Obstructive sleep apnea as a potential contributor to stutteringpriapism: a case series

Background: The etiologies and management of patients with stuttering priapism remain somewhat perplexing, with most cases being idiopathic, however the underlying molecular basis for some causes, such as sickle cell disease, is believed to be due to the depletion of nitric oxide and resulting dysfunction of cyclic guanosine monophosphate (cGMP)-induced vasodilation of corporal smooth muscle. We propose a potential mechanism for stuttering priapism in patients with obstructive sleep apnea (OSA) and report on patients with OSA and success (or lack thereof) in their management at our institution. Cases: A brief query of the institution’s electronic medical record was performed from 01 January 2023 to 01 January 2024 through the use of an existing institutional review board approval, and a total of three patients were identified who were treated for stuttering/recurrent priapism with a pre-existing diagnosis of OSA or with high suspicion of OSA. Some of these patients noted a reduction in priapism episodes with improved control of their OSA through means such as continuous positive airway pressure (CPAP) machines. Conclusions: Obstructive sleep apnea may be a possible risk factor for stuttering priapism and thus should be considered by the clinician. It shares a similar mechanism to that of sickle cell disease’s role in priapism: nitric oxide depletion and PDE5 (phosphodiesterase 5) downregulation resulting in intermittent, unregulated smooth muscle relaxation through non-nitric oxide pathways; thus, this should be evaluated by the clinician.