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

Tancic-Gajic, Milina; Vukčević, Miodrag; Ivović, Miomira; Marina, Ljiljana; Arizanović, Zorana; Soldatović, Ivan; Stojanović, Miloš; Đogo, Aleksandar; Kendereški, Aleksandra; Vujović, Svetlana

doi:10.3389/fendo.2021.622496

Cited by 7 publications

(10 citation statements)

References 56 publications

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“…Few studies showed that the treatment of OSAS—both by surgery ( 51 ) and cPAP ( 52 )—improve the gonadal function and testosterone concentrations. Nevertheless, other studies reported opposite results ( 26 , 32 , 46 ). In particular, a recent systematic review and meta-analysis ( 53 ) found that the cPAP use was not associated with a significant change in total testosterone concentrations, suggesting against the hypothesis of a direct interaction between OSAS and testosterone, albeit the conclusion that cPAP has no effect on testosterone concentrations is highly premature due to the low-quality available studies ( 54 ).…”

Section: Discussionmentioning

confidence: 83%

“…Therefore, as seen above, obesity is a risk factor for OSAS, and it is also related to hypogonadism in male patients ( 30 ). OSAS severity is related to total testosterone serum concentrations: in particular, a higher AHI score correlates with a lower serum testosterone concentration ( 26 , 28 , 31 , 32 ). Furthermore, the severity of hypoxia during sleep is correlated with a reduction in testosterone concentrations ( 26 , 32 ).…”

Section: Introductionmentioning

confidence: 99%

“…OSAS severity is related to total testosterone serum concentrations: in particular, a higher AHI score correlates with a lower serum testosterone concentration ( 26 , 28 , 31 , 32 ). Furthermore, the severity of hypoxia during sleep is correlated with a reduction in testosterone concentrations ( 26 , 32 ). While the quantity and quality of sleep have been linked to testosterone concentrations, other evidence may suggest the reversal association.…”

Section: Introductionmentioning

confidence: 99%

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The complex relation between obstructive sleep apnoea syndrome, hypogonadism and testosterone replacement therapy

Graziani,

Grande,

Ferlin

2023

Front. Reprod. Health

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Obstructive sleep apnoea syndrome (OSAS) is an under-recognized medical disease. The main risk factors for OSAS are male sex, older age, obesity, and metabolic syndrome, that are also associated with male hypogonadism (MH). Therefore, obesity has been classically identified as the most evident link between OSAS and MH. However, OSAS is per se linked to the development of MH by a combined effect of hypoxia, increased night-time awakenings, reduced sleep efficiency and fragmented sleep. Similarly, MH might represent a risk factor for OSAS, mainly related to sleep disturbances that are frequently associated with low testosterone. Data on testosterone replacement therapy (TRT) in patients with OSAS are limited. Nevertheless, TRT is generally contraindicated by guidelines in the presence of untreated or severe OSAS. TRT might in fact worse OSAS symptoms in different ways. Furthermore, OSAS has been proposed to be a risk factor for secondary polycythaemia and TRT might exacerbate polycythaemia. Therefore, TRT in hypogonadal men affected by untreated OSAS or severe OSAS should be considered with caution and in a personalised way. Nevertheless, the type and dosage of TRT should be considered, as short-term high-dose TRT might worsen OSAS, whereas long-term lower doses could eventually determine a clinical improvement of symptoms of OSAS. Here we reviewed the data on the association between OSAS, MH and TRT, including the opportunity of assessment of patients who develop signs and symptoms of OSAS during TRT by polysomnography.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The complex relation between obstructive sleep apnoea syndrome, hypogonadism and testosterone replacement therapy

Graziani,

Grande,

Ferlin

2023

Front. Reprod. Health

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“…One also has to take into account the differences between men and women on the effect of melatonin on nocturnal temperature and haemodynamics ( 32 , 33 ). Besides, sleep apnea and melatonin are interrelated, and sleep apnea itself has been correlated to obesity, with a strong correlation between BMI and AHI ( 34 ). Additional studies should be conducted looking at distal body temperature in KS patients and control subjects, as well as controlling for sex, AHI, and BMI—which can all play a role in melatonin secretion and effect.…”

