Disruption of the Nocturnal Testosterone Rhythm by Sleep Fragmentation in Normal Men

Luboshitzky, Rafael; Zabari, Ziva; Shen‐Orr, Zila; Herer, Paula; Lavie, Peretz

doi:10.1210/jcem.86.3.7296

Cited by 178 publications

(88 citation statements)

References 13 publications

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“…Administration of testosterone to obese men improves insulin sensitivity (26), and, conversely, insulin is also thought to regulate testosterone (27). Previous studies have also linked sleep disruption with reduced testosterone levels (28).…”

Section: Biological Mechanismsmentioning

confidence: 99%

Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes

Yaggi

Araujo²,

McKinlay³

2006

Diabetes Care

664

454

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OBJECTIVE -Short-term partial sleep restriction results in glucose intolerance and insulin resistance. The purpose of this study was to assess the long-term relationship between sleep duration and the incidence of clinical diabetes. RESEARCH DESIGN AND METHODS -A cohort of men from the MassachusettsMale Aging Study without diabetes at baseline (1987)(1988)(1989) were followed until 2004 for the development of diabetes. Average number of hours of sleep per night was grouped into the following categories: Յ5, 6, 7, 8, and Ͼ8 h. Incidence rates and relative risks (RRs) were calculated for the development of diabetes in each sleep duration category. Those reporting 7 h of sleep per night served as the reference group. Multivariate analysis was performed using Poisson regression.RESULTS -Men reporting short sleep duration (Յ5 and 6 h of sleep per night) were twice as likely to develop diabetes, and men reporting long sleep duration (Ͼ8 h of sleep per night) were more than three times as likely to develop diabetes over the period of follow-up. Elevated risks remained essentially unchanged after adjustment for age, hypertension, smoking status, self-rated health status, education, and waist circumference .01] for Յ5 h and 3.12 [1.53-6.37] for Ͼ8 h). RRs were altered considerably for the two extreme sleep groups when adjusted for testosterone (1.51 [0.71-3.19] for Յ5 h and 2.81 [1. 34 -5.90] for Ͼ8 h), suggesting that the effects of sleep on diabetes could be mediated via changes in endogenous testosterone levels.CONCLUSIONS -Short and long sleep durations increase the risk of developing diabetes, independent of confounding factors. Sleep duration may represent a novel risk factor for diabetes. Diabetes Care 29:657-661, 2006D iabetes remains a critical public health challenge. The prevalence of diabetes continues to increase, and it affects an estimated 18 million people in the U.S. (1-3). Patients with diabetes require frequent contact with the health care system for effective management and prevention of complications, and they are at increased risk for premature mortality and hospitalization for conditions such as cardiovascular and kidney disease. Although lifestyle changes such as weight loss and increasing physical activity are the cornerstone of diabetes prevention, efforts are needed to better understand other determinants of the disease and to develop additional prevention strategies. Understanding the link between diabetes and sleep may represent one important part of that effort.Sleep loss is a common condition in modern society, with evidence showing that we are sleeping on average only 6.8 h per night, which is 1.5 h less than we did a century ago (4,5). Nearly one-third of adults report sleeping Ͻ6 h per night, leading some to suggest we live in a sleepdeprived society (6). Factors responsible for this change include increases in environmental light, longer work days/ commuting time, an increase in shift and night work, and the advent of television, radio, and the Internet (7).We are only beginning to reco...

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Section: Biological Mechanismsmentioning

confidence: 99%

Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes

Yaggi

Araujo²,

McKinlay³

2006

Diabetes Care

664

454

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“…Testosterone secretion is tightly linked to sleep cycles, with peak levels occurring just before or after REMS onset [66]. Insufficient and/or fragmented sleep blocks the nocturnal increase in testosterone [67][68][69]. Yet, findings that fluctuations in testosterone levels affect sleep in men remain inconsistent.…”

Section: (C) Sex Steroids Influence Sleepmentioning

confidence: 99%

Sex differences in sleep: impact of biological sex and sex steroids

Mong

Cusmano

2016

Phil. Trans. R. Soc. B

397

300

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One contribution of 16 to a theme issue 'Multifaceted origins of sex differences in the brain'. Men and women sleep differently. While much is known about the mechanisms that drive sleep, the reason for these sex differences in sleep behaviour is unknown and understudied. Historically, women and female animals are underrepresented in studies of sleep and its disorders. Nevertheless, there is a growing recognition of sex disparities in sleep and rhythm disorders. Women typically report poorer quality and more disrupted sleep across various stages of life. Findings from clinical and basic research studies strongly implicate a role for sex steroids in sleep modulation. Understanding how neuroendocrine mediators and sex differences influence sleep is central to advancing our understanding of sleep-related disorders. The investigation into sex differences and sex steroid modulation of sleep is in its infancy. Identifying the mechanisms underlying sex and gender differences in sleep will provide valuable insights leading to tailored therapeutics that benefit each sex. The goal of this review is to discuss our current understanding of how biological sex and sex steroids influence sleep behaviour from both the clinical and pre-clinical perspective.

