Effects of CPAP on Testosterone Levels in Patients With Obstructive Sleep Apnea: A Meta-Analysis Study

Abstract

Background: Obstructive sleep apnea (OSA) represents a frequent complication among patients with obesity and has been associated with neuroendocrine changes, including hypogonadism. Objective: We conducted a systematic review and meta-analysis to evaluate the effects of continuous positive airway pressure (CPAP) on testosterone and gonadotropins in male patients with OSA. Methods: The review was registered on PROSPERO (CRD42018103164). PubMed, Scopus, CENTRAL, and Clinicaltrials.gov were searched until June 2018. Studies reporting the effect of CPAP on total testosterone, free testosterone, sexual hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were included. A subgroup analysis on hypogonadal vs. eugonadal status at baseline was performed. Results: Out of 129 retrieved papers, 10 prospective cohort and 2 randomized controlled studies were included in the review. Three hundred eighty-eight patients were included. CPAP use was not associated with a significant change in total testosterone levels [mean difference 1.08, 95% confidence interval (CI) −0.48 to 2.64] or other outcomes. The subgroup analysis confirmed the overall results. Conclusions: The present review does not support the hypothesis of a direct interaction between OSA and testosterone. Strategies other than CPAP should therefore be considered in managing hypogonadism in patients with OSA.

Critical evaluation of different available guidelines for late‐onset hypogonadism

“…Discordant findings have been found to date on this topic. Particularly, a body of evidence supports the significant improvements that can be achieved with TT following the management of obesity, either by lifestyle measures, pharmacological therapy or bariatric surgery, while no change in TT has been found in hypogonadal subjects with obstructive sleep apnoea following continuous positive airway pressure (CPAP) 17,80‐82 . The mechanisms and effects of physical exercise in obesity have been recently evaluated by using an animal model of metabolically induced hypogonadism 83 .…”

“…TT has been found in hypogonadal subjects with obstructive sleep apnoea following continuous positive airway pressure (CPAP). 17,[80][81][82] The mechanisms and effects of physical exercise in obesity have been recently evaluated by using an animal model of metabolically induced hypogonadism. 83 It should be noted that, despite positive results, high failure rates have been reported for interventions targeting obesity, especially when treatment is discontinued; weight is regained, and a worsening of hypogonadism has to be expected in these patients.…”

Obstructive Sleep Apnea Is Associated With Low Testosterone Levels in Severely Obese Men

“…Some studies have demonstrated that CPAP elevates testosterone levels (49,50). However, the majority of other studies, including two meta-analyses, have reached a different conclusion (51,52). As pointed out by one of the latest systematic reviews, a small number of included studies in their meta-analysis reported an adequate CPAP use (4 h per night on at least 70% of nights), and thus the results might reflect, at least in part, suboptimal CPAP therapy.…”

The Effect of Positive Airway Pressure Therapy on Sexual Life and Quality of Life in Women with Moderate or Severe Obstructive Sleep Apnea Syndrome

“…Some previous studies have evaluated the sexual health status and the effects of CPAP treatment in men with OSAS. Cignarelli [15] et al reported that in males with OSAS, there was a correlation between disease severity and sexual dysfunction. The authors also reported an improvement in the negative impact of these conditions on quality of life after CPAP treatment.…”