Podcast of the Journal of Clinical Sleep Medicine

Journal of Clinical Sleep Medicine, Vol.6, No. 3, 2010 Welcome to the regular podcast of the Journal of Clinical Sleep Medicine. I am Dr. Stuart Quan, editor of the Journal. These podcasts are a regular feature of each issue of the Journal and can be downloaded at the Journal’s website. Each podcast features summaries of important articles published in the current issue of the Journal, as well as occasional interviews with authors of these papers. The lead article in this issue of the Journal is entitled, “Outcome of CPAP Treatment on Intimate and Sexual Relationships in Men with Obstructive Sleep Apnea,” by Drs. Reishtein, Maislin, Weaver, and the multi-site study group from the University of Pennsylvania in Philadelphia, Pennsylvania. When one reviews presenting symptoms in patients with obstructive sleep apnea, one symptom that is commonly cited is impotence. Although most patients present to their physicians with symptoms of daytime sleepiness and loud snoring, on occasion, a patient will present with a complaint of impotence. As noted by the authors, intimate and sexual relationships are important aspects of human life. However, with respect to sleep apnea, the impact of impotence has not been well described. In this study, 123 male patients with obstructive sleep apnea having an apnea-hypopnea index greater than 20 and being 21 to 60 years old underwent polysomnography, multiple-sleep latency testing and completion of the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire before and three months after being started on continuous positive airway pressure treatment. In general, the subjects were obese with a body mass index of 37.59 kg/metered square and they had a mean age of 46.35 years. The mean apnea-hypopnea index before starting treatment was quite high at 66.9. Almost all of the participants were married. Before starting treatment, with respect to four aspects of intimacy and sexual relationships, 69% reported difficulty with desire, 63% with intimacy, 46% with arousal and 29% with orgasm. After using CPAP, there was improvement in all four of these domains with desire being reduced to 40%, intimacy 34%, arousal 2% and orgasm 18%. In addition, the baseline score on the intimate-sexual relationships portion of the FOSQ showed that at baseline it was 3.17 and increased to 3.62 which was an effect size of 0.61 and highly significant. The authors concluded that obstructive sleep apnea has an adverse impact on intimate and sexual relationships and this improved with CPAP therapy. In an editorial accompanying this paper, Dr. James Parrish from the Mayo Clinic in Scottsdale notes that despite improvement in intimacy and sexual function, scores did not return to normal suggesting that other factors were involved in impairment in these individuals. He suggests that male sexual dysfunction is associated with a variety of issues. He notes that snoring by itself can contribute to sexual relationship dysfunction. Furthermore, he suggests that other factors such as older age, obesity, and a number of other medical conditions as well as medications could be contributing to the sexual dysfunction in patients with obstructive sleep apnea. The next paper to be highlighted in this podcast is entitled, “Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea,” by Drs. Permut, DiazAdad, Chatila, Crocetti, Gaughan, D’Alonzo and Krachman from Temple University in Philadelphia, Pennsylvania, the University of Maryland in Baltimore, Maryland and Abington Memorial Hospital in Abington, Pennsylvania. Some patients with obstructive sleep apnea have their apneic and hypopneic episodes almost exclusively when they are laying on their back. Thus, measures to promote sleeping in the non-supine position may be beneficial in these patients. In this paper, the authors studied 38 patients with positional obstructive sleep apnea. They were randomly assigned to a proprietary positioning device or a night on CPAP. The positioning device is constructed of lightweight, semi-rigid synthetic foam and its manufacturer is listed in the published article. The patients had relatively mild obstructive sleep apnea with an apnea-hypopnea index of 13 events/hour of total sleep time overall with an index of 31 in the supine position and two when non-supine. The authors found that the positioning device was effective in normalizing the apnea-hypopnea index to less than five in almost all participants. In addition, the percentage of total sleep time in the supine position decreased from 40% to 0% with the positioning device. The authors conclude that positional therapy was found to be effective in the treatment of these patients and was similar to CPAP. It should be noted, however, that these patients by and large had relatively mild obstructive sleep apnea. The next paper to be highlighted in this issue of the Journal is entitled, “Endothelial Function in Patients with Post-CPAP Residual Sleepiness,” by Drs. El-Solh, Akinnusi, Moitheennazima, Ayyar and Relia from the Veteran’s Affairs Western New York Healthcare System in Buffalo, New York and the State University of New York at Buffalo School of Medicine. Some patients with obstructive sleep apnea who are treated with continuous positive airway pressure remain sleepy despite control of their sleep-disordered breathing. In addition, patients with obstructive sleep apnea have been found to have impairment in endothelial function. In this study, the authors investigated whether patients with residual excessive sleepiness despite Podcast of the Journal of Clinical Sleep Medicine