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28.07.2021 | Sleep Breathing Physiology and Disorders • Original Article

Depression and obesity, but not mild obstructive sleep apnea, are associated factors for female sexual dysfunction

verfasst von: Glaury Coelho, Lia Bittencourt, Monica Levy Andersen, Thais Moura Guimarães, Luciana Oliveira e Silva, Gabriela Pontes Luz, Sergio Tufik, Helena Hachul

Erschienen in: Sleep and Breathing | Ausgabe 2/2022

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Abstract

Purpose

Mild obstructive sleep apnea (OSA) is more prevalent than moderate and severe OSA and is more frequent in men than women. The association between OSA and female sexual dysfunction (FSD) is still poorly explored in published studies. Our aim was to investigate the prevalence of FSD in women with mild OSA and assess the impact of OSA on FSD, as well as to determine the predictors for FSD risk.

Methods

The sample comprised 70 women aged 26–65 years: a control group (N = 28) with no sleep complaints, and a group with mild OSA (an apnea–hypopnea index of 5 or more and less than 15 events/hour, N = 42), who had been diagnosed using polysomnography performed in the sleep laboratory of a sleep research institute. All participants volunteered to take part in the study and completed the female sexual function index (FSFI), the Beck depression index (BDI), the Kupperman menopausal index (KMI), and the Epworth sleepiness scale (ESS). Their socioeconomic group was assessed using the Brazilian Economic Classification Criterion. Polysomnography and serum levels of free testosterone and total testosterone were analyzed.

Results

We found low FSFI scores (< 26.55) in the mild OSA (18.1) and control (21.7) groups (p = 0.97). There was no statistically significant difference between the mild OSA group and the control group. However, a higher BMI (p = 0.04), a higher BDI (p = 0.02), and being sexuality inactive (p = 0.001) were risk factors for FSD.

Conclusion

There was a high prevalence of FSD in the entire sample. The presence of mild OSA did not affect sexual function in this sample. Depressive symptoms and a high BMI were associated risk factors for FSD. Being sexually active may protect female sexual function.

American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–89CrossRef

Iber C, Ancoli-Israel, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine

American Academy of Sleep Medicine - International classification of sleep disorders (2014) 3rd edn (ICSD-3). Diagnostic and coding manual

Collop NA, Adkins D, Phillips BA (2004) Gender differences in sleep and sleep-disordered breathing. Clin Chest Med 25:257–268. https://doi.org/10.1016/j.ccm.2004.01.002CrossRefPubMed

Wimms AJ, Ketheeswaran S, Armitstead JP (2014) Obstructive sleep apnea in women: specific issues and interventions. RESMED Science Center. doi: 10. 1155/ 2016/ 1764837

Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse PE, Drager LF, Griss B, Marshall N, Patel SR, Patil S, Knight SL, Rowley JA, Slyman A (2016) ATS Ad Hoc Committee on Mild Obstructive Sleep Apnea. An official American Thoracic Society research statement: impact of mild obstructive sleep apnea in adults. Am J Respir Crit Care Med. 193:37–54. https://doi.org/10.1164/rccm.201602-0361STCrossRef

Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA (2010) Obstructive sleep apnea syndrome in the São Paulo epidemiologic sleep study. Sleep Med 11:441–446. https://doi.org/10.1016/j.sleep.2009.10.005CrossRefPubMed

Stavaras C, Pastaka C, Papala M, Gravas S, Tzortzis V, Melekos M, Seitanidis G, Gourgoulianis KI (2012) Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome. Intern Journal of Impotence Research 24:228–233. https://doi.org/10.1038/ijir.2012.20CrossRef

Subramanian S, Bopparaju S, Desai A, Wiggins T, Rambaud C, Surani S (2010) Sexual dysfunction in women with obstructive sleep apnea. Sleep Breath 14:59–62. https://doi.org/10.1007/s11325-009-0280-4CrossRefPubMed

10.

DSM V - Diagnostic and statistical manual of mental disorders (2013) American psychiatric association. 5th Ed. Washington, DC: American Psychiatric Association

11.

Abdo C, Oliveira WM Jr, Moreira ED Jr, Fittipald JAS (2004) Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women-results of the Brazilian study on sexual behavior (BSSB). Int J Impot Res 16:160–166. https://doi.org/10.1038/sj.ijir.3901198CrossRefPubMed

12.

