnea syndrome. J Sex Med 2007; 4: 1352–1357.

    Article  Google Scholar 

  14. Onem K, Erol B, Sanli O, Kadioglu P, Yalin AS, Canik U et al. Is sexual dysfunction in women with obstructive sleep apnea-hypopnea syndrome associated with the severity of the disease? A pilot study. J Sex Med 2008; 5: 2600–2609.

    Article  Google Scholar 

  15. Subramanian S, Bopparaju S, Desai A, Wiggins T, Rambaud C, Surani A . Sexual dysfunction in women with obstructive sleep apnea. Sleep Breath 2010; 14: 59–62.

    Article  Google Scholar 

  16. Petersen M, Kristensen E, Berg S, Giraldi A, Midgren B . Sexual function in female patients with obstructive sleep apnea. J Sex Med 2011; 8: 2560–2568.

    Article  Google Scholar 

  17. Johns MW . Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992; 15: 376–381.

    Article  CAS  Google Scholar 

  18. McKinlay SM, Brambilla DJ, Posner JG . The normal menopause transition. Maturitas 1992; 14: 157–160.

    Article  Google Scholar 

  19. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26: 191–208.

    Article  CAS  Google Scholar 

  20. Wiegel M, Meston C, Rosen R . The Female Sexual Function Index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 2005; 31: 1–20.

    Article  Google Scholar 

  21. Richter P, Werner J, Heerlein A, Kraus A, Sauer H . On the validity of the Beck Depression Inventory. A review. Psychopathology 1998; 31: 160–168.

    Article  CAS  Google Scholar 

  22. Beck A, Steer R, Brown LP . Manual for the Beck Depression Inventory II. Psychological Corporation: San Antonio, TX, 1996 pp 1–82.

    Google Scholar 

  23. Rechtschaffen A, Kales A . A Manual of Standardized Terminology: Techniques and Scoring System for Sleep Stages of Human Subjects. UCLA Brain Information Service/Brain Research Institute: Los Angeles, CA, 1968.

    Google Scholar 

  24. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667–689.

  25. Reynaert C, Zdanowicz N, Janne P, Jacques D . Depression and sexuality. Psychiatr Danub 2010; 22 (Suppl 1): S111–S113.

    PubMed  Google Scholar 

  26. Shindel AW, Eisenberg ML, Breyer BN, Sharlip ID, Smith JF . Sexual function and depressive symptoms among female North American medical students. J Sex Med 2011; 8: 391–399.

    Article  Google Scholar 

  27. Harris M, Glozier N, Ratnavadivel R, Grunstein RR . Obstructive sleep apnea and depression. Sleep Med Rev 2009; 13: 437–444.

    Article  Google Scholar 

  28. Habukawa M, Uchimura N, Kakuma T, Yamamoto K, Ogi K, Hiejima H et al. Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: contribution of daytime sleepiness to residual depressive symptoms. Sleep Med 2010; 11: 552–557.

    Article  Google Scholar 

  29. Saunamäki T, Jehkonen M . Depression and anxiety in obstructive sleep apnea syndrome: a review. Acta Neurol Scand 2007; 116: 277–288.

    Article  Google Scholar 

  30. Baran AS, Richert AC . Obstructive sleep apnea and depression. CNS Spectr 2003; 8: 128–134.

    Article  Google Scholar 

  31. Jackson ML, Stough C, Howard ME, Spong J, Downey LA, Thompson B . The contribution of fatigue and sleepiness to depression in patients attending the sleep laboratory for evaluation of obstructive sleep apnea. Sleep Breath 2011; 15: 439–445.

    Article  Google Scholar 

  32. Hayes R, Dennerstein L . The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies. J Sex Med 2005; 2: 317–330.

    Article  Google Scholar 

  33. Nappi RE, Albani F, Valentino V, Polatti F, Chiovato L, Genazzani AR . Aging and sexuality in women. Minerva Ginecol 2007; 59: 287–298.

    CAS  PubMed  Google Scholar 

  34. Camacho ME, Reyes-Ortiz CA . Sexual dysfunction in the elderly: age or disease? Int J Impot Res 2005; 17 (Suppl 1): S52–S56.

    Article  Google Scholar 

  35. Nappi RE, Lachowsky M . Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas 2009; 63: 138–141.

    Article  Google Scholar 

  36. Dennerstein L, Alexander JL, Kotz K . The menopause and sexual functioning: a review of the population-based studies. Annu Rev Sex Res 2003; 14: 64–82.

    PubMed  Google Scholar 

  37. Basson R, Schultz W . Sexual sequelae of general medical disorders. Lancet 2007; 369: 409–424.

    Article  Google Scholar 

  38. Davis SR . Androgens and female sexuality. J Gend Specif Med 2000; 3: 36–40.

    CAS  PubMed  Google Scholar 

  39. Sarrel PM . Sexuality and menopause. Obstet Gynecol 1990; 75 (4 Suppl): S26–S30.

    Google Scholar 

  40. Davison SL, Davis SR . Androgenic hormones and aging--the link with female sexual function. Horm Behav 2011; 59: 745–753.

    Article  CAS  Google Scholar 

  41. Netzer NC, Eliasson AH, Strohl KP . Women with sleep apnea have lower levels of sex hormones. Sleep Breath 2003; 7: 25–29.

    Article  Google Scholar 

  42. Luboshitzky R, Aviv A, Hefetz A, Herer P, Shen-Orr Z, Lavie L et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab 2002; 87: 3394–3398.

    Article  CAS  Google Scholar 

  43. White DP, Douglas NJ, Pickett CK, Weil JV, Zwillich CW . Sexual influence on the control of breathing. J Appl Physiol 1983; 55: 813–822.

    Article  Google Scholar 

  44. Davis SR, Guay AT, Shifren JL, Mazer NA . Endocrine aspects of female sexual dysfunction. J Sex Med 2004; 1: 82–86.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank M Pinaka and A Papakonstantinou for their assistance.

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Correspondence to C Stavaras.

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Stavaras, C., Pastaka, C., Papala, M. et al. Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome. Int J Impot Res 24, 228–233 (2012). https://doi.org/10.1038/ijir.2012.20

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