Sleep apnoea dulls sex life in both sexes; only men have treatment trials

Obstructive sleep apnoea disrupts breathing and sleep quality, and it can strain a couple's sexual relationship as well as the sleeper's daytime alertness. Erectile dysfunction in men with sleep apnoea has attracted research attention, but the wider question of which patient characteristics predict sexual difficulties, and whether women are affected in the same way, has been less clear. Knowing which determinants matter would help clinicians recognise the problem, and knowing which interventions have actually been tested reveals where the evidence stops. That gap is the real subject of this review.

The authors searched PubMed, CINAHL, Cochrane and TRIP for original research published in English between January 2004 and December 2014, in adults aged 18 years and over, including both experimental and non-experimental designs. Study quality was assessed with the Effective Public Health Practice Project tool for quantitative studies. Of the 21 studies included, 6 involved women and contained no trials in which people were assigned at random, while 15 involved men and included 6 such trials. Data were checked and reconciled between authors, and suitable quantitative results were pooled statistically.

Sexual function was affected to a similar degree in both sexes, but effective interventions were reported only for men. In some studies, the severity of the sleep apnoea itself and the medications taken contributed to greater sexual dysfunction. Among women, menopausal status, hormone levels and blood oxygen saturation below 90% were identified as determinants; among men, body mass index, hormonal status and inflammatory markers stood out. Continuous positive airway pressure improved not only clinical measures such as excessive daytime sleepiness but also erectile and orgasmic function, while sildenafil was superior to CPAP specifically for erectile dysfunction.

This maps a lopsided literature rather than resolving a controversy. It confirms that sexual dysfunction is a genuine feature of sleep apnoea for both sexes while showing that almost all treatment evidence has been generated in men, and that the studies in women were not designed to test interventions at all. The authors are explicit that firm generalisations cannot be made from what exists. Open questions include how sleep apnoea affects women's sexual function specifically, whether treating the apnoea helps them, and how much of the male benefit from CPAP reflects better sleep rather than a direct effect.

For anyone with diagnosed or suspected sleep apnoea, this is a reason to see sexual difficulties as potentially part of the picture rather than a separate issue, and a topic worth raising with a clinician. The finding that CPAP improved erectile and orgasmic function in men is encouraging but comes from a limited set of studies, and sildenafil outperformed it for erectile dysfunction in this review. For women, the honest summary is that nobody has yet run the treatment trials, so there is no comparable answer available. Recognising the gap is itself useful when weighing what you are told.