Work

Association between obstructive sleep apnea and erectile dysfunction and changes in erectile function following CPAP therapy: A systematic review

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Obstructive sleep apnea (OSA), a common form of sleep-disordered breathing, is characterized by recurrent upper airway obstruction during sleep and has been linked to vascular and neural dysfunction. Emerging evidence suggests a possible association between OSA and erectile dysfunction (ED); however, the magnitude of this association and the effects of continuous positive airway pressure (CPAP) therapy on erectile function remain uncertain. This review aimed to evaluate the association between OSA and ED and to assess the effects of CPAP therapy on erectile function. PubMed, Web of Science, and Embase (via Ovid) were systematically searched from inception to January 23, 2026. A total of 30 studies were included. Pooled analysis demonstrated that OSA was associated with an increased risk of ED (odds ratio 3.98, 95% CI 2.49–6.36). Several studies suggested that nocturnal oxygenation-related parameters may be associated with ED; however, the available evidence remains limited and heterogeneous, and no direct comparison with the apnea–hypopnea index was performed. These findings should therefore be regarded as hypothesis-generating. CPAP therapy was associated with improvements in erectile function, as reflected by increases in International Index of Erectile Function scores (standardized mean change 0.73, 95% CI 0.50–0.95), Sensitivity analyses showed that the pooled estimate decreased to 0.61 after exclusion of two studies contributing most to heterogeneity, while substantial heterogeneity persisted (I² = 72%). However, most intervention evidence was derived from uncontrolled within-group pre–post comparisons. Some individual studies reported greater improvements among patients with higher CPAP adherence. Current evidence suggests that OSA is associated with an increased likelihood of ED, and CPAP therapy may be associated with larger improvements on erectile function in some patients. However, the overall certainty of evidence remains very low, and well-designed prospective controlled studies are needed.

Source: Cell investigation.

DOI: 10.1016/j.clnves.2026.100091

Authors: Hongliang Jiang, Yiwen Zhou, Pengfei Zheng, Zezhong Mou, Shanwen Chen, Shanhua Mao

Language: English

Topic: Obstructive Sleep Apnea Research

Subfield: Physiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500

Funders: National Natural Science Foundation of China, National Key Research and Development Program of China