Köseoglu N, Köseoglu H, Itil O, Itil O, Öztura I, Baklan B, Ikiz AO Esen AA. Sexual function status in women with obstructive sleep apnea syndrome. J Sex Med 2007; 4: 1352–7. doi: https://doi.org/10.1111/j.1743-6109.2006.00302.x.

13.

Onem K, Erol B, Sanli O, Kadioglu P, Yalin AS, Canik U, Cuhadaroglu C, Kadioglu A (2008) Is sexual dysfunction in women with obstructive sleep apnea-hypopnea syndrome associated with the severity of the disease? A pilot study. J Sex Med 5:2600–2609. https://doi.org/10.1111/j.1743-6109.2008.00934.xCrossRefPubMed

14.

Petersen M, Kristensen E, Berg S, Giraldi AM, Midgren B (2011) Sexual function in female patients with obstructive sleep apnea. The J Sex Med 8:2560–2568. https://doi.org/10.1111/j.1743-6109.2011.02358.xCrossRefPubMed

15.

Fanfulla F, Camera A, Fulgoni P, Chiovato L, Nappi RE (2013) Sexual dysfunction in obese women: does obstructive sleep apnea play a role? Sleep Med 14:252–256. https://doi.org/10.1016/j.sleep.2012.11.023CrossRefPubMed

16.

Steinke E, Johansen PP, Fridlund B, Broström A (2016) Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review. Int J Clin Pract 70:5–19. https://doi.org/10.1111/ijcp.12751CrossRefPubMed

17.

World Health Organization (2013) Geneva: World Health Organization; obesity and overweight. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/

18.

Soules MR, Sherman S, Parrott E et al (2001) Executive summary: stages of reproductive aging workshop (STRAW). Fertil Steril 76:874–878. https://doi.org/10.1210/jc.2011-3362CrossRefPubMed

19.

Associação Brasileira de Empresas de Pesquisa – ABEP (2012) São Paulo. Brazilian economic classification criterion – BECC. Available from: http://www.abep.org/codigo-e-guias-da-abep .

20.

Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545. https://doi.org/10.1093/sleep/14.6.540CrossRefPubMed

21.

Bertolazi ANFSC, Hoff LS et al (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35:877–883. https://doi.org/10.1590/s1806-37132009000900009CrossRefPubMed

22.

Hentschel H, Alberton DL, Capp E, Goldin JR, Passos ED (2007) Validação do Female sexual function index (FSFI) para uso em língua portuguesa. Revista HCPA 27:1

23.

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R (2002) The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208. https://doi.org/10.1080/009262300278597CrossRef

24.

Kupperman HS, Wetchler BB, Blatt MHG (1959) Contemporary therapy of the menopausal syndrome. J Am Med Assoc 171:1627–1637. https://doi.org/10.1001/jama.1959.03010300001001CrossRefPubMed

25.

Cunha JA (2001) Manual da versão em português das escalas Beck. São Paulo: Casa do Psicólogo

26.

Clayton AH, Groth J (2013) Etiology of female sexual dysfunction. Womens Health 9:135–137. https://doi.org/10.2217/whe.13.6CrossRef

27.

Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl-Meyer K, Graziottin A, Heiman JR et al (2004) Revised definitions of women’s sexual dysfunctions. J Sex Med 1:40–48. https://doi.org/10.2217/whe.13.6CrossRefPubMed

28.

Netzer NC, Eliasson AH, Strohl KP (2003) Women with sleep apnea have lower levels of sex hormones. Sleep and Breathing 7:25–29. https://doi.org/10.1007/s11325-003-0025-8CrossRefPubMed

29.

Andersen ML, Alvarenga TF, Mazaro-Costa R, Hachul HC, Tufik S (2011) The association of testosterone, sleep, and sexual function in men and women. Brain Res 1416:80–104. https://doi.org/10.1016/j.brainres.2011.07.060CrossRefPubMed

30.

Jennum P (2010) Quality of life, co-morbidity and obstructive sleep apnoea. The Clinical Respiratory Journal 129–130. doi: https://doi.org/10.1111/j.1752-699X.2010.00211. x.

31.

Hachul H, Bittencourt LRA, Soares JM Jr, Tufik S, Baracat EC (2009) Sleep in post-menopausal women: differences between early and late post-menopause. EurJ Obst Gynecol Rep Biol 145:81–84. https://doi.org/10.1016/j.ejogrb.2009.03.019CrossRef

32.

