And the Puns Just Won't Stop*

Unfortunately retitled "Viagra keeps you up at night" by Blog Around the Clock, Sleepdoctor has this:

Each year, millions of men in American seek treatment for erectile dysfunction (ED), a condition that is often associated with obstructive sleep apnea (OSA). Since its introduction in 1998, Viagra has become the most common form of treatment for ED. It works by enhancing the effects of nitric oxide, a compound that relaxes muscles in the penis and allows for increased blood flow, triggering an erection. Now a new study by a team of Brazilian and American researchers suggests that a single 50-mg dose of Viagra may actually worsen symptoms of obstructive sleep apnea (OSA). The study involved 14 middle-aged men with severe OSA in a double-blind crossover study. Using polysomnography, the researchers analyzed the severity of symptoms and found a significant increase following a dose of Viagra compared to placebo.

There is a full abstract of the study at his post here.

I don't know for sure, but I suspect lots of other primary physicians have a *hard* time talking people into going for a sleep study. They don't like the idea of spending the night away from home, in a strange place, with all kinds of wires attached to their heads and other gadgets stuck to their fingers and faces and bodies. The study is expensive, time-consuming and -- just to rub salt in the wound -- often a hassle to get precertified, and even then often denied by insurance companies. Still, sleep apnea remains a very important condition to diagnose and treat. It can even be fatal (Philadelphia's Reggie White.)

It can also contribute to erectile dysfunction. For which men are flocking to me and my colleagues for Viagra and its friends. And now it turns out to make ED worse; what a vicious cycle.

On the other hand, it also gives me more *leverage* to get my patients into the sleep lab. No Vitamin V without treating your sleep apnea first. Cool.

*Originally titled: "And the puns won't stop *coming*"