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Handelsman DJ, Grossmann M, Yeap BB, Stuckey BGA, Shankara-Narayana N, Conway AJ, Inder WJ, McLachlan RI, Allan C, Jenkins AJ, Jesudason D, Bracken K, Wittert GA. Long-term Outcomes of Testosterone Treatment in Men: A T4DM Postrandomization Observational Follow-up Study. J Clin Endocrinol Metab 2023; 109:e25-e31. [PMID: 37623257 DOI: 10.1210/clinem/dgad485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT The T4DM study randomized 1007 men with impaired glucose tolerance or newly diagnosed diabetes to testosterone undecanoate (TU, 1000 mg) or matching placebo (P) injections every 12 weeks for 24 months with a lifestyle program with testosterone (T) treatment reducing diabetes diagnosis by 40%. BACKGROUND The long-term effects on new diagnosis of diabetes, cardiovascular and prostate disease, sleep apnea, weight maintenance trajectory and androgen dependence were not yet described. METHODS A follow-up email survey after a median of 5.1 years since last injection obtained 599 (59%) completed surveys (316 T, 283 P), with participants in the follow-up survey compared with nonparticipants in 23 anthropometric and demographic variables. RESULTS Randomization to was TU associated with stronger belief in study benefits during (64% vs 49%, P < .001) but not after the study (44% vs 40%, P = .07); there is high interest in future studies. At T4DM entry, 25% had sleep apnea with a new diagnosis more frequent on TU (3.0% vs 0.4%, P = .03) during, but not after, the study. Poststudy, resuming prescribed T treatment was more frequent among TU-treated men (6% vs 2.8%, P = .03). Five years after cessation of TU treatment there was no difference in self-reported rates of new diagnosis of diabetes, and prostate or cardiovascular disease, nor change in weight maintenance or weight loss behaviors. CONCLUSION We conclude that randomized T treatment for 24 months in men with impaired glucose tolerance or new diabetes but without pathological hypogonadism was associated with higher levels of self-reported benefits and diagnosis of sleep apnea during, but not after, the study as well as more frequent prescribed poststudy T treatment consistent with androgen dependence in some men receiving prolonged injectable TU.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Mathis Grossmann
- Department of Medicine Austin Health, The University of Melbourne and Department of Endocrinology, Austin Health, Heidelberg, VIC 3084, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA 6150, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Nandini Shankara-Narayana
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, and PA-Southside Clinical Unit, Medical School, the University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Alicia J Jenkins
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Karen Bracken
- Kolling Institute, University of Sydney, Sydney, NSW 2064, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA 506, Australia
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Graziani A, Grande G, Ferlin A. The complex relation between obstructive sleep apnoea syndrome, hypogonadism and testosterone replacement therapy. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1219239. [PMID: 37881222 PMCID: PMC10597633 DOI: 10.3389/frph.2023.1219239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is an under-recognized medical disease. The main risk factors for OSAS are male sex, older age, obesity, and metabolic syndrome, that are also associated with male hypogonadism (MH). Therefore, obesity has been classically identified as the most evident link between OSAS and MH. However, OSAS is per se linked to the development of MH by a combined effect of hypoxia, increased night-time awakenings, reduced sleep efficiency and fragmented sleep. Similarly, MH might represent a risk factor for OSAS, mainly related to sleep disturbances that are frequently associated with low testosterone. Data on testosterone replacement therapy (TRT) in patients with OSAS are limited. Nevertheless, TRT is generally contraindicated by guidelines in the presence of untreated or severe OSAS. TRT might in fact worse OSAS symptoms in different ways. Furthermore, OSAS has been proposed to be a risk factor for secondary polycythaemia and TRT might exacerbate polycythaemia. Therefore, TRT in hypogonadal men affected by untreated OSAS or severe OSAS should be considered with caution and in a personalised way. Nevertheless, the type and dosage of TRT should be considered, as short-term high-dose TRT might worsen OSAS, whereas long-term lower doses could eventually determine a clinical improvement of symptoms of OSAS. Here we reviewed the data on the association between OSAS, MH and TRT, including the opportunity of assessment of patients who develop signs and symptoms of OSAS during TRT by polysomnography.
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Genzor S, Prasko J, Mizera J, Kufa J, Zurkova M, Jakubec P, Vykopal M, Vanek J. Sex transition from female to male as a risk factor for sleep-disordered breathing. Sleep Med 2023; 102:180-185. [PMID: 36701832 DOI: 10.1016/j.sleep.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 01/16/2023]
Abstract
AIM The female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. PATIENTS AND METHODS All reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. RESULTS In all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects' age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48-43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. CONCLUSION SDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic; Center for Digital Health, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic; Institute for Postgraduate Education in Health Care, Prague, Czech Republic; Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Slovak Republic.
| | - Jan Mizera
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jiri Kufa
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Monika Zurkova
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martin Vykopal
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Isidori AM, Aversa A, Calogero A, Ferlin A, Francavilla S, Lanfranco F, Pivonello R, Rochira V, Corona G, Maggi M. Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2022; 45:2385-2403. [PMID: 36018454 PMCID: PMC9415259 DOI: 10.1007/s40618-022-01859-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To provide the evidence-based recommendations on the role of testosterone (T) on age-related symptoms and signs remains. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) and the and the Italian Society of Endocrinology (SIE) commissioned an expert task force to provide an updated guideline on adult-onset male hypogonadism. Derived recommendations were based on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Clinical diagnosis of adult-onset hypogonadism should be based on a combination of clinical and biochemical parameters. Testosterone replacement therapy (TRT) should be offered to all symptomatic subjects with hypogonadism after the exclusion of possible contraindications. T gels and the long-acting injectable T are currently available preparations showing the best efficacy/safety profile. TRT can improve all aspects of sexual function, although its effect is limited in more complicated patients. Body composition (reducing fat mass and increasing lean mass) is improved after TRT, either in subjects with or without metabolic syndrome or type 2 diabetes. Conversely, the role of TRT in improving glycometabolic control is more conflicting. TRT can result in increasing bone mineral density, particularly at lumbar site, but no information on fracture risk is available. Limited data support the use of TRT for improving other outcomes, including mood frailty and mobility. CONCLUSIONS TRT can improve sexual function and body composition particularly in less complicated adult and in aging subjects with hypogonadism. When hypogonadism is adequately diagnosed, T appropriately prescribed and subjects correctly followed up, no short-term increased risk of adverse events is observed. Longer and larger studies are advisable to better clarify TRT long-term efficacy/safety profile.
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Affiliation(s)
- A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome - Policlinico Umberto I Hospital, Rome, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - S Francavilla
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Lanfranco
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo, Department of Medical Sciences, University of Turin, Turin, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2, 40133, Bologna, Italy.
