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.