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Original Investigation
July 2018

Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep ApneaFollow-up Study of a Randomized Clinical Trial

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
  • 2Department of Otolaryngology–Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California
  • 3Surgery Service, Department of Veterans Affairs Medical Center, Seattle, Washington
JAMA Otolaryngol Head Neck Surg. 2018;144(7):587-593. doi:10.1001/jamaoto.2018.0485
Key Points

Question  What is the association of long-term continuous positive airway pressure with sexual quality of life in patients with sleep apnea?

Findings  In a cohort study of 182 patients with sleep apnea, a significant improvement in sexual quality of life measures was observed among patients who used continuous positive airway pressure vs those who did not at long-term follow-up.

Meaning  In patients with sleep apnea, successful continuous positive airway pressure use may be associated with better improvements in sexual quality of life.


Importance  Obstructive sleep apnea reduces sexual quality of life (QOL) as a result of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. Treatment for obstructive sleep apnea may improve sexual QOL.

Objective  To test the association of long-term continuous positive airway pressure (CPAP) treatment with sexual QOL for patients with obstructive sleep apnea.

Design, Setting, and Participants  Prospective cohort study at a single, tertiary medical center of patients with newly diagnosed obstructive sleep apnea who were prescribed CPAP treatment from September 1, 2007, through June 30, 2010 (follow-up completed June 30, 2011). The statistical analysis was performed from February 1 through December 31, 2017.

Exposures  Use of CPAP treatment objectively measured by the number of hours per night. Users of CPAP were defined as patients who used CPAP treatment for more than 4 hours per night, and nonusers were defined as patients who used CPAP treatment for fewer than 0.5 hours per night.

Main Outcomes and Measures  Data were collected from eligible patients before CPAP treatment was prescribed and 12 months later by using the validated Symptoms of Nocturnal Obstruction and Related Events–25 (SNORE-25) QOL instrument. The 2 sex-specific items used to create the sexual QOL domain were taken from the SNORE-25. The sexual QOL domain was scored in a range from 0 to 5 (higher score is worse). The difference in sexual QOL between CPAP users and nonusers was analyzed using a paired, 2-tailed t test and multivariable linear regression adjusted for potential confounders.

Results  Of the 182 participants in the cohort, 115 (63.2%) were men (mean [SD] age, 47.2 [12.3] years) with severe OSA (mean [SD] apnea-hypopnea index, 32.5 [23.8] events per hour). At the 12-month follow-up, 72 CPAP users (mean [SD] use, 6.4 [1.2] hours per night) had greater improvement than 110 nonusers (0 [0] hours per night) in sexual QOL scores (0.7 [1.2] vs 0.1 [1.1]; difference, 0.54; 95% CI, 0.18-0.90; effect size, 0.47). A moderate treatment association was observed after adjustment for age, sex, race/ethnicity, marital status, income level, educational level, body mass index, apnea-hypopnea index, and the Functional Comorbidity Index (adjusted difference, 0.49; 95% CI, 0.09-0.89; effect size, 0.43). Subgroup analysis revealed a large treatment association for women (adjusted difference, 1.34; 95% CI, 0.50-2.18; effect size, 0.87) but not for men (adjusted difference, 0.16; 95% CI, −0.26 to 0.58; effect size, 0.19).

Conclusions and Relevance  Successful CPAP use may be associated with improved sexual QOL. Subgroup analysis revealed a large improvement in women but no improvement in men. Further study is warranted to test other measures of sexual QOL and other treatments.

Trial Registration  ClinicalTrials.gov Identifier: NCT00503802