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Abstract
Sleep serves important biological functions, and influences health and longevity through endocrine and metabolic related systems. Sleep debt, circadian misalignment and sleep disruption from obstructive sleep apnea is widespread in modern society and accumulates with life because recovery sleep is not completely restorative. Accumulated disordered sleep throughout life impacts the ageing process and the development of age-related diseases. When epidemiological and interventional studies are considered collectively, sleep loss and lower sleep duration are associated with lower morning, afternoon and 24-h testosterone; as well as higher afternoon, but not morning or 24-h cortisol. These reciprocal changes imbalances anabolic-catabolic signaling because testosterone and cortisol are respectively the main anabolic and catabolic signals in man. Fixing testosterone-cortisol balance by means of a novel dual-hormone clamp mitigates the induction of insulin resistance by sleep restriction and provided the first proof-of-concept that the metabolic harm from sleep loss can be ameliorated by approaches that do not require sleeping more. Obstructive sleep apnea is associated with lower testosterone, even after controlling for age and obesity whereas the conclusion that continuous positive airway pressure therapy has no effect on testosterone is premature because available studies are underpowered and better-quality studies suggest otherwise. High dose testosterone therapy induces OSA, but more physiological dosing may not; and this effect may be transient or may dissipate with longer term therapy. Studies investigating the origin of the diurnal testosterone rhythm, the effect of circadian misalignment on testosterone-cortisol balance, and methods to mitigate metabolic harm, are required.
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Affiliation(s)
- Peter Y Liu
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Harbor UCLA Medical Center and The Lundquist Institute, 1124 W Carson St., Box 446, Torrance, CA, 90502, USA.
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Radha T Reddy
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Harbor UCLA Medical Center and The Lundquist Institute, 1124 W Carson St., Box 446, Torrance, CA, 90502, USA
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Obstructive sleep apnea and serum total testosterone: a system review and meta-analysis. Sleep Breath 2022; 27:789-797. [DOI: 10.1007/s11325-022-02655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 10/16/2022]
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Feng C, Yang Y, Chen L, Guo R, Liu H, Li C, Wang Y, Dong P, Li Y. Prevalence and Characteristics of Erectile Dysfunction in Obstructive Sleep Apnea Patients. Front Endocrinol (Lausanne) 2022; 13:812974. [PMID: 35250871 PMCID: PMC8896119 DOI: 10.3389/fendo.2022.812974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/12/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common and severe social problem. Erectile dysfunction (ED) is an important health concern. The prevalence of OSA with ED is increasing, which significantly affects the quality of life and work efficiency of patients. However, the mechanism underlying the comorbidity of these two diseases remains unclear. OBJECTIVES (1) Investigate the prevalence of OSA with ED; (2) analyze the correlation between OSA and ED; and (3) explore the treatment response to and possible mechanism of uvulapalatopharyngoplasty (UPPP) in patients with OSA and ED. This study aims to provide a theoretical basis for the clinical diagnosis and comprehensive treatment of OSA with ED and improve prevention and treatment strategies. MATERIALS AND METHODS In total, 135 subjects were enrolled in the study. Clinical data, polysomnography, the ESS score, Beck anxiety score, Beck depression score, IIEF-5 score and ASEX score were recorded before UPPP and 6 months after UPPP. Sex hormones were measured for all subjects using a Roche electrochemiluminescence analyzer. RESULT The prevalence of OSA with ED was 64.52%, and the prevalence of severe OSA with ED was 73.02%. The prevalence of OSA with ED increased with age, BMI and apnea-hypopnea index (AHI) value. Among polysomnography indicators, minimum oxygen saturation and average oxygen saturation may predict the occurrence of OSA with ED. Improving the patient's anxiety and depression is very important for treating OSA with ED. Sex hormone levels were not significantly correlated with the occurrence of OSA with ED. CONCLUSION ED is a common symptom of OSA patients. This study showed that sex hormone levels in OSA patients with ED were not significantly correlated with the condition, but further investigation of this relationship is worthwhile. It is recommended that the free and combined types of sex hormones be further distinguished during testing because the free type is the active form. UPPP surgical treatment is effective for OSA with ED, and its possible mechanism is protection of the peripheral nerves of the sex organs by improving nighttime hypoxia and arousal.
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Affiliation(s)
- Chen Feng
- Department of Otolaryngology Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Yan Yang
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Lixiao Chen
- Department of Otolaryngology Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruixiang Guo
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Huayang Liu
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Chaojie Li
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Yan Wang
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Pin Dong
- Department of Otolaryngology Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Pin Dong, ; Yanzhong Li,
| | - Yanzhong Li
- Department of Otorhinolaryngology, Qilu Hospital, Shandong University Cheeloo College of Medicine, Jinan, China
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
- *Correspondence: Pin Dong, ; Yanzhong Li,
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LoMauro A, Aliverti A. Sex and gender in respiratory physiology. Eur Respir Rev 2021; 30:30/162/210038. [PMID: 34750114 DOI: 10.1183/16000617.0038-2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
Sex is a biological concept determined at conception. Gender is a social concept. Medicine recognises sex as a biological variable and recommends including sex as a factor in clinical practice norms and as a topic of bench and clinical research. Sex plays a role in respiratory physiology according to two pathways: hormones and anatomy, with females characterised by smaller dimensions at every level of the respiratory system. Sex hormones also play specific roles in lung inflammatory processes, breathing control and in response to diseases. The literature is extremely controversial because many factors need to be considered to avoid erroneous comparisons. The main difficulty lies in creating homogeneous groups of subjects according to age, body weight, lung/airway size, fluctuations in circulating hormone levels, and exercise protocol. Because almost all of the knowledge available in physiology is based on research in males, medicine for women is therefore less evidence-based than that being applied to men. Finally, the number of transsexual people is increasing and they represent new challenges for clinicians, due to the anatomical and physiological changes that they undergo.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Archiza B, Leahy MG, Kipp S, Sheel AW. An integrative approach to the pulmonary physiology of exercise: when does biological sex matter? Eur J Appl Physiol 2021; 121:2377-2391. [PMID: 33903937 DOI: 10.1007/s00421-021-04690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada.
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - Shalaya Kipp
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
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Twitchell DK, Pastuszak AW, Khera M. Controversies in Testosterone Therapy. Sex Med Rev 2020; 9:149-159. [PMID: 33309270 DOI: 10.1016/j.sxmr.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Testosterone prescriptions have increased dramatically in recent years, largely because of changes in expert guidelines. Concerns have been raised that testosterone therapy (TTh) may be associated with an increased incidence of conditions such as cardiovascular (CV) disease, thromboembolic events, obstructive sleep apnea (OSA), benign prostatic hyperplasia (BPH), and prostate cancer (PCa) and also may be a beneficial therapy in the management of prediabetes. As such, considerable debate remains regarding which hypogonadal populations are appropriate candidates for TTh. OBJECTIVES This systematic review aims to affirm or refute, using the most current evidence, the published concerns surrounding TTh and its potential increased risk of conditions such as CV disease, thromboembolic events, OSA, urolithiasis, BPH, and PCa, as well as its role as a potential tool for managing prediabetes. METHODS A systematic review of literature surrounding TTh and its impact on increasing risk for the adverse conditions mentioned previously was performed. 62 publications were selected for inclusion based on their relevance to the effects and risks of TTh. Evidence is current through December 2019. RESULTS Evidence demonstrates that positive associations exist between TTh and OSA, erythrocytosis, as well as urolithiasis. TTh may potentially be used to treat hypogonadal men with prediabetes. While low testosterone is positively correlated with adverse CV events, TTh in hypogonadal men either has no effect or decreases such risk. TTh is likely not associated with increased risk of PCa incidence or recurrence. CONCLUSIONS Despite historical beliefs that TTh increases the risk of CV disease, thromboembolic events, BPH, and PCa, recent evidence suggests that TTh conveys less risk than previously perceived. While caution should continue to be exercised, evidence suggests that TTh is a reasonable treatment option in many hypogonadal men who were previously excluded from TTh based on risk factors and prior health histories. Twitchell DK, Pastuszak AW, Khera M. Controversies in Testosterone Therapy. Sex Med Rev 2021;9:149-159.
