Testosterone levels in obese male patients with obstructive sleep apnea syndrome: Relation to oxygen desaturation, body weight, fat distribution and the metabolic parameters
- 103 Downloads
- 43 Citations
Abstract
To investigate the impact of obstructive sleep apnea syndrome (OSAS) on testosterone levels and on the main parameters of the metabolic syndrome in abdominally obese men, 15 male subjects with abdominal obesity phenotype and polysomnographic diagnosis of OSAS (OB-OSAS) and 15 controls matched for age and anthropometric parameters (OB) were investigated. Anthropometry, SHBG, sex hormones and several parameters of the metabolic syndrome were measured. Only subjects with an Epworth Sleepiness Score greater than 10 underwent a polysomnographic study with calculation of the number of desaturation rates per sleeping hour (ODI), the minimal oxygen saturation during each desaturation episode (minSaO2) and the mean minimal arterial oxygen saturation for the whole night period (MminSaO2). Both total and free testosterone levels were lower in OB-OSAS than in OB patients. A negative correlation between polysomnographic parameters (ODI, minSaO2 and MminSaO2) and testosterone levels was found. The relationship between total and free testosterone and ODI persisted after adjusting for body mass index (BMI) and waist (W) values. Triglyceride and uric acid levels were significantly higher in OB-OSAS than in OB patients. A negative correlation between testosterone and acid uric level and a positive correlation between testosterone and HDL-cholesterol level was found, regardless of BMI and W circumference, particularly in the OB-OSAS group. Our study suggests that, in patients with obesity and OSAS, the severity of hypoxia during sleeping hours may be an additional factor in reducing testosterone levels, regardless of BMI and abdominal fatness. This may contribute in worsening metabolic abnormalities which, in men with OSAS, exceed those expected on the basis of degree of obesity and pattern of fat distribution.
Key-words
Testosterone obesity OSAS metabolic parametersPreview
Unable to display preview. Download preview PDF.
References
- 1.Guilleminault C. Clinical features and evaluation of obstructive sleep apnea. In: Kryger M.H., Roth T., Dement W.C. (Eds.), The principles and practice of sleep medicine. W.B. Saunders, Philadelphia, 1989 pp. 552–558.Google Scholar
- 2.Hoffstein V., Chan C.K., Slutsky A.S. Sleep apnea and systemic hypertension: a casual association review. Am. J. Med. 1991, 91: 190–196.PubMedCrossRefGoogle Scholar
- 3.Partinen M., Guilleminault C. Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest 1990, 97: 27–32.PubMedCrossRefGoogle Scholar
- 4.Haraldsson P-O, Carenfelt C., Diderichsen F., Nygren A., Tingvall C. Clinical symptoms of sleep apnea syndrome and automobile accidents. ORL J. Otorhinolaryngol. Relat. Spec. 1990, 52: 57–62.PubMedCrossRefGoogle Scholar
- 5.Grunstein R.R. Metabolic aspects of sleep apnea. Sleep 1996, 19: S218–S220.PubMedGoogle Scholar
- 6.Ellison H. Obesity and hormonal factors in sleep and sleep apnea. Med. Clin. North Am. 1985, 69: 1265–1280.Google Scholar
- 7.Shinohara E., Kihara S., Yamashita S., et al. Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J. Intern. Med. 1997, 241: 11–18.PubMedCrossRefGoogle Scholar
- 8.Pasquali R., Colella P., Cirignotta F., et al. Treatment of obese patients with obstructive sleep apnea syndrome (OSAS): effect of weight loss and interference of otorhinolaryngoiatric pathology. Int. J. Obes. 1990, 14: 207–217.PubMedGoogle Scholar
