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Does Testosterone Worsen Sleep Apnea?: It Depends on the Dose
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<blockquote data-quote="Nelson Vergel" data-source="post: 27288" data-attributes="member: 3"><p>Obstructive sleep apnea</p><p></p><p>The potential risk of adverse effects of TRT on sleep, specifically OSA, has been a growing area of research and discussion. Our literature search retrieved five studies that evaluated this association [Barrett-Connor et al. 2008; Bercea et al. 2013; Hoyos et al. 2012a, 2012b; Killick et al. 2013]. However, only one trial addressed TRT in relation to the possible worsening of OSA.</p><p></p><p>An 18-week randomized, double-blind, placebo-controlled, parallel group trial in 67 men found that TRT in obese men with severe OSA mildly worsened sleep-disordered breathing in a time-limited manner, irrespective of initial T concentrations in the short term (7 weeks), but this worsening resolved after 18 weeks [Hoyos et al. 2012a]. In the trial, sleep and breathing were measured by nocturnal polysomnography at 0, 7, and 18 weeks. T, compared with placebo, worsened the oxygen desaturation index (ODI) by 10.3 events/h and nocturnal hypoxemia [sleep time with oxygen saturation less than 90%, SpO(2) T90%] by 6.1% at 7 weeks. TRT did not alter ODI or SpO(2) T90% at 18 weeks compared with placebo. The authors also found that the TRT effects on ODI and SpO(2) T90% were not influenced by baseline T concentrations (T by treatment interactions, all p > 0.35). Moreover, serum T concentrations did not correlate with ODI or SpO(2) T90% (all p > 0.19) [Hoyos et al. 2012a].</p><p></p><p>The same authors, using the same cohort, also sought to evaluate body compositional and cardiometabolic effects of TRT with TU in men with obesity and severe OSA [Hoyos et al. 2012b]. This trial concluded that 18 weeks of TRT improved several important cardiometabolic parameters, including insulin resistance, decreased liver fat, and increased lean muscle mass, but did not differentially reduce overall weight or the metabolic syndrome.</p><p></p><p>The remaining three trials did not adequately assess the relationship between TRT and OSA but offered some interesting results. One study of 1312 community-dwelling men aged 65 years or older from six clinical centers in the USA determined that low serum total T levels were associated with less healthy sleep in older men, explained by the degree of central adiposity [Barrett-Connor et al. 2008]. Another trial evaluated 40 men with severe OSA and 40 control subjects. Serum T in the OSA group was significantly lower compared with controls, and a statistically significant inverse correlation was found between serum T level and depressive symptoms [Bercea et al. 2013]. The third trial yielded positive correlations between changes in serum T and hyperoxic ventilatory recruitment threshold in 21 men with OSA , and between changes in hyperoxic ventilatory recruitment threshold and time spent with oxygen saturations during sleep less than 90% weeks, but these changes had resolved by 18 weeks [Killick et al. 2013].</p><p></p><p>To date, there are no randomized trials focusing on the long-term effects of TRT and OSA. It is recommended that clinicians inquire about symptoms of OSA in men with TD on TRT and to offer a referral for polysomnogram evaluation in men with hallmark symptoms, especially those who are starting T therapy [Bhasin et al. 2010].</p><p></p><p>Source:</p><p></p><p>Ther Adv Drug Saf. 2014 Oct; 5(5): 190&#8211;200.<strong>Adverse effects of testosterone replacement therapy: an update on the evidence and controversy</strong></p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 27288, member: 3"] Obstructive sleep apnea The potential risk of adverse effects of TRT on sleep, specifically OSA, has been a growing area of research and discussion. Our literature search retrieved five studies that evaluated this association [Barrett-Connor et al. 2008; Bercea et al. 2013; Hoyos et al. 2012a, 2012b; Killick et al. 2013]. However, only one trial addressed TRT in relation to the possible worsening of OSA. An 18-week randomized, double-blind, placebo-controlled, parallel group trial in 67 men found that TRT in obese men with severe OSA mildly worsened sleep-disordered breathing in a time-limited manner, irrespective of initial T concentrations in the short term (7 weeks), but this worsening resolved after 18 weeks [Hoyos et al. 2012a]. In the trial, sleep and breathing were measured by nocturnal polysomnography at 0, 7, and 18 weeks. T, compared with placebo, worsened the oxygen desaturation index (ODI) by 10.3 events/h and nocturnal hypoxemia [sleep time with oxygen saturation less than 90%, SpO(2) T90%] by 6.1% at 7 weeks. TRT did not alter ODI or SpO(2) T90% at 18 weeks compared with placebo. The authors also found that the TRT effects on ODI and SpO(2) T90% were not influenced by baseline T concentrations (T by treatment interactions, all p > 0.35). Moreover, serum T concentrations did not correlate with ODI or SpO(2) T90% (all p > 0.19) [Hoyos et al. 2012a]. The same authors, using the same cohort, also sought to evaluate body compositional and cardiometabolic effects of TRT with TU in men with obesity and severe OSA [Hoyos et al. 2012b]. This trial concluded that 18 weeks of TRT improved several important cardiometabolic parameters, including insulin resistance, decreased liver fat, and increased lean muscle mass, but did not differentially reduce overall weight or the metabolic syndrome. The remaining three trials did not adequately assess the relationship between TRT and OSA but offered some interesting results. One study of 1312 community-dwelling men aged 65 years or older from six clinical centers in the USA determined that low serum total T levels were associated with less healthy sleep in older men, explained by the degree of central adiposity [Barrett-Connor et al. 2008]. Another trial evaluated 40 men with severe OSA and 40 control subjects. Serum T in the OSA group was significantly lower compared with controls, and a statistically significant inverse correlation was found between serum T level and depressive symptoms [Bercea et al. 2013]. The third trial yielded positive correlations between changes in serum T and hyperoxic ventilatory recruitment threshold in 21 men with OSA , and between changes in hyperoxic ventilatory recruitment threshold and time spent with oxygen saturations during sleep less than 90% weeks, but these changes had resolved by 18 weeks [Killick et al. 2013]. To date, there are no randomized trials focusing on the long-term effects of TRT and OSA. It is recommended that clinicians inquire about symptoms of OSA in men with TD on TRT and to offer a referral for polysomnogram evaluation in men with hallmark symptoms, especially those who are starting T therapy [Bhasin et al. 2010]. Source: Ther Adv Drug Saf. 2014 Oct; 5(5): 190–200.[B]Adverse effects of testosterone replacement therapy: an update on the evidence and controversy[/B] [/QUOTE]
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Does Testosterone Worsen Sleep Apnea?: It Depends on the Dose
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