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Affiliation(s)
| | | | - Mohit Khera
- Department of Urology - Baylor College of Medicine, Houston, TX, USA.
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11
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Ostroumova OD, Isaev RI, Kotovskaya YV, Tkacheva ON. [Drugs affecting obstructive sleep apnea syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:46-54. [PMID: 33076645 DOI: 10.17116/jnevro202012009146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sleep-disordered breathing is one of the most common sleep-associated disorders. At the same time, their prevalence tends to increase with age. One of the most common forms of respiratory failure during sleep is obstructive sleep apnea syndrome (OSA), which is characterized by repeated episodes of cessation of breathing or a significant decrease in respiratory flow while maintaining respiratory effort as a result of obstruction of the upper respiratory tract. Drugs have different effects on OSA. There are drugs that worsen OSA, drugs that do not affect OSA, and drugs that improve OSA. Benzodiazepines, opioids, muscle relaxants, and male hormones adversely affect OSA. Also of clinical interest are drugs that do not affect OSA and can even potentially improve respiratory function during sleep. These include anti-inflammatory drugs, diuretics, bronchodilators, acetylcholinesterase inhibitors, antiparkinsonian, decongestant drugs, drugs for intranasal use, topical soft tissue lubricant, female sex hormones. Finally, the effect of a number of drugs on OSA is not definitively established and requires further study (benzodiazepine receptor agonist hypnotics, angiotensin-converting enzyme inhibitors, opiate receptor antagonists, antidepressants, proton-pump inhibitors, TNF-α antagonists, glutamate receptor antagonists, drugs for the treatment of acromegaly, drugs for the treatment of narcolepsy). Raising awareness of doctors of different specialties about the impact of various drugs on OSA can not only prevent the deterioration of respiratory distress during sleep, but also, with a rational individual approach, makes it possible to even improve the quality of sleep and blood saturation, thereby contributing to a more favorable course of OSA and the underlying disease.
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Affiliation(s)
- O D Ostroumova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Russian Clinical and Research Center of Gerontology, Moscow, Russia
| | - R I Isaev
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - Yu V Kotovskaya
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O N Tkacheva
- Russian Gerontological Research and Clinical Center, Moscow, Russia
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Giagulli VA, Castellana M, Lisco G, Triggiani V. Critical evaluation of different available guidelines for late‐onset hypogonadism. Andrology 2020; 8:1628-1641. [DOI: 10.1111/andr.12850] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Vito Angelo Giagulli
- Interdisciplinary Department of Medicine‐Section of Internal Medicine Geriatrics, Endocrinology and Rare Diseases School of Medicine University of Bari “Aldo Moro” Bari Italy
- Outpatients Clinic of Endocrinology and Metabolic Disease Conversano Hospital Bari Italy
| | - Marco Castellana
- National Institute of Gastroenterology "Saverio de Bellis" Research Hospital Bari Italy
| | - Giuseppe Lisco
- Hospital Unit of Endocrinology Perrino Hospital Brindisi Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine‐Section of Internal Medicine Geriatrics, Endocrinology and Rare Diseases School of Medicine University of Bari “Aldo Moro” Bari Italy
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13
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Earl DC, Brown LK. On Not Knowing What We Don't Know to Knowing What We Don't Know: Obstructive Sleep Apnea in the Transgender Community. J Clin Sleep Med 2020; 15:1393-1395. [PMID: 31596202 DOI: 10.5664/jcsm.8010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David C Earl
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Lee K Brown
- University of New Mexico Health System Sleep Disorders Centers, Albuquerque, New Mexico.,Sleep Medicine Section, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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14
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Barbonetti A, D’Andrea S, Francavilla S. Testosterone replacement therapy. Andrology 2020; 8:1551-1566. [DOI: 10.1111/andr.12774] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Arcangelo Barbonetti
- Andrology Unit Department of Life, Health and Environmental Sciences University of L’Aquila L’Aquila Italy
| | - Settimio D’Andrea
- Andrology Unit Department of Life, Health and Environmental Sciences University of L’Aquila L’Aquila Italy
| | - Sandro Francavilla
- Andrology Unit Department of Life, Health and Environmental Sciences University of L’Aquila L’Aquila Italy
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15
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Liu PY. A Clinical Perspective of Sleep and Andrological Health: Assessment, Treatment Considerations, and Future Research. J Clin Endocrinol Metab 2019; 104:4398-4417. [PMID: 31042277 PMCID: PMC6735730 DOI: 10.1210/jc.2019-00683] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT Sleep that is insufficient, misaligned, or disrupted causes hypersomnolence and neuropsychological deficits, adversely affects cardiometabolic health, and is increasingly recognized to impair other biological processes that lead to conditions important to men, such as hypogonadism, erectile dysfunction, and infertility. EVIDENCE ACQUISITION Literature review from 1970 to December 2018. EVIDENCE SYNTHESIS High-quality and complementary epidemiological and interventional studies establish that abnormal sleep is associated with increased mortality, hypertension, and other cardiometabolic disorders (insufficient, disrupted, and misaligned sleep), as well as reduced fecundity and total sperm count (insufficient sleep), erectile dysfunction (disrupted sleep), and low testosterone (both). Circadian misalignment shifts the peak of testosterone's diurnal rhythm to occur soon after waking up, irrespective of the biological clock time, but it does not change the mean concentration. Preliminary studies show that extending sleep in individuals who are chronically sleep deprived may become a strategy to reduce insulin resistance and hypertension. Continuous positive airway pressure therapy can improve erectile function, and possibly systemic testosterone exposure, but only when used adherently by men with obstructive sleep apnea. Both high-dose and replacement-dose testosterone therapies modestly worsen sleep-disordered breathing, but they also improve cardiometabolic function and sexual desire. Persistence of either the adverse or beneficial outcomes over the longer term requires further investigation. CONCLUSIONS Sleep is increasingly recognized to be essential for healthy living. Establishing the effect of abnormal sleep, and of improving sleep, on andrological issues of prime interest to men will promote prioritization of sleep, and may thereby improve overall long-term health outcomes.