- 9.Bjrntorp P. The regulation of adipose tissue distribution in humans. Int. J. Obes. 1996, 20: 291–302.Google Scholar
- 10.Rebuffè-Scrive M., Mårin P., Björntorp P. Effect of testosterone on abdominal adipose tissue in men. Int. J. Obes. 1991, 15: 791–795.PubMedGoogle Scholar
- 11.Gambineri A., Pasquali R. Testosterone therapy in men: clinical and pharmacological perspectives. J. Endocrinol. Invest. 2000, 23: 196–214.PubMedCrossRefGoogle Scholar
- 12.Pasquali R., Casimirri F., Cantobelli S., et al. Effect of obesity and body fat distribution on sex hormones and insulin in men. Metabolism 1991, 40: 101–104.PubMedCrossRefGoogle Scholar
- 13.Glass A.R., Swerdloff R.S., Bray G.A., Dehms W.T., Atkinson R.L. Low serum testosterone and sex hormonebinding globulin in massively obese men. J. Clin. Endocrinol. Metab. 1977, 45: 1211–1219.PubMedCrossRefGoogle Scholar
- 14.Pasquali R., Casimirri F., DeIasio R., et al. Insulin regulates testosterone and sex hormone-binding globulin concentrations in adult normal weight and obese men. J. Clin. Endocrinol. Metab. 1995, 80: 654–658.PubMedGoogle Scholar
- 15.Vermeulen A., Kaufmann J.M., Deslypere J.P., Thomas G. Attenuated luteinizing hormone (LH) pulse amplitude but normal LH pulse frequency, and its relation to plasma androgens in hypogonadism of obese men. J. Clin. Endocrinol. Metab. 1993, 76: 1140–1146.PubMedGoogle Scholar
- 16.Killinger D.W., Perel E., Daniilescu D., Kharlip L., Lindsay W.R. The relationship between aromatase activity and body fat distribution. Steroids 1987, 50: 61–72.PubMedCrossRefGoogle Scholar
- 17.Mårin P., Holmang S., Jonsson L., et al. The effects of testosterone treatment on body composition and metabolism in middle-age obese men. Int. J. Obes. 1992, 16: 991–997.Google Scholar
- 18.Mårin P. Effects of androgens in men with the metabolic syndrome. Aging Male 1998, 1: 129–136.CrossRefGoogle Scholar
- 19.Obesity: preventing and managing the global epidemic. Report of a WHO Expert Committee. Geneva, World Health Organization, Technical Report Series, No. 894, 2000: 1–253.Google Scholar
- 20.Johns M.W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991, 14: 540–545.PubMedGoogle Scholar
- 21.Johns M.W. Daytime sleepiness, snoring, and obstructive sleep apnea. Chest 1993, 103: 30–36.PubMedCrossRefGoogle Scholar
- 22.Johns M.W. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard. Sleep. Res. 2000, 9: 5–11.CrossRefGoogle Scholar
- 23.WHO Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva, World Health Organization, Technical Report Series, No. 854, 1995: 368–369.Google Scholar
- 24.Duncan M.H., Singh B.M., Wise P.H., Carter G., Alaghband-Zadeh J. A simple measure of insulin resistance. Lancet 1995, 346: 120–121.PubMedCrossRefGoogle Scholar
- 25.Santamaria J.D., Prior J.C., Fleetham J.A. Reversible reproductive dysfunction in men with sleep apnoea. Clin. Endocrinol. (Oxf.) 1988, 28: 461–470.CrossRefGoogle Scholar
- 26.Grunstein R.R., Handelsman D.J., Lawrence S.J., Blackwell C., Caterson I.D., Sullivan C.E. Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J. Clin. Endocrinol. Metab. 1989, 68: 352–358.PubMedCrossRefGoogle Scholar
- 27.Semple Pd’ A., Beastall G.H., Hume R. Male sexual dysfunction, low testosterone and respiratory hypoxia. Br. J. Sex. Med. 1980, 64: 48–53.Google Scholar
- 28.Kouchiyama S., Honda Y., Kuriyama T. Influence of nocturnal oxygen desaturation on circadian rhythm of testosterone secretion. Respiration 1990, 57: 359–363.PubMedCrossRefGoogle Scholar
