Obstructive sleep apnea is not an independent determinant of testosterone in men

in European Journal of Endocrinology
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  • 1 Department of Endocrinology and Metabolism, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • 2 School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
  • 3 Freemason Foundation Centre for Men’s Health, University of Adelaide, Adelaide, South Australia, Australia
  • 4 Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
  • 5 NeuroSleep – NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
  • 6 Department of Endocrinology and Diabetes, Queen Elizabeth Hospital, Woodville, South Australia, Australia

Correspondence should be addressed to G A Wittert; Email: gary.wittert@adelaide.edu.au
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Objective

Obstructive sleep apnea (OSA) is generally considered to lower serum testosterone concentration in men, although data supporting this as a direct effect are limited. The aim of this study was to determine the relationship between the presence and severity of OSA and testosterone in a community-based cohort of men aged over 40 years.

Design and methods

Anthropometry, polysomnography and biomedical information were collected from enrolled, consenting men from the prospective, longitudinal MAILES study cohort. Fasting morning blood samples (n = 1869) were drawn between 2010 and 2012 for measurement of testosterone using liquid chromatography mass spectrometry. Home polysomnography was completed in 861 men between 2010 and 2012. The final analysis sample consisted of 623 men aged 41–86 years. The effect of OSA on testosterone were analyzed using linear regression models controlling for potential confounders (age, BMI and sex hormone binding globulin (SHBG)).

Results

The mean (s.d.) cohort characteristics were: age 59.0 (10.2) years, testosterone 16.8 (5.3) nmol/L, SHBG 32.9 (13.1) nmol/L, BMI 28.6 (4.2) kg/m2 and apnoea hypopnoea index (AHI) 14.9 (13.7). OSA was present in 51.5%. There was an inverse relationship between AHI and testosterone (P = 0.01), which was lost after covariate adjustment.

Conclusions

These data suggest that obesity, rather than OSA per se, determine testosterone concentration. This accords with the graded effect of weight loss, but limited effect of continuous positive airway pressure to increase testosterone, and highlights the importance of managing obesity in men with low testosterone concentration, particularly in the context of OSA.

Supplementary Materials

    • Supplementary Table S1: Linear regression (not standardized) coefficients for the models of log total testosterone with OSA measures (AHI, ODI, TST90 and arousal index) as continuous variables adjusting for log SHBG, age , BMI and study (FAMAS vs NWAHS).
    • Supplementary Table S2: Linear regression coefficients for the models of log total testosterone with OSA measures as discrete variables adjusting for log SHBG, age, BMI and study (FAMAS vs NWAHS).
    • Supplementary Table S3: Linear regressions of log total testosterone on AHI, ODI, TST90 and arousal index, using data from only the subset of men with less than 25% variability in measured testosterone between M1 & M2 (n = 466).
    • Supplementary figure 1

 

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