Does Testosterone Worsen Sleep Apnea?: It Depends on the Dose

[Nelson Vergel]

Asian J Androl. 2014 Jan 7.

The relationship between sleep disorders and testosterone in men.

Wittert G.



Abstract

Plasma testosterone levels display circadian variation, peaking during sleep, and reaching a nadir in the late afternoon, with a superimposed ultradian rhythm with pulses every 90 min reflecting the underlying rhythm of pulsatile luteinizing hormone (LH) secretion. The increase in testosterone is sleep, rather than circadian rhythm, dependent and requires at least 3 h of sleep with a normal architecture. Various disorders of sleep including abnormalities of sleep quality, duration, circadian rhythm disruption, and sleep-disordered breathing may result in a reduction in testosterone levels. The evidence, to support a direct effect of sleep restriction or circadian rhythm disruption on testosterone independent of an effect on sex hormone binding globulin (SHBG), or the presence of comorbid conditions, is equivocal and on balance seems tenuous. Obstructive sleep apnea (OSA) appears to have no direct effect on testosterone, after adjusting for age and obesity. However, a possible indirect causal process may exist mediated by the effect of OSA on obesity. Treatment of moderate to severe OSA with continuous positive airway pressure (CPAP) does not reliably increase testosterone levels in most studies. In contrast, a reduction in weight does so predictably and linearly in proportion to the amount of weight lost. Apart from a very transient deleterious effect, testosterone treatment does not adversely affect OSA. The data on the effect of sleep quality on testosterone may depend on whether testosterone is given as replacement, in supratherapeutic doses, or in the context abuse. Experimental data suggest that testosterone may modulate individual vulnerability to subjective symptoms of sleep restriction. Low testosterone may affect overall sleep quality which is improved by replacement doses. Large doses of exogenous testosterone and anabolic/androgenic steroid abuse are associated with abnormalities of sleep duration and architecture.

More on sleep apnea:Treatment of Sleep Apnea Does Not Improve Testosterone Blood Levels

The relationship between sleep disorders and testosterone in men

 

[robs2nd75]

Ty, Nelson!

 

[Nelson Vergel]

Arch Sex Behav. 2015 Sep 14.
Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure.

Zhang XB1, Lin QC2, Zeng HQ3, Jiang XT3, Chen B3, Chen X2.


Abstract

In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.

 

[Nelson Vergel]

Uninterrupted Sleep May be More Important Than Amount of Sleep


Getting uninterrupted sleep may be more important to people's mood than the overall amount of sleep, according to a new study from Johns Hopkins University.

For the study, 62 healthy men and women underwent a three-day sleep experiment in an inpatient clinical research facility. The participants were randomly selected to either have three consecutive nights of uninterrupted sleep, later bedtimes, or forced awakenings.

The findings, reported Nov. 1 in the journal Sleep, showed that by the second night those with the eight forced awakenings saw a 31 percent reduction in positive mood. Those with a delayed bedtime saw their positive mood decrease by about 12 percent compared to the first day.

http://www.biosciencetechnology.com...et_cid=4921814&et_rid=449166332&type=headline

 

[Nelson Vergel]

Obstructive sleep apnea

The potential risk of adverse effects of TRT on sleep, specifically OSA, has been a growing area of research and discussion. Our literature search retrieved five studies that evaluated this association [Barrett-Connor et al. 2008; Bercea et al. 2013; Hoyos et al. 2012a, 2012b; Killick et al. 2013]. However, only one trial addressed TRT in relation to the possible worsening of OSA.

An 18-week randomized, double-blind, placebo-controlled, parallel group trial in 67 men found that TRT in obese men with severe OSA mildly worsened sleep-disordered breathing in a time-limited manner, irrespective of initial T concentrations in the short term (7 weeks), but this worsening resolved after 18 weeks [Hoyos et al. 2012a]. In the trial, sleep and breathing were measured by nocturnal polysomnography at 0, 7, and 18 weeks. T, compared with placebo, worsened the oxygen desaturation index (ODI) by 10.3 events/h and nocturnal hypoxemia [sleep time with oxygen saturation less than 90%, SpO(2) T90%] by 6.1% at 7 weeks. TRT did not alter ODI or SpO(2) T90% at 18 weeks compared with placebo. The authors also found that the TRT effects on ODI and SpO(2) T90% were not influenced by baseline T concentrations (T by treatment interactions, all p > 0.35). Moreover, serum T concentrations did not correlate with ODI or SpO(2) T90% (all p > 0.19) [Hoyos et al. 2012a].

The same authors, using the same cohort, also sought to evaluate body compositional and cardiometabolic effects of TRT with TU in men with obesity and severe OSA [Hoyos et al. 2012b]. This trial concluded that 18 weeks of TRT improved several important cardiometabolic parameters, including insulin resistance, decreased liver fat, and increased lean muscle mass, but did not differentially reduce overall weight or the metabolic syndrome.

The remaining three trials did not adequately assess the relationship between TRT and OSA but offered some interesting results. One study of 1312 community-dwelling men aged 65 years or older from six clinical centers in the USA determined that low serum total T levels were associated with less healthy sleep in older men, explained by the degree of central adiposity [Barrett-Connor et al. 2008]. Another trial evaluated 40 men with severe OSA and 40 control subjects. Serum T in the OSA group was significantly lower compared with controls, and a statistically significant inverse correlation was found between serum T level and depressive symptoms [Bercea et al. 2013]. The third trial yielded positive correlations between changes in serum T and hyperoxic ventilatory recruitment threshold in 21 men with OSA , and between changes in hyperoxic ventilatory recruitment threshold and time spent with oxygen saturations during sleep less than 90% weeks, but these changes had resolved by 18 weeks [Killick et al. 2013].

To date, there are no randomized trials focusing on the long-term effects of TRT and OSA. It is recommended that clinicians inquire about symptoms of OSA in men with TD on TRT and to offer a referral for polysomnogram evaluation in men with hallmark symptoms, especially those who are starting T therapy [Bhasin et al. 2010].

Source:

Ther Adv Drug Saf. 2014 Oct; 5(5): 190–200.Adverse effects of testosterone replacement therapy: an update on the evidence and controversy

 

[Fat01]

Men with sleep apnea are more likely to suffer from low testosterone, but testosterone products can actually worsen sleep apnea.So, testosterone is typically thought of in terms of its roles in libido, male fertility, energy, aggression and drive, so the fact that sleep patterns and testosterone levels are closely related may come as a surprise to many.

 

[Nelson Vergel]

These videos show the different CPAP machines and mask types available in the market.

CPAPtalk.com - CPAP Videos

 

[FangFang]

I've been waking up gasping for air....Not looking forward to dealing with this.

 

[Nelson Vergel]

I've been waking up gasping for air....Not looking forward to dealing with this.

You should get checked for sleep apnea.