- 29.Barret Connor E., Khaw K.T. Endogenous sex hormones and cardiovascular disease in men: a prospective population-based study. Circulation 1988, 78: 539–545.CrossRefGoogle Scholar
- 30.Yarnell J.W., Beswick A.D., Sweetnam P.M., Riad Fahmy D. Endogenous sex hormones and ischemic heart disease in men: the Caerphilly prospective study. Arterioscler. Thromb. 1993, 13: 517–520.PubMedCrossRefGoogle Scholar
- 31.Lindholm J., Winkel P., Brodthagen U., Gyntelberg F. Coronary risk factors and plasma sex hormones. Am. J. Med. 1982, 73: 648–651.PubMedCrossRefGoogle Scholar
- 32.Barret Connor E., Khaw K.T., Yen S.S. Endogenous sex hormone levels in older adult men with diabetes mellitus. Am. J. Epidemiol. 1990, 132: 895–901.Google Scholar
- 33.Zhao S.P., Li X.P. The association of low plasma testosterone level with coronary artery disease in Chinese men. Int. J. Cardiol. 1998, 63: 161–164.PubMedCrossRefGoogle Scholar
- 34.Dickerman R.D., McConathy W.J., Zachariah N.Y. Testosterone, sex hormone-binding globulin, lipoproteins, and vascular disease risk. J. Cardiovasc. Risk 1997, 4: 363–366.PubMedCrossRefGoogle Scholar
- 35.Zmuda J.M., Cauley J.A., Kriska A., Glynn N.W., Gutai J.P., Kuller L.H. Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men. A 13-year follow-up of former Multiple Risk Factor Intervention Trial participants. Am. J. Epidemiol. 1997, 146: 609–617.PubMedCrossRefGoogle Scholar
- 36.Haffner S.M., Mykkanen L., Valdez R.A., Katz M.S. Relationship of sex hormones to lipids and lipoproteins in non-diabetic men. J. Clin. Endocrinol. Metab. 1993, 77: 1610–1615.PubMedGoogle Scholar
- 37.Phillips G.B. Relationship between serum sex hormones and the glucose-insulin-lipid defect in men with obesity. Metabolism 1993, 42: 116–120.PubMedCrossRefGoogle Scholar
- 38.Sewdarsen M., Jialal I., Vythilingum S., Desai R. Sex hormone levels in young Indian patients with myocardial infarction. Arteriosclerosis 1986, 6: 418–421.PubMedCrossRefGoogle Scholar
- 39.Phillips G.B., Pinkernell B.H., Jing T.Y. The association of hypotestosteronemia with coronary artery disease in men. Arterioscler. Thromb. 1994, 14: 701–706.PubMedCrossRefGoogle Scholar
- 40.Muscelli E., Camastra S., Catalano C., Galvan A.O, Baldi S., Ferranini E. Metabolic and cardiovascular assessment in moderate obesity: effect of weight loss. J. Clin. Endocrinol. 1997, 82: 2937–2943.CrossRefGoogle Scholar
- 41.Pasquali R., Casimirri F., Melchionda N., et al. Weight loss and sex steroid metabolism in massively obese man. J. Endocrinol. Invest. 1988, 11: 205–210.PubMedCrossRefGoogle Scholar
- 42.Sandblom R.E., Matsumoto A.M., Schoene R.B., et al. Obstructive sleep apnea syndrome induced by testosterone administration. N. Engl. J. Med. 1983, 308: 508–510.PubMedCrossRefGoogle Scholar
- 43.Matsumoto A.M., Sandblom R.E., Schoene R.B., et al. Testosterone replacement in hypogonadal men: effects on obstructive sleep apnoea, respiratory drives, and sleep. Clin. Endocrinol. (Oxf.) 1985, 22: 713–721.CrossRefGoogle Scholar
- 44.Cistulli P.A., Grunstein R.R., Sullivan C.E. Effect of testosterone administration on upper airway collapsibility during sleep. Am. J. Respir. Crit. Care Med. 1994, 149: 530–532.PubMedCrossRefGoogle Scholar
- 45.Schneider B.K., Pikett C.K., Zwillich C.W., et al. Influence of testosterone on breathing during sleep. J. Appl. Physiol. 1986, 61: 618–623.PubMedGoogle Scholar
- 46.Millman R.P., Kimmel P.L., Shore E.T., Wasserstein A.G. Sleep apnea in hemodialysis patients: the lack of testosterone effect on its pathogenesis. Nephron 1985, 40: 407–410.PubMedCrossRefGoogle Scholar