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Affiliation(s)
- Peter Y Liu
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Correspondence and Reprint Requests: Peter Y. Liu, PhD, Division of Endocrinology and Metabolism, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Research Institute, 1124 West Carson Street, Box 446, Torrance, California 90502. E-mail:
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16
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Sex differences in breathing. Comp Biochem Physiol A Mol Integr Physiol 2019; 238:110543. [PMID: 31445081 DOI: 10.1016/j.cbpa.2019.110543] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/15/2023]
Abstract
Breathing is a vital behavior that ensures both the adequate supply of oxygen and the elimination of CO2, and it is influenced by many factors. Despite that most of the studies in respiratory physiology rely heavily on male subjects, there is much evidence to suggest that sex is an important factor in the respiratory control system, including the susceptibility for some diseases. These different respiratory responses in males and females may be related to the actions of sex hormones, especially in adulthood. These hormones affect neuromodulatory systems that influence the central medullary rhythm/pontine pattern generator and integrator, sensory inputs to the integrator and motor output to the respiratory muscles. In this article, we will first review the sex dependence on the prevalence of some respiratory-related diseases. Then, we will discuss the role of sex and gonadal hormones in respiratory control under resting conditions and during respiratory challenges, such as hypoxia and hypercapnia, and whether hormonal fluctuations during the estrous/menstrual cycle affect breathing control. We will then discuss the role of the locus coeruleus, a sexually dimorphic CO2/pH-chemosensitive nucleus, on breathing regulation in males and females. Next, we will highlight the studies that exist regarding sex differences in respiratory control during development. Finally, the few existing studies regarding the influence of sex on breathing control in non-mammalian vertebrates will be discussed.
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17
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Hachul H, Polesel DN, Tock L, Carneiro G, Pereira AZ, Zanella MT, Tufik S, Togeiro SM. Sleep disorders in polycystic ovary syndrome: influence of obesity and hyperandrogenism. ACTA ACUST UNITED AC 2019; 65:375-383. [PMID: 30994836 DOI: 10.1590/1806-9282.65.3.375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/02/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to evaluate the sleep of subjects with polycystic ovary syndrome (PCOS), with and without hyperandrogenism, in comparison with a healthy control group and examine the effects of hyperandrogenism and obesity on sleep parameters. METHODS A total of 44 volunteers were recruited to participate in the study. Clinical, biochemical and polysomnographic parameters were used to diagnose PCOS and hyperandrogenism. The evaluation of sleep quality was made using validated questionnaires and polysomnography test. The frequency of obstructive sleep apnea was also compared between the groups. RESULTS The study revealed that women with PCOS presented poorer subjective sleep quality, increased incidence of snoring and a higher risk of obstructive sleep apnea, based on the Berlin questionnaire. Also, after adjusting for body mass index, PCOS subjects had rapid eye movement (REM) time lower than those in the control group. PCOS women versus those without hyperandrogenism did not differ on any sleep measurement. Women with obstructive sleep apnea were only diagnosed in the PCOS group. CONCLUSIONS Our results indicate that PCOS impairs subjective sleep quality, as well as objective sleep quality, due to a reduction in REM sleep stage time in women diagnosed with the syndrome. Obesity affected sleep-related parameters but hyperandrogenism had no effect. Only the PCOS group had obstructive sleep apnea diagnosis.
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Affiliation(s)
- Helena Hachul
- Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, SP, Brasil.,Department of Gynecology & Obstetrics, Santa Marcelina Hospital, São Paulo, SP, Brasil
| | - Daniel N Polesel
- Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, SP, Brasil
| | - Luciana Tock
- Department of Endocrinology, Federal University of de Sao Paulo, Sao Paulo, SP, Brasil
| | - Glaucia Carneiro
- Department of Endocrinology, Federal University of de Sao Paulo, Sao Paulo, SP, Brasil
| | - Andrea Z Pereira
- Department of Endocrinology, Federal University of de Sao Paulo, Sao Paulo, SP, Brasil
| | - Maria Teresa Zanella
- Department of Endocrinology, Federal University of de Sao Paulo, Sao Paulo, SP, Brasil
| | - Sergio Tufik
- Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, SP, Brasil
| | - Sônia M Togeiro
- Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, SP, Brasil
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18
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Hajali V, Andersen ML, Negah SS, Sheibani V. Sex differences in sleep and sleep loss-induced cognitive deficits: The influence of gonadal hormones. Horm Behav 2019; 108:50-61. [PMID: 30597139 DOI: 10.1016/j.yhbeh.2018.12.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 12/23/2018] [Accepted: 12/25/2018] [Indexed: 12/30/2022]
Abstract
Males and females can respond differentially to the same environmental stimuli and experimental conditions. Chronic sleep loss is a frequent and growing problem in many modern societies and has a broad variety of negative outcomes for health and well-being. While much has been done to explore the deleterious effects of sleep deprivation (SD) on cognition in both human and animal studies over the last few decades, very little attention has been paid to the part played by sex differences and gonadal steroids in respect of changes in cognitive functions caused by sleep loss. The effects of gonadal hormones on sleep regulation and cognitive performances are well established. Reduced gonadal function in menopausal women and elderly men is associated with sleep disturbances and cognitive decline as well as dementia, which suggests that sex steroids play a key role in modulating these conditions. Finding out whether there are sex differences in respect of the effect of insufficient sleep on cognition, and how neuroendocrine mediators influence cognitive impairment induced by SD could provide valuable insights into the best therapies for each sex. In this review, we aim to highlight the involvement of sex differences and gonadal hormone status on the severity of cognitive deficits induced by sleep deficiency in both human and animal studies.
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Affiliation(s)
- Vahid Hajali
- Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Sajad Sahab Negah
- Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Sheibani
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
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19
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Shigehara K, Konaka H, Sugimoto K, Nohara T, Izumi K, Kadono Y, Namiki M, Mizokami A. Sleep disturbance as a clinical sign for severe hypogonadism: efficacy of testosterone replacement therapy on sleep disturbance among hypogonadal men without obstructive sleep apnea. Aging Male 2018; 21:99-105. [PMID: 28920756 DOI: 10.1080/13685538.2017.1378320] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The present subanalysis of the EARTH study investigates the effects of one year testosterone replacement therapy (TRT) on sleep disturbance among hypogonadal men without obstructive sleep apnea. METHODS Sleep disturbance was defined as three or more points in question 4 of the aging males symptoms (AMS) questionnaire. All participants completed the AMS scale, International Prostatic Symptoms Score (IPSS), Sexual Health Inventory for Men (SHIM) and Short Form 36 (SF-36) health survey at baseline and after 12 months. Sexual symptoms were also evaluated based on three AMS subscores (Q15, 16 and 17). RESULTS We identified 100 patients with sleep disturbance, of whom 48 (24 each in the TRT and control groups) were ultimately included for analysis. All SF-36 categories , AMS scale, IPSS and SHIM score subdomains were significantly worse in patients with sleep disturbance than in those without disturbance. Statistically significant differences in sleep disturbance, erectile symptoms, sexual desire and some domains of the SF-36 were observed between the TRT and control groups after 12 months. CONCLUSION Sleep disturbance may be one of the clinical signs for severe hypogonadism. Moreover, TRT improved sleep conditions, sexual function and quality of life among hypogonadal men with sleep disturbance.
