Abstract
IntroductionThe complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients. ObjectiveThe purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C). MethodsTen subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities. Results and conclusionThe main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic–pituitary–adrenal and hypothalamic–pituitary–gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.
Highlights
The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients
Bercea and co-workers reported that the morning serum testosterone concentration in obese patients with severe OSA was associated with increased anxiety/depression and sleep efficiency disturbances.[5]
The major finding of this study is that male obese OSA patients have a reduced T concentration in the evening and a reduced C concentration in the morning compared with non-apneic obese controls
Summary
The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients. ଝ Please cite this article as: Ghiciuc CM, Dima-Cozma LC, Bercea RM, Lupusoru CE, Mihaescu T, Cozma S, et al Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study. Obstructive sleep apnea (OSA) is a chronic respiratory disturbance that can be diagnosed with an overnight polysomnography (PSG). It is a serious health problem with prevalence greater than 26% in the general middle-aged population.1---3. Sleep fragmentation, obesity, and ageing in OSA patients were found to be associated with low serum testosterone levels. Bercea and co-workers reported that the morning serum testosterone concentration in obese patients with severe OSA was associated with increased anxiety/depression and sleep efficiency disturbances.[5]
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