Obstructive Sleep Apnea Is Associated With Low Testosterone Levels in Severely Obese Men.

Milina Tančić-Gajić,Aleksandra Kendereški,Zorana Arizanović,Miodrag Vukčević,Ljiljana V Marina,Miomira Ivović,Svetlana Vujović,Aleksandar Đogo,Miloš Stojanović,Ivan Soldatović

doi:10.3389/fendo.2021.622496

Abstract

BackgroundDisrupted sleep affects cardio-metabolic and reproductive health. Obstructive sleep apnea syndrome represents a major complication of obesity and has been associated with gonadal axis activity changes and lower serum testosterone concentration in men. However, there is no consistent opinion on the effect of obstructive sleep apnea on testosterone levels in men.ObjectiveThe aim of this study was to determine the influence of obstructive sleep apnea on total and free testosterone levels in severely obese men.Materials and methodsThe study included 104 severely obese (Body Mass Index (BMI) ≥ 35 kg/m2) men, aged 20 to 60, who underwent anthropometric, blood pressure, fasting plasma glucose, lipid profile, and sex hormone measurements. All participants were subjected to polysomnography. According to apnea-hypopnea index (AHI) patients were divided into 3 groups: <15 (n = 20), 15 - 29.9 (n = 17) and ≥ 30 (n = 67).ResultsThere was a significant difference between AHI groups in age (29.1 ± 7.2, 43.2 ± 13.2, 45.2 ± 10.2 years; p < 0.001), BMI (42.8 ± 5.9, 43.2 ± 5.9, 47.1 ± 7.8 kg/m2; p = 0.023), the prevalence of metabolic syndrome (MetS) (55%, 82.4%, 83.6%, p = 0.017), continuous metabolic syndrome score (siMS) (4.01 ± 1.21, 3.42 ± 0.80, 3.94 ± 1.81, 4.20 ± 1.07; p = 0.038), total testosterone (TT) (16.6 ± 6.1, 15.2 ± 5.3, 11.3 ± 4.44 nmol/l; p < 0.001) and free testosterone (FT) levels (440.4 ± 160.8, 389.6 ± 162.5, 294.5 ± 107.0 pmol/l; p < 0.001). TT level was in a significant negative correlation with AHI, oxygen desaturation index (ODI), BMI, MetS and siMS. Also, FT was in a significant negative correlation with AHI, ODI, BMI, age, MetS and siMS. The multiple regression analysis revealed that both AHI and ODI were in significant correlation with TT and FT after adjustment for age, BMI, siMS score and MetS components.ConclusionObstructive sleep apnea is associated with low TT and FT levels in severely obese men.

Highlights

Obesity is a complex metabolic disorder with a markedly increased prevalence in both the developed and underdeveloped countries
There was a significant difference between apnea-hypopnea index (AHI) groups in age (29.1 ± 7.2, 43.2 ± 13.2, 45.2 ± 10.2 years; p < 0.001), body mass index (BMI) (42.8 ± 5.9, 43.2 ± 5.9, 47.1 ± 7.8 kg/m2; p = 0.023), the prevalence of metabolic syndrome (MetS) (55%, 82.4%, 83.6%, p = 0.017), continuous metabolic syndrome score (4.01 ± 1.21, 3.42 ± 0.80, 3.94 ± 1.81, 4.20 ± 1.07; p = 0.038), total testosterone (TT) (16.6 ± 6.1, 15.2 ± 5.3, 11.3 ± 4.44 nmol/l; p < 0.001) and free testosterone (FT) levels (440.4 ± 160.8, 389.6 ± 162.5, 294.5 ± 107.0 pmol/l; p < 0.001)
The multiple regression analysis revealed that both AHI and oxygen desaturation index (ODI) were in significant correlation with TT and FT after adjustment for age, BMI, continuous metabolic syndrome score (siMS) score and MetS components

Summary

Introduction

Obesity is a complex metabolic disorder with a markedly increased prevalence in both the developed and underdeveloped countries. The risk of developing male infertility increases with obesity severity. Alterations in sex steroid hormones contribute to infertility in obese men [4]. Low testosterone levels in obese men are considered a consequence of reduced sex hormone binding globulin (SHBG) synthesis, increased androgens aromatization to estradiol, and central gonadal axis suppression. Complex metabolic disorders, increased pro-inflammatory adipocytokines, impaired insulin signaling in the central nervous system, dysregulated leptin signaling, and increased estrogen may lead to hypothalamic suppression via effects on kisspeptin neurons in obese men [6, 7]. Obstructive sleep apnea syndrome represents a major complication of obesity and has been associated with gonadal axis activity changes and lower serum testosterone concentration in men. There is no consistent opinion on the effect of obstructive sleep apnea on testosterone levels in men

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Results

Conclusion