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Affiliation(s)
- Kazuyoshi Shigehara
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Hiroyuki Konaka
- b Department of Urology , Kanazawa Red Cross Hospital , Kanazawa , Japan
| | | | - Takahiro Nohara
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Koji Izumi
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Yoshifumi Kadono
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
| | - Mikio Namiki
- d Department of Urology , Hasegawa Hospital , Toyama , Japan
| | - Atsushi Mizokami
- a Department of Integrative Cancer Therapy and Urology , Kanazawa University Graduate School of Medical Science , Kanazawa , Japan
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20
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Kim SD, Cho KS. Obstructive Sleep Apnea and Testosterone Deficiency. World J Mens Health 2018; 37:12-18. [PMID: 29774669 PMCID: PMC6305865 DOI: 10.5534/wjmh.180017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by intermittent hypoxia and sleep fragmentation. OSA in middle-aged men is often associated with decreased testosterone secretion, together with obesity and aging. Although OSA treatment does not reliably increase testosterone levels in most studies, OSA treatment with testosterone replacement therapy (TRT) may not only improve hypogonadism, but can also alleviate erectile/sexual dysfunction. However, because TRT may exacerbate OSA in some patients, patients should be asked about OSA symptoms before and after starting TRT. Furthermore, TRT should probably be avoided in patients with severe untreated OSA.
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Affiliation(s)
- Sung Dong Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kyu Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
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21
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Melehan KL, Hoyos CM, Hamilton GS, Wong KK, Yee BJ, McLachlan RI, O’Meagher S, Celermajer D, Ng MK, Grunstein RR, Liu PY. Randomized Trial of CPAP and Vardenafil on Erectile and Arterial Function in Men With Obstructive Sleep Apnea and Erectile Dysfunction. J Clin Endocrinol Metab 2018; 103:1601-1611. [PMID: 29409064 PMCID: PMC6457007 DOI: 10.1210/jc.2017-02389] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Erectile function is important for life satisfaction and often impaired in men with obstructive sleep apnea (OSA). Uncontrolled studies show that treating OSA with continuous positive airway pressure (CPAP) improves erectile function. Phosphodiesterase type 5 inhibitors (e.g., vardenafil) are the first-line therapy for erectile dysfunction (ED), but may worsen OSA. OBJECTIVE To assess the effects of CPAP and vardenafil on ED. DESIGN Sixty-one men with moderate-to-severe OSA and ED were randomized to 12 weeks of CPAP or sham CPAP, and 10 mg daily vardenafil or placebo in a two-by-two factorial design. MAIN OUTCOME MEASURES International Index of Erectile Function (primary end point), treatment and relationship satisfaction, sleep-related erections, sexual function, endothelial function, arterial stiffness, quality of life, and sleep-disordered breathing. RESULTS CPAP increased the frequency of sleep-related erections, overall sexual satisfaction, and arterial stiffness but did not change erectile function or treatment or relationship satisfaction. Vardenafil did not alter erectile function, endothelial function, arterial stiffness, or sleep-disordered breathing, but did improve overall self-esteem and relationship satisfaction, other aspects of sexual function, and treatment satisfaction. Adherent CPAP improved erectile function, sexual desire, overall sexual, self-esteem, relationship, and treatment satisfaction, as well as sleepiness, and quality of life. Adherent vardenafil use did not consistently change nocturnal erection quality. CONCLUSION CPAP improves overall sexual satisfaction, sleep-related erections, and arterial stiffness. Low-dose daily vardenafil improves certain aspects of sexual function and did not worsen OSA. Adherent CPAP or vardenafil use further improves ED and quality of life.
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Affiliation(s)
- Kerri L Melehan
- CIRUS, Centre for Sleep & Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Camilla M Hoyos
- CIRUS, Centre for Sleep & Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Keith K Wong
- CIRUS, Centre for Sleep & Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Brendon J Yee
- CIRUS, Centre for Sleep & Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research and Monash University, Clayton, Victoria, Australia
| | - Shamus O’Meagher
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Martin K Ng
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep & Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Y Liu
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California
- Correspondence and Reprint Requests: Peter Y. Liu, MBBS (Hons I), FRACP, PhD, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, California 90502. E-mail:
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22
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Cole AP, Hanske J, Jiang W, Kwon NK, Lipsitz SR, Kathrins M, Learn PA, Sun M, Haider AH, Basaria S, Trinh QD. Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men. BJU Int 2018; 121:811-818. [DOI: 10.1111/bju.14149] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander P. Cole
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Division of Urological Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Julian Hanske
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Marien Hospital; Ruhr-University Bochum; Herne Germany
| | - Wei Jiang
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Nicollette K. Kwon
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Martin Kathrins
- Division of Urological Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Peter A. Learn
- Department of Surgery; Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center; Bethesda MD USA
| | - Maxine Sun
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Adil H. Haider
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Shehzad Basaria
- Section on Men's Health; Aging and Metabolism; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Division of Urological Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Wang D, Wong KK, Rowsell L, Don GW, Yee BJ, Grunstein RR. Predicting response to oxygen therapy in obstructive sleep apnoea patients using a 10-minute daytime test. Eur Respir J 2018; 51:51/1/1701587. [DOI: 10.1183/13993003.01587-2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/07/2017] [Indexed: 11/05/2022]
Abstract
There is no satisfactory treatment for obstructive sleep apnoea (OSA). Supplemental low-flow oxygen therapy (LFO2) has been shown to reduce hypoxaemia and is well tolerated by patients with OSA. However, oxygen therapy may be beneficial only to certain subsets of patients with OSA. In this study, we evaluated a 10-min awake ventilatory chemoreflex test in predicting individual OSA response to 2 months of LFO2therapy.At baseline, patients with OSA underwent ventilatory chemoreflex testing in the afternoon, prior to the overnight polysomnography. Subjects were reassessed with polysomnography after 2 months of nocturnal oxygen treatment.20 patients with OSA completed the study. After 2 months of O2treatment, changes in the apnoea–hypopnoea index (AHI) were significantly correlated with baseline CO2ventilatory response threshold (VRT) and chemosensitivity (p<0.05). In predicting a fall in AHI, the area under the receiver operating characteristic curve (AUC) was 0.79 for VRT and 0.89 for chemosensitivity. When these two variables were combined in a logistic regression model, the prediction effect became stronger with an AUC of 0.97, sensitivity of 0.92 and specificity of 0.83.Our awake ventilatory chemoreflex test could be considered a simple potential clinical tool to predict individual OSA response to oxygen therapy. It could provide a novel personalised medicine approach to OSA treatment.
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Gautier-Veyret E, Pépin JL, Stanke-Labesque F. Which place of pharmacological approaches beyond continuous positive airway pressure to treat vascular disease related to obstructive sleep apnea? Pharmacol Ther 2017; 186:45-59. [PMID: 29277633 DOI: 10.1016/j.pharmthera.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, occurring during sleep, leading to chronic intermittent hypoxia (IH), which harms the cardiovascular system. OSA is associated with both functional and structural vascular alterations that contribute to an increased prevalence of fatal and non-fatal cardiovascular events. OSA is a heterogeneous disease with respect to the severity of hypoxia, the presence of daytime symptoms, obesity, and cardiovascular comorbidities. Various clusters of OSA phenotypes have been described leading to more highly personalized treatment. The aim of this review is to describe the various therapeutic strategies including continuous positive airway pressure (CPAP), oral appliances, surgery, weight loss, and especially pharmacological interventions that have been evaluated to reduce vascular alterations in both OSA patients and preclinical animal models. Conventional therapies, predominantly CPAP, have a limited impact on vascular alterations in the presence of co-morbidities. A better knowledge of pharmacological therapies targeting IH-induced vascular alterations will facilitate the use of combined therapies and is crucial for designing clinical trials in well-defined OSA phenotypes.
