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To the Editor: The study by Dr Esposito and colleagues¹ showed positive effects of a program of lifestyle change and weight loss on erectile function in obese men, but did not address sleep-disordered breathing, which is associated with both obesity and erectile dysfunction.² Given the high body mass indices of study participants, many may have had sleep apnea. Weight loss is also known to be effective for treating sleep apnea,³ and a recent study found that treatment of sleep apnea with nasal continuous positive airway pressure resulted in improved erectile function.⁴ Esposito et al showed that the group of obese men with erectile dysfunction had evidence of abnormal endothelial function and ab normalities of vascular endothelial function, which have been described with obstructive sleep apnea.⁵

Given this, the possibility should be considered that sleep-disordered breathing may have been a major factor in the origin of the participants’ erectile dysfunction, and . . . [Full Text of this Article]

Steven H. Feinsilver, MD
sfeinsil@nshs.edu
North Shore University Hospital
Manhasset, NY

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