Does CPAP improve sexual QOL in women with sleep apnea?
Long-term sexual quality of life (QOL) may be improved in women with obstructive sleep apnea (OSA) who are using continuous positive airway pressure (CPAP) for at least 4 hours a night, according to a follow-up study in JAMA Otolaryngology – Head & Neck Surgery. Previous studies had only seen improved sexual QOL in men with OSA following CPAP treatment.
This study included 182 adult patients with newly diagnosed OSA who were prescribed CPAP. Of the 182 participants, 115 (63.2%) were men (mean [SD] age, 47.2 [12.3] years) and 137 (75.3%) were white. The participants were obese (mean [SD] body mass index [BMI], 31.9 [6.7]) and had severe OSA (mean [SD] apnea-hypopnea index, 32.5 [23.8] events per hour). The cohort also had QOL comorbidities (mean [SD] Functional Comorbidity Index, 2.2 [1.7]). Of the participant group, there were 72 CPAP users (mean [SD], 6.4 [1.2] hours per night) and 110 nonusers.
The researchers used the Symptoms of Nocturnal Obstruction and Related Events-25 (SNORE-25), a five-point Likert scale, to assess QOL change in OSA. They also created a sexual QOL domain from the 2 sex-specific items in the questionnaire (“Because of medical problem, unable to have sexual relations” and “Lack of desire for sexual relations”). Using the mean for the responses to those 2 questions, they created a sexual QOL score ranging from 0 to 5 (a higher score is worse). Both the CPAP users and nonusers had a clinically important baseline deficit in sexual QOL. But at 12 months, CPAP users experienced a mean improvement in QOL (mean [SD] change, 0.7 [1.2]; 95% CI, 0.4-1.0; ES (mean change score divided by the baseline SD), 0.60). Nonusers had no significant change in sexual QOL at 12 months (mean [SD] change, 0.1 [1.1]; 95% CI, -0.1 to 0.4; ES, 0.11).
In unadjusted analysis, CPAP users had greater improvement than nonusers with a moderate ES (unadjusted difference, 0.54; 95% CI, 0.18-0.90; ES, 0.47). The association remained after adjusting for age, sex, race, marital status, income and education levels, BMI, apnea-hypopnea index, and the Functional Comorbidity Index. Adjusted and unadjusted subgroup analysis in women showed that CPAP users had a greater improvement in sexual QOL at 12 months than nonusers (unadjusted difference, 1.24; 95% CI, 0.51-1.96; ES, 0.80; adjusted difference, 1.34; 95% CI, 0.50-2.18; ES, 0.87). However, adjusted and unadjusted analysis in men revealed no significant difference in sexual QOL between CPAP users and nonusers (unadjusted difference, 0.14; 95% CI, -0.23 to 0.51; ES, 0.17; adjusted difference, 0.16; 95% CI, -0.26 to 0.58; ES, 0.19). In fully adjusted analyses, the addition of marital status alone to the initial model slightly weakened the association (adjusted difference, 0.31; 95% CI, -0.09 to 0.71). The addition of income level alone strengthened the association (adjusted difference, 0.55; 95% CI, 0.15-0.94) but the addition of education slightly weakened the association (adjusted difference, 0.35; 95% CI, -0.03 to 0.74).
The researchers believe the study supported their hypothesis that long-term CPAP use improves sexual QOL in a cohort of patients with OSA. However, they were surprised to find that subgroup analysis showed that men had no treatment outcome, while women had a pronounced treatment outcome in sexual QOL. This result differs from previous studies that returned a more pronounced outcome in men. They also note a few strengths and limitations to this study. Among the mentioned strengths were the measurement of CPAP use, a broad sample of patients with OSA, a validated QOL instrument and inclusion of a general population with OSA. Among the mentioned limitations were not using a validated instrument for measuring sexual QOL and the scope of the QOL assessment. The researchers believe that future research should include a larger multicenter trial that compares CPAP with less cumbersome treatments and using a validated sexual QOL instrument.