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Affiliation(s)
- Elodie Gautier-Veyret
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France.
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
| | - Françoise Stanke-Labesque
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
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Rousseau JP, Tenorio-Lopes L, Baldy C, Janes TA, Fournier S, Kinkead R. On the origins of sex-based differences in respiratory disorders: Lessons and hypotheses from stress neuroendocrinology in developing rats. Respir Physiol Neurobiol 2017; 245:105-121. [DOI: 10.1016/j.resp.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 12/31/2022]
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26
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Pivonello R, Auriemma RS, Grasso LFS, Pivonello C, Simeoli C, Patalano R, Galdiero M, Colao A. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary 2017; 20:46-62. [PMID: 28224405 DOI: 10.1007/s11102-017-0797-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Ludovica F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Mariano Galdiero
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
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Jullian-Desayes I, Revol B, Chareyre E, Camus P, Villier C, Borel JC, Pepin JL, Joyeux-Faure M. Impact of concomitant medications on obstructive sleep apnoea. Br J Clin Pharmacol 2016; 83:688-708. [PMID: 27735059 DOI: 10.1111/bcp.13153] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 01/11/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is characterized by repeated episodes of apnoea and hypopnoea during sleep. Little is known about the potential impact of therapy drugs on the underlying respiratory disorder. Any influence should be taken into account and appropriate action taken, including drug withdrawal if necessary. Here, we review drugs in terms of their possible impact on OSA; drugs which (1) may worsen OSA; (2) are unlikely to have an impact on OSA; (3) those for which data are scarce or contradictory; and (4) drugs with a potentially improving effect. The level of evidence is ranked according to three grades: A - randomized controlled trials (RCTs) with high statistical power; B - RCTs with lower power, non-randomized comparative studies and observational studies; C - retrospective studies and case reports. Our review enabled us to propose clinical recommendations. Briefly, agents worsening OSA or inducing weight gain, that must be avoided, are clearly identified. Drugs such as 'Z drugs' and sodium oxybate should be used with caution as the literature contains conflicting results. Finally, larger trials are needed to clarify the potential positive impact of certain drugs on OSA. In the meantime, some, such as diuretics or other antihypertensive medications, are helpful in reducing OSA-associated cardiovascular morbidity.
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Affiliation(s)
- Ingrid Jullian-Desayes
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Bruno Revol
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alps University Hospital, Grenoble, France
| | - Elisa Chareyre
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Philippe Camus
- Pneumology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Céline Villier
- Pharmacovigilance Department, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Pepin
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
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28
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Lozo T, Komnenov D, Badr MS, Mateika JH. Sex differences in sleep disordered breathing in adults. Respir Physiol Neurobiol 2016; 245:65-75. [PMID: 27836648 DOI: 10.1016/j.resp.2016.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
The prevalence of sleep disordered breathing is greater in men compared to women. This disparity could be due to sex differences in the diagnosis and presentation of sleep apnea, and the pathophysiological mechanisms that instigate this disorder. Women tend to report more non-typical symptoms of sleep apnea compared to men, and the presentation of apneic events are more prevalent in rapid compared to non-rapid eye movement sleep. In addition, there is evidence of sex differences in upper airway structure and mechanics and in neural mechanisms that impact on the control of breathing. The purpose of this review is to summarize the literature that addresses sex differences in sleep-disordered breathing, and to discuss the influence that upper airway mechanics, chemoreflex properties, and sex hormones have in modulating breathing during sleep in men and women.
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Affiliation(s)
- Tijana Lozo
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - Dragana Komnenov
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - M Safwan Badr
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Biomedical Engineering, Wayne State University Detroit, MI 48201, United States
| | - Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States.
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Abstract
Obstructive sleep apnea (OSA) is a common condition among middle-aged men and is often associated with reduced testosterone (T) levels. OSA can contribute to fatigue and sexual dysfunction in men. There is suggestion that T supplementation alters ventilatory responses, possibly through effects on central chemoreceptors. Traditionally, it has been recommended that T replacement therapy (TRT) be avoided in the presence of untreated severe sleep apnea. With OSA treatment, however, TRT may not only improve hypogonadism, but may also alleviate erectile/sexual dysfunction.
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Affiliation(s)
- Omar Burschtin
- Mount Sinai School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 11 East 26th Street, 13th Floor, New York, NY 10010, USA
| | - Jing Wang
- NYU School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, 462 First Avenue Room 7N24, New York, NY 10016, USA.
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30
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Yeap BB, Grossmann M, McLachlan RI, Handelsman DJ, Wittert GA, Conway AJ, Stuckey BGA, Lording DW, Allan CA, Zajac JD, Burger HG. Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations. Med J Aust 2016; 205:228-31. [DOI: 10.5694/mja16.00448] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/06/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
| | - Mathis Grossmann
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC
| | | | | | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, SA
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney, Sydney, NSW
| | - Bronwyn GA Stuckey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
- Keogh Institute for Medical Research, Sir Charles Gairdner Hospital, Perth, WA
| | | | | | - Jeffrey D Zajac
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC
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32
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Chen YC, Chen TW, Su MC, Chen CJ, Chen KD, Liou CW, Tang P, Wang TY, Chang JC, Wang CC, Lin HC, Chin CH, Huang KT, Lin MC, Hsiao CC. Whole Genome DNA Methylation Analysis of Obstructive Sleep Apnea: IL1R2, NPR2, AR, SP140 Methylation and Clinical Phenotype. Sleep 2016; 39:743-55. [PMID: 26888452 DOI: 10.5665/sleep.5620] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 11/03/2015] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES We hypothesized that DNA methylation patterns may contribute to disease severity or the development of hypertension and excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA). METHODS Illumina's (San Diego, CA, USA) DNA methylation 27-K assay was used to identify differentially methylated loci (DML). DNA methylation levels were validated by pyrosequencing. A discovery cohort of 15 patients with OSA and 6 healthy subjects, and a validation cohort of 72 patients with sleep disordered breathing (SDB). RESULTS Microarray analysis identified 636 DMLs in patients with OSA versus healthy subjects, and 327 DMLs in patients with OSA and hypertension versus those without hypertension. In the validation cohort, no significant difference in DNA methylation levels of six selected genes was found between the primary snoring subjects and OSA patients (primary outcome). However, a secondary outcome analysis showed that interleukin-1 receptor 2 (IL1R2) promoter methylation (-114 cytosine followed by guanine dinucleotide sequence [CpG] site) was decreased and IL1R2 protein levels were increased in the patients with SDB with an oxygen desaturation index > 30. Androgen receptor (AR) promoter methylation (-531 CpG site) and AR protein levels were both increased in the patients with SDB with an oxygen desaturation index > 30. Natriuretic peptide receptor 2 (NPR2) promoter methylation (-608/-618 CpG sites) were decreased, whereas levels of both NPR2 and serum C type natriuretic peptide protein were increased in the SDB patients with EDS. Speckled protein 140 (SP140) promoter methylation (-194 CpG site) was increased, and SP140 protein levels were decreased in the patients with SDB and EDS. CONCLUSIONS IL1R2 hypomethylation and AR hypermethylation may constitute an important determinant of disease severity, whereas NPR2 hypomethylation and SP140 hypermethylation may provide a biomarker for vulnerability to EDS in OSA. COMMENTARY A commentary on this article appears in this issue on page 723.
