Chronic Obstructive Pulmonary Disease There is a clear association between respiratory diseases and ED independent of comorbid conditions, such as peripheral vascular disease or coronary artery disease. Chronic obstructive pulmonary disease (COPD) is a common chronic disease in men. Dyspnea and hypoxemia diminish a patient’s functional capacity and can lead to ED. The prevalence of ED in patients with respiratory disease has been reported as high as 75%.

Several investigators have demonstrated that as pulmonary function tests (i.e., FEV1, FRC, PaO2) worsen, so does a man’s erectile function. Pathophysiology of ED in patients with COPD is multifactorial. Disruption of the hypothalamic– pituitary–gonadal axis has been reported in patients with COPD.

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Reversal of hypoxemia with long-term oxygen has been shown to be effective in improving impotence. Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is also a common chronic disease. It has been reported in as many as 10% of men over 40 years old. Recurrent intermittent hypoxemia and transient increases in sympathetic tone during apneic episodes result in an increased risk of daytime somnolence, hypertension, and ischemic cardiovascular events. Erectile dysfunction has also been found to be associated with OSA.

This association appears to be strongest in the most severe cases of OSA. Causes for ED in these patients include hypoxemiadriven neural damage, microvascular endothelial damage from increased sympathetic tone and hypertension, low gonadotropin secretion, and psychosocial abnormalities, including daytime somnolence and depressed mood