madman
Super Moderator
Abstract
INTRODUCTION AND OBJECTIVES:
The relationship between testosterone replacement therapy (TRT) and obstructive sleep apnea (OSA) is an emerging field of interest. TRT is typically contraindicated in patients with severe uncontrolled OSA, but our previous research has shown OSA risk factors still increase OSA incidence in patients taking TRT. This study therefore explores how TRT affects OSA risk in patients stratified by risk factors, including whether these risk factors change the relationship between TRT and odds of developing OSA.METHODS:
Using EPIC System’s SlicerDicer feature, we retrospectively collected single-institution data of patients diagnosed with low testosterone (low T) or hypogonadism from 1/1/2015 to 1/1/2025. They were stratified by whether they were prescribed TRT within 6 months after diagnosis, stratified by OSA risk factors, and assessed for OSA visit-diagnoses within 2 years after TRT or 24 months after low T diagnosis. Females and people with a history of TRT or OSA before 1/1/15 were excluded. Data analyzed descriptively and with chi-square analyses via Microsoft Excel.RESULTS:
Of 6,888 patients with hypogonadism (a mix of laboratory-confirmed low testosterone and clinical diagnoses) 11.5% (n=796) diagnosed with OSA after starting TRT. OSA trends were examined across this cohort to account for heterogeneity in inclusion criteria. There was a significant association between TRT use and odds of OSA among patients regardless of most risk factors: age (p<0.00001), race/ethnicity (p<0.00001), smoking status (p<0.00004), alcohol consumption (p<0.00001), BMI (p<0.00001), and diabetes (p<0.0037). TRT increased the odds of OSA more for people < 50 by 67%, significantly more than the 24% increased odds for people > 50 years old. However, there was no difference among subgroups for any other risk factor. TRT use did not significantly affect OSA odds in patients with a family history of OSA (p<0.0849) but did among patients with no history/none reported.CONCLUSIONS:
Our findings suggest that TRT may significantly affect odds of developing OSA among hypogonadal patients regardless of most known OSA risk factors. However, only age may significantly affect the relationship between TRT and OSA, with people <50 at higher risk of developing OSA while on TRT. Using our results, clinicians may more accurately counsel patients on risks of starting TRT, especially among young hypogonadal patients.