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“…32,33,40 These studies also revealed a significant correlation between maximal testosterone levels and total oxygen desaturation time. 32,33 In our study, this correlation was significant for both oxygen desaturation variables, ODI and O 2 nadir. The relationship between the reduction in TT and elevated ODI persisted even after adjusting for BMI.…”

Section: Discussionmentioning

confidence: 64%

“…14,25,30 The significant association of low TT levels with high AHI values suggest that gonadal dysfunction is a consequence of OSA rather than a primary condition independent of the hypothalamic-pituitarygonadal axis. 4,32,33 Several factors may account for lower testosterone secretion levels in middle-aged men with OSA, including hypoxemia, 14,29 fragmented sleep, obesity, 21,34 and advanced age. 2 There has been growing recognition that sex hormones play important roles in almost all physiological processes, including breathing.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoxemia is Associated With Low Testosterone Levels in Overweight Males and Older Men With Normal Weight

Viana

Daflon

Couto

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives:The relationship among obstructive sleep apnea (OSA), body mass index (BMI), and testosterone levels has long been suggested. Obese men have shown a negative correlation between testosterone level and sleep apnea severity. Yet, little is known about the association between testosterone levels and sleep apnea in men who are not obese. This study evaluated the association between the total testosterone (TT) level and OSA in patients who are not obese. Methods: A retrospective review of 523 records of patients in whom OSA was diagnosed from 2013-2016 was performed. The study included men with a BMI < 30 kg/m 2 and with TT levels measured in a blood sample collected the morning after a sleep study. Results: In all, 153 nonobese men met inclusion criteria, of whom 47 (30.7%) had testosterone levels below the reference values; 44 of these individuals (93.6%) were overweight (P = .029). Reduced testosterone levels showed significant correlations with the oxygen desaturation index, the lowest oxygen saturation < 80% (O2 nadir < 80%), and rapid eye movement (REM) sleep duration, after adjusting for BMI. Among patients with normal weight, only 3 who had O2 nadir < 80% and were older than 50 years presented with a reduced TT level. Conclusions:In a large population of nonobese men with OSA, we demonstrated that hypoxemia (O2 nadir < 80%) and overweight are associated with reduced testosterone levels. This association was only observed among normal-weight individuals older than 50 years. Keywords: body mass index, hypoxia, obstructive sleep apnea, sex hormone, testosterone Citation: Viana A Jr, Daflon AC, Couto A, Neves D, de Araujo-Melo MH, Capasso R. Nocturnal hypoxemia is associated with low testosterone levels in overweight males and older men with normal weight. J Clin Sleep Med. 2017;13(12):1395-1401. I NTRO DUCTI O NProgressive decreases in androgen production are observed in at least 20% of males aged 60 to 70 years.1 Total testosterone (TT) levels were found to be stable in men up to the ages of 50 to 55 years, while a reduction in TT of approximately 35% has been described in males between the ages of 25 and 75 years. 2,3 In healthy patients aged 20 to 100 years, subnormal levels of TT and free testosterone were observed in only 1% of the population younger than 40 years, whereas this percentage increased to more than 10%, 20%, and 40% in those aged 40-60 years, 60-80 years, and older than 80 years, respectively.2 Hypogonadal testosterone levels have been found in approximately 12% of men older than 50 years and in 50% of men older than 80 years. 4,5 The etiology of this testosterone decline is multifactorial and involves disturbed neuroendocrine gonadotropin regulation. 1,6 Obstructive sleep apnea (OSA) is a common disorder. In men 40-49 years old, the prevalence of apnea-hypopnea index [AHI] ≥ 5 events/h has been reported at 25%; furthermore, in this same age group, the prevalence of AHI ≥ 15 events/h has been reported at 11%.7 Peppard et al. reported that, among overweight men, the prevalence o...

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Disruption of the Nocturnal Testosterone Rhythm by Sleep Fragmentation in Normal Men

Cited by 178 publications

References 13 publications

Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes

Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes

Sex differences in sleep: impact of biological sex and sex steroids

Nocturnal Hypoxemia is Associated With Low Testosterone Levels in Overweight Males and Older Men With Normal Weight

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