Association between obstructive sleep apnea and male serum testosterone: A systematic review and meta‐analysis

Abstract

Background Currently, there is no consensus on the effect of obstructive sleep apnea on male serum testosterone levels. This systematic review and meta‐analysis aimed to determine the association between obstructive sleep apnea and male serum testosterone level. Methods The literature related to obstructive sleep apnea and male serum testosterone in the PubMed, Embase, and Cochrane Library databases were searched from their inception to June 10, 2021. Data were pooled using the Stata 15 software. We performed a subgroup analysis of studies after matching the age and body mass index, as well as according to the severity of obstructive sleep apnea. Results Eighteen studies involving 1823 men were included in the systematic review and meta‐analysis. A significant inverse association between obstructive sleep apnea and male serum testosterone (SMD = −0.76; 95% CI: −1.18, −0.33; p = 0.001) was found. After adjusting for age and body mass index, this inverse association still existed (SMD = −0.8; 95% CI = −1.41, −0.18, p = 0.012). According to the subgroup analysis of obstructive sleep apnea severity, our results showed that serum testosterone was not significantly decreased in mild (SMD = −0.58; 95% CI = −1.88, 0.73, p = 0.386) and moderate obstructive sleep apnea patients (SMD = −0.94; 95% CI = −2.04, 0.15, p = 0.092), whereas it was significantly reduced in patients with severe obstructive sleep apnea (SMD = −1.21; 95% CI = −2.02, −0.41, p = 0.003). Conclusions Obstructive sleep apnea is inversely associated with male serum testosterone levels, independent of body mass index and age. Notably, the severity of obstructive sleep apnea is also correlated with male serum testosterone, which is significantly reduced in patients with severe obstructive sleep apnea.

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“…This association may [ 37 ] or may not [ 104 – 106 ] be due to obesity. A recent meta-analysis of 18 studies involving 1823 men with or without OSA also found a significant inverse relationship between OSA and testosterone concentrations – a relationship which remained after controlling for age and obesity [ 107 ]. Notably, a significantly lower testosterone was only observed in men with severe OSA.…”