Reversible Reproductive Dysfunction in Men With Obstructive Sleep Apnoea

Abstract

A central, reversible decrease in male sexual function appears related to some aspect of obstructive sleep apnoea (OSA). Lower serum testosterone (T) levels were documented in 15 men with OSA versus nine snorers (no OSA), (9.18 +/- 0.92 vs 11.55 +/- 0.90 nmol/l, mean +/- SEM), P less than 0.05 in a consecutive case series of 24 men referred for diagnostic overnight sleep studies. Gonadotrophins did not differ between the two groups. Although the men with OSA did not differ in body mass index (BMI) or weight from the snorers, they were older (51 +/- 3.9 vs 44 +/- 3.1 years), P less than 0.02. Serum T did not correlate with age, but was correlated with minimum nocturnal arterial oxygen saturation (Min SaO2) (r = 0.589), P less than 0.02. A prospective controlled trial of uvulopalatopharyngoplasty therapy (UPP) for OSA in 12 subsequent subjects showed reproductive improvement which was parallel with improved apnoea at 3 months postsurgery. T increased (13.31 +/- 1.07 to 16.59 +/- 0.72 nmol/l), P less than 0.02, without significant changes in BMI, serum PRL, LH or FSH. All seven of the men who reported decreased sexual interest prior to surgery felt their libido and sexual functioning had returned to normal 3 months following UPP. Some aspect of OSA in men appears to produce a reversible hypothalamic-pituitary reproductive dysfunction.

Gonadal function in men with chronic illness

“…Men with obstructive sleep apnoea were more likely to be hypogonadal than BMI matched controls (Santamaria et al, 1988). Lower testosterone levels but similar gonadotrophin levels were found in the obstructive sleep apnoea patients, suggesting a hypothalamic-pituitary aetiology, possibly related to hypoxia, sleep fragmentation or obesity.…”

Therapeutic Dilemmas for Androgen Deficiency in Aging Males

“…Other studies have demonstrated no change in upper airway caliber with high-dose testosterone [58], no development of OSA symtomatology with TRT versus placebo [91], and no effect of testosterone blockade on nocturnal breathing or chemosensitivity in OSA patients [92]. Santamarie and colleagues even demonstrated that low testosterone levels may be associated with OSA [93]. The development of OSA is likely to involve many physical and biophysiologic changes within the body.…”

Obstructive Sleep Apnea (OSA) in Preadolescent Girls is Associated with Delayed Breast Development Compared to Girls without OSA

“…However, in adulthood, sleep fragmentation and/or nocturnal hypoxia secondary to obstructive sleep apnea (OSA) is associated with low sex steroid levels, [3][4][5][6][7][8] which in some cases improve after correction of OSA with continuous positive airway pressure (CPAP) treatment or surgery. 3,8,9 These fi ndings raise concern that pediatric OSA, which affects 1% to 5% of children, 10 may also diminish reproductive hormone secretion during childhood, potentially interfering with normal pubertal maturation.…”