Abstract
Background
Obstructive sleep apnea (OSA) has several notable complications such as hypertension and diabetes. Studies have also shown that OSA is associated with erectile dysfunction and reduced androgen levels. However, the effect of OSA on semen quality remains poorly studied.
Methods
Men attending a tertiary reproductive center for semen analysis were tested with a portable sleep breathing monitor. Patients were divided into four groups based on their apnea hypopnea index: none, mild, moderate, and severe obstructive sleep apnea. Differences between groups were assessed using χ2, and associations were tested with multiple regression analysis.
Results
We included a total of 175 male subjects with a mean age of 32.2 ± 3.6 years. There were significant differences between groups in progressive sperm motility (%) (43 ± 16, 42 ± 17, 36 ± 18, 29 ± 18, respectively; p = 0.002), total motility (%) (59 ± 19, 59 ± 20, 49 ± 21, 42 ± 20, respectively; p = 0.010), and vitality (%) (80 ± 10, 81 ± 11, 79 ± 8, 72 ± 19, respectively; p = 0.039). Asthenospermia (progressive motility < 35%) was significantly more common in subjects with OSA (χ2 = 5.195, p = 0.023). In multiple regression models, after adjusting for age and body mass index, apnea hypopnea index remained negatively and significantly associated with progressive motility, total motility, and vitality.
Conclusions
OSA is an independent risk factor for sperm motility and vitality, and further investigation is now needed to determine if continuous positive pressure ventilation or other therapies can improve semen quality in these patients.
Similar content being viewed by others
Data availability
The datasets generated during and analysed during the current study are not publicly available due individual privacy but are available from the corresponding author on reasonable request.
Abbreviations
- AHI:
-
Apnea-hypopnea index
- BMI:
-
Body mass index
- CPAP:
-
Continuous positive airway pressure
- DFI:
-
DNA fragmentation index
- ODI:
-
Oxygen desaturation index
- OSA:
-
Obstructive sleep apnea
- PR:
-
Progressive motility
- SDB:
-
Sleep-disordered breathing
- T90:
-
Percentage of sleep time with SpO2 < 90%
- WHO:
-
World Health Organization
References
Carson SA, Kallen AN (2021) Diagnosis and Management of Infertility: A Review. JAMA 326(1):65–76
Winters BR, Walsh TJ (2014) The epidemiology of male infertility. Urol Clin North Am 41(1):195–204
Agarwal A et al (2021) Male infertility. Lancet 397(10271):319–333
Infertility Workup for the Women’s Health Specialist (2019) ACOG Committee Opinion, Number 781. Obstet Gynecol 133(6):e377–e384
Levine H et al (2023) Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 29(2):157–176
Minhas S et al (2021) European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 80(5):603–620
Veasey SC, Rosen IM (2019) Obstructive Sleep Apnea in Adults. N Engl J Med 380(15):1442–1449
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239
Patel SR (2019) Obstructive Sleep Apnea. Ann Intern Med 171(11):Itc81-itc96
Andersen ML et al (2010) Prevalence of erectile dysfunction complaints associated with sleep disturbances in Sao Paulo, Brazil: a population-based survey. Sleep Med 11(10):1019–1024
Tančić-Gajić M et al (2021) Obstructive Sleep Apnea Is Associated With Low Testosterone Levels in Severely Obese Men. Front Endocrinol (Lausanne) 12:622496
Viana A Jr et al (2017) Nocturnal Hypoxemia is Associated With Low Testosterone Levels in Overweight Males and Older Men With Normal Weight. J Clin Sleep Med 13(12):1395–1401
Torres M et al (2014) Male fertility is reduced by chronic intermittent hypoxia mimicking sleep apnea in mice. Sleep 37(11):1757–1765
Jhuang YH et al (2021) Association of Obstructive Sleep Apnea With the Risk of Male Infertility in Taiwan. JAMA Netw Open 4(1):e2031846
Hammoud AO et al (2012) Updates on the relation of weight excess and reproductive function in men: sleep apnea as a new area of interest. Asian J Androl 14(1):77–81
Bjorndahl L et al (2022) The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen ensuring quality and standardization in basic examination of human ejaculates. Fertil Steril 117(2):246–251
Kandil H et al (2021) Editorial Commentary on Draft of World Health Organization Sixth Edition Laboratory Manual for the Examination and Processing of Human Semen. World J Mens Health 39(4):577–580
Berry RB et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619
