MATERIALS and METHODS
Sexually active men between the ages of 20 and 50 years who were
diagnosed with PE within the last 3 months but not treated, presented to
the sleep laboratory of Esrefpasa Metropolitan Municipality Hospital
between January 2018 and June 2020, and were diagnosed as having
moderate or severe OSAS were included in the study. Patients diagnosed
as having mild OSAS were excluded. The control group consisted of men
with PE who did not have OSAS (apnea-hypopnea index [AHI]
< 5).
Patients with a history of urogenital system tumors, urogenital system
surgery, neurogenic bladder, hypogonadism, kidney and liver failure,
urethral stricture, bladder stones, overactive bladder, or chronic
prostatitis were excluded from the study. In addition, patients with
malnutrition and those using drugs that adversely affect libido and
erectile function, such as antidepressants, were also excluded.
The study was approved by the local ethics committee and performed in
accordance with the ethical standards set forth in the 1964 Declaration
of Helsinki and later amendments. Informed consent was obtained from all
participants.
For sleep analysis, we used standard 14-channel polysomnography,
including electroencephalogram (C3-A2, C4-A1, O1-A2, O2-A1),
electro-oculograms, electromyograms (EMG) of the left/right extremity,
electrocardiogram (ECG), heart rate, nasal and oral air flow, thoracic
and abdominal movements, registration of snoring, body position, oxygen
saturation (SaO2) monitored by pulse oximetry, and
polysomnography with video monitoring. Apnea was defined as the
cessation of airflow for at least 10 s. Hypopnea was defined as any
reduction of airflow lasting at least 10 s and resulting in arousal or
oxygen desaturation (>4% decrease in
SaO2).
Apnea-hypopnea index (AHI) was calculated as the number of apnea and
hypopnea events per hour of total sleep time (9). OSAS was graded as
mild (AHI=5–14), moderate (AHI=15–29), or severe (AHI≥30). Only
patients diagnosed with moderate or severe OSAS were included in the
study; those with mild OSAS were excluded. Men with AHI below 5 were
included in the control group.
At the start of the study, all participants’ demographic features,
height, weight, body mass index (BMI), chronic comorbid diseases,
history of smoking and alcohol use, serum thyroid function test results,
and total testosterone levels were determined. BMI was calculate as
weight (kg) / height (m)2.
The Arabic Index of Premature Ejaculation (AIPE) and intravaginal
ejaculation latency time (IELT) were evaluated for the diagnosis of PE.
An AIPE value less than 30 supports the diagnosis of PE (10). IELT was
defined as the time from first penetration to ejaculation in seconds
(11).
Indications for CPAP usage according to the American Academy of Sleep
Medicine 2008 report were AHI ≥15 or AHI ≥5 plus the presence of
major/obvious symptoms, cardiovascular or cerebrovascular risk factors
(hypertension, stroke, excessive daytime sleepiness, ischemic heart
disease, insomnia), and the existence of mental disorders (12). CPAP
titration was done on another day for the patients in whom treatment was
planned according to AHI score.
Patients with OSAS who agreed to participate in the study underwent 1
year of CPAP therapy, after which their AIPE and IELT were reevaluated.
Similarly, AIPE and IELT were evaluated in the patients in the control
group at 1-year follow-up. None of the patients in the control or study
groups received additional treatment for PE during the study period.