Erectile Dysfunction and Nocturia in Patients with Obstructive Sleep Apnea: Relationship with Hypoxia Parameters

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Background: Obstructive sleep apnoea (OSA) is characterized by recurrent episodes of airflow limitations resulting in oxygen desaturations during sleep. Intermittent hypoxia can cause lower urinary tract symptoms, particularly erectile dysfunction (ED) and nocturia. Aim and Objective: We aimed to evaluate the ED and nocturia and their relationship with OSA severity and hypoxia parameters in patients with OSA. Methods: In this prospective observational study, we evaluated 201 consecutive male patients underwent polysomnography between April 2024-February 2025, 180 patients with an apnoea-hypopnea index (AHI) of ≥5/h were included. Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were administered. Results: It was observed that 101 patients had ED (56%) and 72 had nocturia (40%). Patients with ED had higher AHI (p=0.014) and oxygen desaturation index (ODI) (p=0.012) compared to those without ED, while no difference was found in ESS and PSQI. Patients with nocturia were older (p<0.001), had higher BMI (p=0.040), AHI (p<0.001), and ODI (p<0.001) than those without nocturia; and poor sleep quality rate was higher (92% vs. 61%; p<0.001), while ESS scores were similar. Nocturia positively correlated with age (p<0.001), BMI (p=0.011), ODI (p<0.001), and sleep time with oxygen saturation (SpO2) below 90% (p=0.003); whereas minimum and mean SpO2 (p=0.004 and p<0.001, respectively) correlated negatively. Conclusions: This study shows that prevalence of ED and nocturia was high in patients with OSA, and these symptoms were associated with hypoxia parameters.

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