Evaluation of Sexual Dysfunction and Its Predictors in Men with Obstructive Sleep Apnea Syndrome: A Multidimensional Clinical and Psychological Approach

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is a common sleep-related breathing disorder associated with significant cardiovascular, metabolic, and neuropsychological consequences. Increasing evidence suggests that OSAS may also adversely affect male sexual function; however, sexual health remains underrecognized in routine clinical practice. This study aimed to evaluate the prevalence of sexual dysfunction in men with OSAS and to identify its clinical, psychological, and polysomnographic predictors using a multidimensional approach. Methods: This cross-sectional study included 52 men diagnosed with OSAS and 40 age-matched healthy controls. All participants underwent overnight type 1 polysomnography. Daytime sleepiness, anxiety, depression, sexual function, and quality of life were assessed using the Epworth Sleepiness Scale (ESS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Arizona Sexual Experience Scale (ASEX), and SF-36 questionnaire, respectively. Associations between sexual dysfunction and demographic, psychological, and sleep-related parameters were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate predictive factors. Results: Sexual dysfunction was significantly more prevalent in men with OSAS compared to controls (p = 0.04) and was strongly associated with increasing OSAS severity. Men with sexual dysfunction exhibited significantly higher apnea-hypopnea index (AHI), ESS, anxiety, and depression scores, along with lower physical functioning, vitality, and mental health scores (all p < 0.05). ROC analysis demonstrated that AHI was a significant associated factor of sexual dysfunction (AUC = 0.709), with a sensitivity of 91% and specificity of 81% at a cutoff value of 59.75. Conclusion: Sexual dysfunction in men is closely related to the severity of OSAS rather than its mere presence. AHI emerges as a key associated factor, highlighting the importance of comprehensive sexual and psychological assessment in the clinical management of men with OSAS.