Prevalence and Severity of Obstructive Sleep Apnea in Men with Polycythemia on Testosterone Therapy

Abstract

ABSTRACT Introduction Polycythemia is independently associated with both testosterone therapy (TTH) and obstructive sleep apnea (OSA). Objective The purpose of this study was to evaluate the prevalence and severity of OSA in men who experience polycythemia while on TTH. Methods Study population included men who had polycythemia [hematocrit (HCT) >50%] while on TTH for TD, with total and free T levels within the normal range. Men completed screening questionnaires for OSA and daytime sleepiness, respectively: STOP-BANG (SB, range 0-8) and the Epworth Sleepiness Scale (ESS, range 0-24). Men whose scores demonstrated intermediate to high risk of OSA proceeded to a diagnostic sleep study which recorded the following parameters: apnea hypoxia index (AHI, normal <5 events/h), total duration SpO2 saturation <88% and SpO2 nadir. Descriptive statistics are presented. Results 73 men had a mean age of 60±11.5 years. Mean HCT pre-TTH and on TTH were 45±3% and 52±1.5%, respectively, for a mean increase of 6.6±3.6%. Mean on-treatment total T level 686±285 ng/dL. Median STOP-BANG score was 4 (IQR 3-5), median ESS score was 5 (IQR 3-9). 63% of patients screened positive for OSA on questionnaires. 81% of sleep studies confirmed OSA; mean AHI of the group was 15.4±13.2 events/hour (range 1.6-54.6 events/hour). 36% of men had AHI≥15 events/hour and 14% ≥30 AHI events/hour. Mean SpO2 nadir was 83±5% (range 69%-93%). 67% of men with OSA had an oxygen nadir in the 80s, 19% in the 70s and 3% in the 60s. Total duration of hypoxia (SpO2 ≤88%) was 32±50 minutes (range 0.1-202 minutes), 46% of men having hypoxia <10 minutes, 8% 10-20 minutes, 19% 70-150 minutes. Conclusions Men on TTH who are eugonadal that experience polycythemia have high rates of OSA. 80% of the patients undergoing sleep study had OSA. These data suggest that men with polycythemia on TTH should be screened for OSA. Disclosure No