Section: Discussionmentioning

confidence: 99%

Multifactorial sleep disturbance in Klinefelter syndrome: a case report

Elbaz¹,

Duquesne²,

Caetano³

et al. 2023

Transl Androl Urol

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Background Klinefelter syndrome (KS), which is related to the presence of an additional X chromosome in a man, is associated with a broad variety of physical and psychosocial impairments. While the focus is usually placed on symptoms related to hypogonadism, such as infertility, recent studies have noted evidence of poor sleep in those patients. Case Description We report on the case of a 44-year-old man with KS who consulted in our Sleep medicine center for excessive daytime sleepiness and delayed sleep with irregular patterns. Polysomnography (PSG) revealed sleep apnea syndrome, with both obstructive and central apnea. Peripheral temperature monitoring revealed patterns indicative of altered melatonin secretion. The present case report suggests that sleep disturbance in patients with KS appears multifactorial with the occurrence of: obstructive sleep apnea (OSA), iatrogenic central apnea due to testosterone therapy, and circadian sleep/wake disorder. Conclusions While this topic warrants larger studies with control groups, this case report suggests there might be specific sleep impairments, associated with three different mechanisms, in patients with KS. Those sleep disorders can worsen psycho-social and cognitive difficulties in those patients, and should therefore be screened for and treated.

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“…The relationship between obesity, testosterone and steroidogenesis was investigated in various studies. Although it is well known that obesity is associated with hypogonadism [ 82 ] and weight loss promotes testosterone increase, the data on different diet regimes in relation to testosterone changes are still a matter of debate. Testosterone influences lipid, protein and carbohydrate metabolism, and lower testosterone levels favour pluripotent stem cell conversion into adipocytes while leptin itself inhibits testosterone secretion from the Leydig cells [ 83 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of very low-calorie ketogenic diet on hypothalamic–pituitary–adrenal axis and renin–angiotensin–aldosterone system

Barrea

Verde

Camajani³

et al. 2023

J Endocrinol Invest

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Background The hypothalamic–pituitary–adrenal (HPA) axis is a neuroendocrine system involved in controlling stress responses in humans under physiological and pathological conditions; cortisol is the main hormone produced by the HPA axis. It is known that calorie restriction acts as a stressor and can lead to an increase in cortisol production. Renin–angiotensin–aldosterone system (RAAS) is a complex endocrine network regulating blood pressure and hydrosaline metabolism, whose final hormonal effector is aldosterone. RAAS activation is linked to cardiometabolic diseases, such as heart failure and obesity. Obesity has become a leading worldwide pandemic, associated with serious health outcomes. Calorie restriction represents a pivotal strategy to tackle obesity. On the other hand, it is well known that an increased activity of the HPA may favour visceral adipose tissue expansion, which may jeopardize a successful diet-induced weight loss. Very low-calorie ketogenic diet (VLCKD) is a normoprotein diet with a drastic reduction of the carbohydrate content and total calorie intake. Thanks to its sustained protein content, VLCKD is extremely effective to reduce adipose tissue while preserving lean body mass and resting metabolic rate. Purpose The purpose of this narrative review is to gain more insights on the effects of VLCKD on the HPA axis and RAAS, in different phases of weight loss and in different clinical settings.

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

Cited by 7 publications

References 56 publications

The complex relation between obstructive sleep apnoea syndrome, hypogonadism and testosterone replacement therapy

The complex relation between obstructive sleep apnoea syndrome, hypogonadism and testosterone replacement therapy

Multifactorial sleep disturbance in Klinefelter syndrome: a case report

Effects of very low-calorie ketogenic diet on hypothalamic–pituitary–adrenal axis and renin–angiotensin–aldosterone system

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