Kang S et al (2020) Validation of noncontact cardiorespiratory monitoring using impulse-radio ultra-wideband radar against nocturnal polysomnography. Sleep Breath 24(3):841–848
Hirotsu C, Tufik S, Levy Andersen M (2014) Sleep apnea as a potential threat to reproduction. Sleep 37(11):1731–2
Alvarenga TA et al (2022) The effects of sleep deprivation and obstructive sleep apnea syndrome on male reproductive function: a multi-arm randomised trial. J Sleep Res 32(1):e13664
Sharma R et al (2016) Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen. Eur Urol 70(4):635–645
Salas-Huetos A, Bullo M, Salas-Salvado J (2017) Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Hum Reprod Update 23(4):371–389
Caetano G et al (2021) Impact of sleep on female and male reproductive functions: a systematic review. Fertil Steril 115(3):715–731
Li Z et al (2021) Effects of Environmental and Pathological Hypoxia on Male Fertility. Front Cell Dev Biol 9:725933
Peng Y et al (2003) Systemic and cellular responses to intermittent hypoxia: evidence for oxidative stress and mitochondrial dysfunction. Adv Exp Med Biol 536:559–564
Lavie L (2009) Oxidative stress–a unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis 51(4):303–312
Park YJ, Pang MG (2021) Mitochondrial functionality in male fertility: from spermatogenesis to fertilization. Antioxidants (Basel) 10(1):98
Gharagozloo P, Aitken RJ (2011) The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy. Hum Reprod 26(7):1628–1640
Oleszczuk K, Giwercman A, Bungum M (2011) Intra-individual variation of the sperm chromatin structure assay DNA fragmentation index in men from infertile couples. Hum Reprod 26(12):3244–3248
Arafa M et al (2020) Efficacy of antioxidant supplementation on conventional and advanced sperm function tests in patients with idiopathic male infertility. Antioxidants (Basel) 9(3):219
Xu F et al (2018) Effect of long-term deep slow-wave sleep deprivation on the reproductive system in male rats. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 36(8):585–589
Chen Q et al (2016) Inverse U-shaped Association between Sleep Duration and Semen Quality: Longitudinal Observational Study (MARHCS) in Chongqing. China Sleep 39(1):79–86
Tingting X, Danming Y, Xin C (2018) Non-surgical treatment of obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 275(2):335–346
Li Z et al (2019) The effect of CPAP and PDE5i on erectile function in men with obstructive sleep apnea and erectile dysfunction: A systematic review and meta-analysis. Sleep Med Rev 48:101217
Li Z et al (2016) Efficacy of nasal continuous positive airway pressure on patients with OSA with erectile dysfunction and low sex hormone levels. Respir Med 119:130–134
Zhang XB et al (2016) Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure. Arch Sex Behav 45(1):235–240
Zhang TJ et al (2018) Effect of oral appliance on reproductive system of the male New-Zealand rabbit with obstructive sleep apnea-hypopnea syndrome. Zhonghua Yi Xue Za Zhi 98(38):3090–3095
Acknowledgements
The authors would like to thank all the patients for participating in this study. The authors would also like to thank all the research assistants at the Reproductive Medicine Center and Department of Respiratory and Critical Care Medicine for their assistance in data collection. This study was funded by the National Natural Science Foundation of China (Nos. 81970082, 82270101).
Funding
This research was supported by grants from the National Natural Science Foundation of China (Nos. 81970082, 82270101).
Author information
Authors and Affiliations
Contributions
ZW and QZ contributed to study design, data collection, data analysis and drafting the manuscript. JY and KH contributed to correcting the manuscript, final approval, and obtaining funding. JD, SY, WJ, SZ, LL, QL, ZZ and HC contributed to data collection and cleaning.
Corresponding authors
Ethics declarations
Ethical approval
The research protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University and has been performed in accordance with the 1964 Helsinki declaration and its later amendments.
Statement of informed consent
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, Z., Zhang, Q., Ding, J. et al. Effect of obstructive sleep apnea on semen quality. Sleep Breath 27, 2341–2349 (2023). https://doi.org/10.1007/s11325-023-02847-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-023-02847-8