CPAP VERSUS CPAP PLUS LOW DOSE OF PDE-INHIBITOR IN MEN WITH OBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYNDROME (OSAHS) AND ERECTILE DYSFNCTION Vaios Papadimitriou 1 , Fragkiskos Sofras 1 , Izolde Bouloukaki 2 , Nikos Tzanakis 2 , Elina Vlachaki 2 , Charalampos Mermigis 2 , Nikolaos M. Siafakas 2 , Sophia E. Schiza 2 . 1. Department of Urology, University General Hospital, Medical School of the University of Crete, Greece 2. Sleep Disorders Unit, Medical School, University of Crete, Heraklion, Greece INTRODUCTION: •Several studies have demonstrated erectile dysfunction (ED) in substantial proportions of male patients diagnosed with obstructive sleep apnea-hypopnea syndrome (OSAHS). •In addition, up to 30-45% of patients with ED may be diagnosed with OSAHS. •OSAHS therefore represents a potentially modifiable risk factor for ED and elimination of OSAHS could contribute to treatment of ED. •Treatment with continuous positive airway pressure (CPAP) improves ED. •The treatment options for ED have expanded in recent years, with the introduction of PDE5 inhibitors. •Currently, three PDE-5 inhibitors – sildenafil, tadalafil and vardenafil – are approved , but only one of these, tadalafil, with the advantage of a longer duration of action, has been approved to be taken once daily. PURPOSE: We aimed to evaluate the effects of CPAP versus CPAP plus low dose of PDE-5 inhibitor (Tadalafil) for 3 months on ED and on nocturnal penile tumescence (NPT) in men with OSAHS and ED. METHODS: •Consecutive patients, aged 25-65, with symptoms suggestive of OSAHS were asked to participate in this study. •All patients fulfilled a revised International Index of Erectile Function questionnaire (IIEF) before sleep evaluation. •IIEF scores <26 was considered indicative of ED. •Exclusion criteria were: known ED treated with medication, uncontrolled hypertension, metabolic syndrome, cardiovascular, neurogenic and psychiatric diseases, COPD, alcoholism, illicit drug abuse and hyperlipidemia. •Eligible patients were randomized into two groups. Group 1 was treated with CPAP and group 2 with CPAP plus 5 mg Tadalafil once daily for 3 months. •Patients were evaluated with NPT using Rigiscan device in combination with overnight polysomnography before and after the treatment period. •The main outcome measures for effectiveness were the IIEF scores and erectile events •Treatment compliance was monitored monthly. RESULTS II: •After treatment, there was a significant improvement in IIEF score (p=0.018) in group 1 and in group 2 (p=0.001), although the difference between the two groups was not significant (p=0.107). •There was also a significant increase of total erectile events in group 1 (p=0.002) and in group 2 (p=0.003). CONCLUSIONS: •Our findings suggest that CPAP improves sexual performance in patients with OSAHS and ED. •Therefore clinicians assessing patients with ED should also screen for underlying OSAHS. •Furthermore, the combination of CPAP and low dose of PDE-5 inhibitor seems to be highly effective in these patients. •Both treatment modalities are safe and well tolerated. References: 1. Li X, Dong Z, Wan Y, Wang Z. Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a meta-analysis. Aging Male. 2010; 2:82-6 2.Budweiser S, Enderlein S, Jörres RA, et al. Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009;6:3147-57 3. Goncalves M.A., Guilleminault C., Ramos E., Pahla A., et al. Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment. Sleep Med 2005;6:333-9 4. Perimenis P., Konstantinopoulos A., Karkoulias K., et al. Sildenafil combined with continous positive airway pressure for treatment of erectile dysfunction in men with obstreuctive sleep apnea. Int Urol Nephrol 2007;39:542-52 5. Heruti R, Shochat T, Tekes-Manova D, et al. Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men. J Sex Med 2005;2:543-50 6. Karkoulias K, Perimenis P, Charokopos N, et al. Does CPAP therapy improve erectile dysfunction in patients with obstructive sleep apnea syndrome? Clin Ter. 2007; 6:515-8 RESULTS I: Flow diagram of patients through each stage of the trial. Group 1 Group 2 Age 48,18 ± 8,26 46,91 ± 8,91 AHI 51,69 ± 29,92 48,09 ± 26,39 BMI 34,42 ± 3,9 32,41 ± 3,74 IIEF-5 score before therapy 14.36 ± 6.73 14.3 ± 5.46 IIEF-5 score after therapy 21.18 ± 7.37 25.7 ± 5.01 Total Rigidity Events before therapy 1.46 ± 1.12 1.1 ± 1.1 Total Rigidity Events after therapy 2.45 ± 1.44 2.3 ± 0.95 Table 1. 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