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Sleep-related painful erection in a patient with obstructive sleep apnea syndrome

International Journal of Impotence Research volume 31, pages 150–151 (2019)Cite this article

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Sleep-related painful erection (SRPE) is an uncommon disorder. To date, only five instances have been reported in conjunction with obstructive sleep apnea syndrome (OSAS) [1,2,3,4]. Three of the patients involved were undergoing continuous positive airway pressure (CPAP) treatments, during which the SRPEs immediately dissipated [4], only to resume their usual frequency once CPAP had ceased. These three patients refused further drug therapy and unfortunately were lost to follow-up surveillance. In another patient, SRPEs occurred during CPAP treatments undertaken over the course of 1 year [3]. Herein, we report a patient with SRPEs and OSAS who experienced marked symptomatic relief after just 1 week of a combined treatment protocol. Both conditions have now stabilized during continued therapy, worsening if the full treatment regimen is not sustained.

The patient was a 45-year-old Chinese man with a 2-year history of anxiety disorders for which he received alprazolam (0.8 mg/day) and escitalopram (20 mg/day). During the previous year, he also suffered from SRPEs and daytime drowsiness (Pittsburgh sleep quality index [PSQI], 8/21). The SRPEs occurred 4–5 times per night, often awakening the patient, and there was a need to void 2–3 times nightly. Penile rigidity was maximal (grade 4) for 15–20 min after awakening or micturition. In addition, mild depression (Patient Health Question-9 [PHQ-9] score, 7/27; normal value < 5) and severe anxiety (Generalised Anxiety Disorder Assessment-7 [GAD-7 score], 15/21; normal value < 5) were evident. The patient’s subjective discomfort score by visual analog scale (VAS; range, 0–10) was 8 prior to treatment. A diagnosis of SRPE was ultimately confirmed through video-supported polysomnography, which also indicated severe hypoxic OSAS (AHI [apnea-hypopnea index], 55.0/h; nadir SpO2, 79.0%).

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References

  1. Vreugdenhil S, Weidenaar AC, de Jong IJ, van Driel MF. Sleep-related painful erections: a meta-analysis on the pathophysiology and risks and benefits of medical treatments. J Sex Med. 2017;15:5–19.

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Authors and Affiliations

  1. Department of Urology, Peking Union Medical College Hospital, Beijing, China

    Jianzhong Zhang & Hongjun Li

  2. Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China

    Yi Xiao

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  1. Jianzhong Zhang
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  2. Yi Xiao
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  3. Hongjun Li
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Correspondence to Hongjun Li.

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Zhang, J., Xiao, Y. & Li, H. Sleep-related painful erection in a patient with obstructive sleep apnea syndrome. Int J Impot Res 31, 150–151 (2019). https://doi.org/10.1038/s41443-018-0110-y

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