Obstructive sleep apnea, atrial fibrillation, and erectile dysfunction: are they only coexisting conditions or a new clinical syndrome? The concept of the OSAFED syndrome.

Patients rarely suffer from only 1 disease. Most of them have several conditions with common risk factors and etiology, and which often increase the severity of each other. The phenotypes linked to 1 condition are often linked to many others. We describe 3 patients with obstructive sleep apnea (OSA), atrial fibrillation (AF), and erectile dysfunction (ED), all of which are highly prevalent in the general population. OSA is one of the most common sleep disorders, affecting approximately 24% of men and 9% of women between 30 and 60 years of age. AF is one of the most common arrhythmias, present in approximately 2% of the population, and erectile dysfunction can be found in 18% to 40% of the male population older than 20 years. The presence of these 3 conditions in the same patient may be not only a coincidence but rather a new clinical syndrome. We present data which allow one to consider OSA, AF, and ED as parts of a clinical syndrome: OSAFED (obstructive sleep apnea, atrial fibrillation, and erectile dysfunction), with a larger effect on the cardiovascular risk profile than those 3 conditions taken alone. Introducing the OSAFED acronym into everyday clinical practice would have the tremendous advantage of reminding health care workers to screen every patient with either OSA, AF, or ED for the remaining 2 diseases. This would result in an early diagnosis and break the vicious circle of mutual disease exacerbation.