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.