DISCUSSION
In this study, we determined that in patients with PE, the presence of
OSAS was associated with significantly worse IELT and AIPE scores, while
the treatment of OSAS was associated with significant improvement in
both scores, without any specific treatments for PE.
Though it is not a rare condition, the exact pathophysiological
mechanisms underlying PE remain unclear. Several potential factors have
been proposed, including anxiety and depression, 5-HT receptor
dysfunction, genetic factors, thyroid diseases, and prostate
inflammation (13-16).
To the best of our knowledge, this is the first study in the literature
to demonstrate that OSAS was associated with more severe PE. The
pathology of OSAS depends on repeated episodes of hypoxia during sleep
that may result in cyclic changes in arterial oxygen saturation and
increased production of reactive oxygen species (17,18). OSAS has been
linked to sexual disturbances in previous studies. Higher prevalence of
sexual dysfunction and erectile dysfunction was reported in OSAS
patients (7,19). Matos et al. (20) reported increased serum
concentration of tumor necrosis factor-alpha, which is an inflammatory
marker, in association with erectile dysfunction in men with OSAS.
Similarly, oxidative stress and systemic inflammation may play a role in
the development of PE in OSAS patients. However, since we did not
evaluate inflammatory or oxidative stress markers before or after
treatment, we cannot draw any conclusions regarding the
pathophysiological role of inflammation in PE among patients with OSAS.
Another important finding in this study was the improvement of IELT and
AIPE scores in patients with moderate or severe OSAS after 1 year of
CPAP therapy. Husnu et al. (22) reported a significant improvement in
erectile dysfunction complaints in patients with OSAS after 3 months of
regular CPAP usage. Similarly, Taskin et al. (23) also reported an
improvement in erection function in OSAS patients with CPAP treatment.
The significant improvement in IELT and AIPE scores after 1 year of CPAP
therapy in our study support these findings and demonstrate the
association between PE and OSAS. Although CPAP is not a direct treatment
method for PE, our study showed that PE also improved with treatment of
OSAS.
Some psychological factors and hormonal and inflammatory diseases were
suggested to have important roles in the pathophysiological mechanisms
of PE (13-16). In this study, unemployment was more common in OSAS
groups, which may aggravate the psychological factors involved in PE.
Moreover, we also determined that serum total testosterone levels were
significantly lower in the OSAS groups, which may also play a role in
shorter IELT and poorer AIPE scores. We did not observe any significant
differences between the groups in terms of thyroid function tests.
There are some limitations to this study that should be mentioned. The
data related to PE in this study were based on patient reports.
Secondly, we did not evaluate the participants’ Epworth sleepiness scale
scores or serum testosterone levels at 1 year. Therefore, we could not
assess the role of these factors in PE.
In conclusion, we determined that the presence of moderate or severe
OSAS was associated with significantly worse IELT and AIPE scores in men
with PE, and the treatment of OSAS was associated with significant
improvement in both scores in the absence of any specific treatments for
PE. Larger studies evaluating the pathophysiological mechanisms of PE in
OSAS patients are warranted.