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Affiliation(s)
- Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| | - Ting-Wen Chen
- Molecular Medicine Research Center, Chang Gung University, Taiwan.,Bioinformatics Center, Chang Gung University, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Chung-Jen Chen
- Division of Rheumatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Den Chen
- Center of Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Petrus Tang
- Molecular Medicine Research Center, Chang Gung University, Taiwan.,Bioinformatics Center, Chang Gung University, Taiwan
| | - Ting-Ya Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Chieh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Hsin-Ching Lin
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
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33
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Abstract
Obstructive sleep apnea (OSA) is a common condition among middle-aged men and is often associated with reduced testosterone (T) levels. OSA can contribute to fatigue and sexual dysfunction in men. There is suggestion that T supplementation alters ventilatory responses, possibly through effects on central chemoreceptors. Traditionally, it has been recommended that T replacement therapy (TRT) be avoided in the presence of untreated severe sleep apnea. With OSA treatment, however, TRT may not only improve hypogonadism, but may also alleviate erectile/sexual dysfunction.
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Affiliation(s)
- Omar Burschtin
- Mount Sinai School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 11 East 26th Street, 13th Floor, New York, NY 10010, USA
| | - Jing Wang
- NYU School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, 462 First Avenue Room 7N24, New York, NY 10016, USA.
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34
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Variation of reproductive hormone profile in male patients with obstructive sleep apnea: a meta-analysis. Sleep Biol Rhythms 2015. [DOI: 10.1007/s41105-015-0041-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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35
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Davies S, Papp VG, Antoni C. Voice and Communication Change for Gender Nonconforming Individuals: Giving Voice to the Person Inside. Int J Transgend 2015. [DOI: 10.1080/15532739.2015.1075931] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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36
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Seftel AD, Kathrins M, Niederberger C. Critical Update of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism: A Systematic Analysis. Mayo Clin Proc 2015. [PMID: 26205546 DOI: 10.1016/j.mayocp.2015.06.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
"Testosterone Therapy in Men With Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline" (Guidelines), published in 2010, serves as an important guide for the treatment of hypogonadal men. Using the Guidelines as a basis, we searched for the most recent level 1 evidence that continues to support the recommendations or provide an impetus to modify all or some of them. We performed a systematic analysis with a PubMed query from January 1, 2010, through March 2, 2015, using the following key words: testosterone/deficiency, testosterone/therapeutic use, cardiovascular, morbidity, mortality, screening, sexual function, lower urinary tract symptoms, obstructive sleep apnea, prostate cancer, fertility, bone mineral density, osteoporosis, quality of life, cognitive, erectile dysfunction, and adverse effects. We identified 17 trials representing level 1 evidence that specifically addressed recommendations made in the Guidelines. Trials examining outcomes of testosterone replacement therapy in men with severe lower urinary tract symptoms and untreated obstructive sleep apnea were identified, potentially refuting the current dogma against treatment in the setting of these conditions. Hypogonadal men with type 2 diabetes mellitus and metabolic syndrome were examined in several trials, demonstrating the beneficial effects of therapy on sexual function and insulin sensitivity. Several trials served as reinforcing evidence for the beneficial effects of testosterone therapy on osteoporosis, muscle strength, and symptoms of frailty. As in the Guidelines, inconsistent effects on quality of life, well-being, and erectile function were also noted in publications. Despite controversies surrounding cardiovascular morbidity and treatment in the setting of prostate cancer, no studies examining these issues as primary end points were identified. The low number of eligible studies since 2010 is a limitation of this analysis.
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Affiliation(s)
- Allen D Seftel
- Division of Urology, Cooper Medical School of Rowan University, Camden, NJ.
| | - Martin Kathrins
- Department of Urology, University of Illinois at Chicago, Chicago, IL
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37
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Morley JE. Sleep and the Nursing Home. J Am Med Dir Assoc 2015; 16:539-43. [DOI: 10.1016/j.jamda.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
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38
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Abstract
Plasma testosterone levels display circadian variation, peaking during sleep, and reaching a nadir in the late afternoon, with a superimposed ultradian rhythm with pulses every 90 min reflecting the underlying rhythm of pulsatile luteinizing hormone (LH) secretion. The increase in testosterone is sleep, rather than circadian rhythm, dependent and requires at least 3 h of sleep with a normal architecture. Various disorders of sleep including abnormalities of sleep quality, duration, circadian rhythm disruption, and sleep-disordered breathing may result in a reduction in testosterone levels. The evidence, to support a direct effect of sleep restriction or circadian rhythm disruption on testosterone independent of an effect on sex hormone binding globulin (SHBG), or the presence of comorbid conditions, is equivocal and on balance seems tenuous. Obstructive sleep apnea (OSA) appears to have no direct effect on testosterone, after adjusting for age and obesity. However, a possible indirect causal process may exist mediated by the effect of OSA on obesity. Treatment of moderate to severe OSA with continuous positive airway pressure (CPAP) does not reliably increase testosterone levels in most studies. In contrast, a reduction in weight does so predictably and linearly in proportion to the amount of weight lost. Apart from a very transient deleterious effect, testosterone treatment does not adversely affect OSA. The data on the effect of sleep quality on testosterone may depend on whether testosterone is given as replacement, in supratherapeutic doses, or in the context abuse. Experimental data suggest that testosterone may modulate individual vulnerability to subjective symptoms of sleep restriction. Low testosterone may affect overall sleep quality which is improved by replacement doses. Large doses of exogenous testosterone and anabolic/androgenic steroid abuse are associated with abnormalities of sleep duration and architecture.
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Affiliation(s)
- Gary Wittert
- Discipline of Medicine and Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
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39
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Grech A, Breck J, Heidelbaugh J. Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Ther Adv Drug Saf 2014; 5:190-200. [PMID: 25360240 DOI: 10.1177/2042098614548680] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Testosterone replacement therapy (TRT) has been used in millions of men worldwide to treat diminished libido and erectile dysfunction, and to improve strength and physical function. The estimated likelihood of adverse effects of long-term TRT is still essentially unknown, as overall high-quality evidence based upon prospective randomized trials to recommend for or against its use in most men with testosterone deficiency (TD) is lacking. Evidence to suggest that TRT increases cardiovascular morbidity and mortality risks is poor, as results vary across study populations and their baseline comorbidities. While TRT may increase serum prostate-specific antigen levels in some men, it often remains within clinically acceptable ranges, and has not been shown to increase the risk of prostate cancer. Current literature supports that TRT does not substantially worsen lower urinary tract symptoms, and may actually improve symptoms in some men. Limited evidence suggests that TRT may initially worsen obstructive sleep apnea in some men, but that this is not a longstanding effect. TRT may result in erythrocytosis in some men, however long-term studies have not reported significant adverse events (e.g. cerebrovascular accident, vascular occlusive events, venous thromboembolisms). Future research will require dedicated focus on evaluation of large, multiethnic cohorts of men through prospective trials to better elucidate both risk and hazard ratios of TRT as it relates to cardiovascular disease, prostate cancer, lower urinary tract symptoms, obstructive sleep apnea, erythrocytosis, and other to-be-determined theoretical risks in men both with and without cardiovascular risk equivalents.
