madman
Super Moderator
* Substantial evidence suggests that sleep disorders may impair testosterone levels, partially improved after specific treatments (for instance: positive airway pressure for OSA). On the other hand, appropriate indications for testosterone replacement therapy (TRT) can alleviate hypogonadism symptoms and cardiometabolic dysfunction, but may increase the risk of OSA, requiring careful management. This narrative review highlights the importance of a holistic approach in managing sleep disorders, CVDs, and hormonal imbalances and emphasises the need for further research to improve patient outcomes.
* Poor sleep quality and conditions like obstructive sleep apnea (OSA) are prevalent among individuals with CVDs and contribute to cardiovascular pathology through several mechanisms, including sympathetic activation, oxidative stress, and systemic inflammation.
Fig. 3: Bidirectional pathways linking sleep, hormonal dysfunction, and cardiometabolic risk: Sleep fragmentation and OSA may reduce testosterone and increase cortisol, contributing to obesity and cardiovascular disease (CVD). In turn, metabolic dysfunction and obesity can worsen sleep and hormonal balance, forming a self-reinforcing cycle. Sleep plays a central, modifiable role in this interplay. Created with BioRender.com.
Summary
Sleep disorders, cardiovascular diseases (CVDs), and hormonal imbalances, particularly with respect to testosterone levels, are closely interconnected and significantly impact public health. This review examines the complex interactions between these 3 factors. Poor sleep quality and conditions like obstructive sleep apnea (OSA) are prevalent among individuals with CVDs and contribute to cardiovascular pathology through several mechanisms, including sympathetic activation, oxidative stress, and systemic inflammation. Testosterone plays a critical role in metabolic regulation, muscle and bone health, and mood. Low testosterone levels are associated with increased CVD risk factors like insulin resistance and arterial stiffness. Substantial evidence suggests that sleep disorders may impair testosterone levels, partially improved after specific treatments (for instance: positive airway pressure for OSA). On the other hand, appropriate indications for testosterone replacement therapy (TRT) can alleviate hypogonadism symptoms and cardiometabolic dysfunction, but may increase the risk of OSA, requiring careful management. This narrative review highlights the importance of a holistic approach in managing sleep disorders, CVDs, and hormonal imbalances and emphasises the need for further research to improve patient outcomes.
Conclusions
Understanding the interplay between sleep, particularly OSA, CVD, and testosterone levels is essential for advancing patient care. This review highlights the need for an integrated, multidisciplinary approach that includes sleep evaluation in patients with CVD or hypogonadism, and hormonal screening in those with OSA. Clinicians should be aware of the bidirectional effects of TRT and OSA, balancing potential benefits with risks. Addressing these interconnected systems holistically may improve diagnostic accuracy, guide safer therapeutic choices, and ultimately enhance cardiometabolic outcomes. Further research is warranted to translate these insights into clinical practice (Table 1).
* Poor sleep quality and conditions like obstructive sleep apnea (OSA) are prevalent among individuals with CVDs and contribute to cardiovascular pathology through several mechanisms, including sympathetic activation, oxidative stress, and systemic inflammation.
Fig. 3: Bidirectional pathways linking sleep, hormonal dysfunction, and cardiometabolic risk: Sleep fragmentation and OSA may reduce testosterone and increase cortisol, contributing to obesity and cardiovascular disease (CVD). In turn, metabolic dysfunction and obesity can worsen sleep and hormonal balance, forming a self-reinforcing cycle. Sleep plays a central, modifiable role in this interplay. Created with BioRender.com.
Summary
Sleep disorders, cardiovascular diseases (CVDs), and hormonal imbalances, particularly with respect to testosterone levels, are closely interconnected and significantly impact public health. This review examines the complex interactions between these 3 factors. Poor sleep quality and conditions like obstructive sleep apnea (OSA) are prevalent among individuals with CVDs and contribute to cardiovascular pathology through several mechanisms, including sympathetic activation, oxidative stress, and systemic inflammation. Testosterone plays a critical role in metabolic regulation, muscle and bone health, and mood. Low testosterone levels are associated with increased CVD risk factors like insulin resistance and arterial stiffness. Substantial evidence suggests that sleep disorders may impair testosterone levels, partially improved after specific treatments (for instance: positive airway pressure for OSA). On the other hand, appropriate indications for testosterone replacement therapy (TRT) can alleviate hypogonadism symptoms and cardiometabolic dysfunction, but may increase the risk of OSA, requiring careful management. This narrative review highlights the importance of a holistic approach in managing sleep disorders, CVDs, and hormonal imbalances and emphasises the need for further research to improve patient outcomes.
Conclusions
Understanding the interplay between sleep, particularly OSA, CVD, and testosterone levels is essential for advancing patient care. This review highlights the need for an integrated, multidisciplinary approach that includes sleep evaluation in patients with CVD or hypogonadism, and hormonal screening in those with OSA. Clinicians should be aware of the bidirectional effects of TRT and OSA, balancing potential benefits with risks. Addressing these interconnected systems holistically may improve diagnostic accuracy, guide safer therapeutic choices, and ultimately enhance cardiometabolic outcomes. Further research is warranted to translate these insights into clinical practice (Table 1).