Costa R, Costa D, Pestana J (2017) Subjective sleep quality, unstimulated sexual arousal, and sexual frequency. Sleep Sci 10(4):147–153. https://doi.org/10.5935/1984-0063.20170026CrossRefPubMedPubMedCentral

33.

Kische H, Ewert R, Fietze I, Gross S, Wallaschofski H, Völzke H, Dörr M, Nauck M, Obst A, Stubbe B, Penzel T, Haring R (2016) Sex hormones and sleep in men and women from the general population: a cross-sectional observational study. J Clin Endocrinol Metab 101:3968–3977. https://doi.org/10.1210/jc/2016-1832CrossRefPubMed

34.

Avis NE, Brockwell S, Colvin A (2005) A universal menopausal syndrome? Am J Med 118:37S-46S. https://doi.org/10.1016/j.amjmed.2005.09.057CrossRef

35.

Al-Azzawi F, Palacios S (2009) Hormonal changes during menopause. Maturitas 63:135–137. https://doi.org/10.1016/j.maturitas.2009.03.009CrossRefPubMed

36.

Cabral PUL, Canário ACG, Spyrides MHC, Uchôa SAC, Eleutério J Jr, Gonçalves AK (2013) Determinants of sexual dysfunction among middle-aged women. Int J Gynecol Obstet 120:271–274. https://doi.org/10.1016/j.ijgo.2012.09.023CrossRef

37.

Hess R, Conroy MB, Ness R, Bryce CL, Dillon S, Chang CCH, Matthews KA (2010) Association of lifestyle and relationship factors with sexual functioning of women during midlife. J Sex Med 6:1358–1368. https://doi.org/10.1111/j.1743-6109.2009.01225.xCrossRef

38.

Lee SH, Lee YJ, Kim S, Choi JW, Jeong DU (2017) Depressive symptoms are associated with poor sleep quality rather than apnea-hypopnea index or hypoxia during sleep in patients with obstructive sleep apnea. Sleep Breath: 997–1003. doi: https://doi.org/10.1007/s11325-017-1550-1.

39.

McCall WV, Harding D, O’Donovan C (2006) Correlates of depressive symptoms in patients with obstructive sleep apnea. J Clin Sleep Med 2(4):424–426CrossRef

40.

Acker J, Richter K, Piehl A, J Herold J, Ficker JH, Niklewski G. Obstructive sleep apnea (OSA) and clinical depression—prevalence in a sleep center. Sleep Breath 2017; 21: 311–318. doi: https://doi.org/10.1007/s11325-016-1411-3.

41.

Lee SA, Yoon H, Kim HW (2019) Is severe obstructive sleep apnea associated with less depressive symptoms? J Psychosom Res 122:6–12. https://doi.org/10.1016/j.jpsychores.2019.04.017CrossRefPubMed

42.

Luz GP, Guimaraes TM, Weaver TE, Nery LE, Oliveira e Silva L, et al. (2015) Impaired sustained attention and lapses are present in patients with mild obstructive sleep apnea. Sleep & Breath 20: 1–5. doi: https://doi.org/10.1007/s11325-015-1279-7.

43.

Porto R. Dépression et sexualité [Depressive symptoms and sexuality]. Presse Med. 2014;1111–5. French. doi: https://doi.org/10.1016/j.lpm.2014.07.001.

44.

Mozafari M, Khajavikhan J, Jaafarpour M, Khani A, Direkvand-Moghadam A, Najafi F (2015) Association of body weight and female sexual dysfunction: a case control study. Iran Red Crescent Med J 17(1):e24685. https://doi.org/10.5812/ircmj.24685CrossRefPubMedPubMedCentral

45.

Esposito K, Ciotola M, Giugliano F, Bisogni C, Schisano B, Autorino R et al (2007) Association of body weight with sexual function in women. Int J Impot Res 19(4):353–357. https://doi.org/10.1038/sj.ijir.3901548CrossRefPubMed

Titel: Depression and obesity, but not mild obstructive sleep apnea, are associated factors for female sexual dysfunction
verfasst von: Glaury Coelho
Lia Bittencourt
Monica Levy Andersen
Thais Moura Guimarães
Luciana Oliveira e Silva
Gabriela Pontes Luz
Sergio Tufik
Helena Hachul
Publikationsdatum: 28.07.2021
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 2/2022
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02433-w

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Depression and obesity, but not mild obstructive sleep apnea, are associated factors for female sexual dysfunction