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Affiliation(s)
- Anthony Grech
- University of Michigan - Family Medicine, Ann Arbor, MI, USA
| | - John Breck
- University of Michigan - Family Medicine, Ann Arbor, MI, USA
| | - Joel Heidelbaugh
- University of Michigan, Family Medicine, Ypsilanti Health Center, 200 Arnet Suite 200, Ypsilanti, MI 48198, USA
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40
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Characterizing the phenotypes of obstructive sleep apnea: Clinical, sleep, and autonomic features of obstructive sleep apnea with and without hypoxia. Clin Neurophysiol 2014; 125:1783-91. [DOI: 10.1016/j.clinph.2014.01.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/26/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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41
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Abstract
PURPOSE OF REVIEW This review describes evolving concepts and recent data on the relationship between serum testosterone levels and normal and disordered sleep. RECENT FINDINGS Sex-related differences in circadian rhythms and sleep physiology are in part due to organizational and activational effects of sex steroids. Testosterone affects the organization of circadian rhythms and the timing, but not the duration, of sleep. Increasing testosterone during puberty leads to later bedtimes. The diurnal variation in testosterone depends on sleep rather than circadian rhythm or season. Pubertal onset is heralded, well before virilization, by a luteinizing hormone level at least 3.7 U/l during sleep. Total sleep deprivation lowers testosterone, but sleep restriction only does so if it occurs in the first half of the night. The recovery of testosterone from sleep disruption is impaired in old as compared with young rodents. In men with obstructive sleep apnoea (OSA), low testosterone is related to obesity rather than the OSA itself, and improves with weight loss but inconsistently with continuous positive airway pressure (CPAP). Testosterone treatment only transiently worsens severity of OSA, which need not be considered a contraindication to its use. SUMMARY Testosterone treatment is unlikely to benefit sleep in men with secondary hypogonadism, for example due to obesity or depression, in contrast to the management of the underlying abnormality.
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Affiliation(s)
- Gary Wittert
- Discipline of Medicine and Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
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42
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Celec P, Mucska I, Ostatníková D, Hodosy J. Testosterone and estradiol are not affected in male and female patients with obstructive sleep apnea treated with continuous positive airway pressure. J Endocrinol Invest 2014; 37:9-12. [PMID: 24464445 DOI: 10.1007/s40618-013-0003-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/17/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) improves symptoms in patients with obstructive sleep apnea syndrome (OSAS). It is currently unclear, whether CPAP also alters endocrine parameters such as sex hormone levels. In a previous study, we have found no changes in sex hormones in patients with OSAS after one night with CPAP. AIM The aim of this study was to prove long-term effects of CPAP on sex hormone concentrations in patients with OSAS. METHODS Twenty-two women and 67 men with severe OSAS (respiratory distress index > 30/h) were enrolled in the study. Fasting blood venous samples were taken before CPAP therapy and after 1 and 6 months of CPAP treatment. Testosterone and estradiol were measured in all samples using commercially available ELISA kits. RESULTS No effects of long-term CPAP treatment were found on testosterone or estradiol levels in OSAS patients of either gender. CONCLUSIONS The results are in line with previous smaller studies. However, our study is larger and longer than previously published studies. In addition, this is the first study analyzing the effects of CPAP on testosterone and estradiol and in both genders. Positive effects of CPAP on sexual functions reported in other studies might, thus, be mediated by other than endocrine effects.
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Affiliation(s)
- P Celec
- Institute of Molecular Biomedicine, Comenius University, Bratislava, Slovakia,
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43
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Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 2013; 188:996-1004. [PMID: 23721582 PMCID: PMC3826282 DOI: 10.1164/rccm.201303-0448oc] [Citation(s) in RCA: 705] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/21/2013] [Indexed: 12/30/2022] Open
Abstract
RATIONALE The pathophysiologic causes of obstructive sleep apnea (OSA) likely vary among patients but have not been well characterized. OBJECTIVES To define carefully the proportion of key anatomic and nonanatomic contributions in a relatively large cohort of patients with OSA and control subjects to identify pathophysiologic targets for future novel therapies for OSA. METHODS Seventy-five men and women with and without OSA aged 20-65 years were studied on three separate nights. Initially, the apnea-hypopnea index was determined by polysomnography followed by determination of anatomic (passive critical closing pressure of the upper airway [Pcrit]) and nonanatomic (genioglossus muscle responsiveness, arousal threshold, and respiratory control stability; loop gain) contributions to OSA. MEASUREMENTS AND MAIN RESULTS Pathophysiologic traits varied substantially among participants. A total of 36% of patients with OSA had minimal genioglossus muscle responsiveness during sleep, 37% had a low arousal threshold, and 36% had high loop gain. A total of 28% had multiple nonanatomic features. Although overall the upper airway was more collapsible in patients with OSA (Pcrit, 0.3 [-1.5 to 1.9] vs. -6.2 [-12.4 to -3.6] cm H2O; P <0.01), 19% had a relatively noncollapsible upper airway similar to many of the control subjects (Pcrit, -2 to -5 cm H2O). In these patients, loop gain was almost twice as high as patients with a Pcrit greater than -2 cm H2O (-5.9 [-8.8 to -4.5] vs. -3.2 [-4.8 to -2.4] dimensionless; P = 0.01). A three-point scale for weighting the relative contribution of the traits is proposed. It suggests that nonanatomic features play an important role in 56% of patients with OSA. CONCLUSIONS This study confirms that OSA is a heterogeneous disorder. Although Pcrit-anatomy is an important determinant, abnormalities in nonanatomic traits are also present in most patients with OSA.
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Affiliation(s)
- Danny J. Eckert
- Division of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Neuroscience Research Australia and the School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia; and
| | - David P. White
- Division of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy S. Jordan
- Division of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Atul Malhotra
- Division of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Wang D, Eckert DJ, Grunstein RR. Drug effects on ventilatory control and upper airway physiology related to sleep apnea. Respir Physiol Neurobiol 2013; 188:257-66. [PMID: 23685318 DOI: 10.1016/j.resp.2013.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/05/2013] [Accepted: 05/08/2013] [Indexed: 12/30/2022]
Abstract
Understanding the inter-relationship between pharmacological agents, ventilatory control, upper airway physiology and their consequent effects on sleep-disordered breathing may provide new directions for targeted drug therapy. Where available, this review focuses on human studies that contain both drug effects on sleep-disordered breathing and measures of ventilatory control or upper airway physiology. Many of the existing studies are limited in sample size or comprehensive methodology. At times, the presence of paradoxical findings highlights the complexity of drug therapy for OSA. The existing studies also highlight the importance of considering inter-individual pharmacokinetics and underlying causes of sleep apnea in interpreting drug effects on sleep-disordered breathing. Practical ways to assess an individual's ventilatory control and how it interacts with upper airway physiology is required for future targeted pharmacotherapy in sleep apnea.
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Affiliation(s)
- David Wang
- Woolcock Institute of Medical Research, University of Sydney, Glebe Point Road, Glebe, 2037 NSW, Australia; Department of Respiratory & Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
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