Efficacy of continuous positive airway pressure on testosterone in men with obstructive sleep apnea: a meta-analysis.
Level 3 - non-randomized controlled study
Meta-analysis of pre- and post-treatment cohort studies rather than randomized controlled trials.
PubMed 25503098 · doi:10.1371/journal.pone.0115033
What was done
Authors conducted a systematic review and meta-analysis across PubMed, Cochrane Library, Embase, and Web of Science through June 2014. They extracted pre- and post-treatment data on serum total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) in men with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP).
What was found
A total of 7 studies with 9 cohorts including 232 men were analyzed. CPAP treatment showed no significant change in total testosterone levels overall (SMD = -0.14, 95% CI: -0.63 to 0.34, z = 0.59, p = 0.558) or in subgroups treated for >3 months. No significant differences were observed for free testosterone (SMD = 0.16, 95% CI: -0.09 to 0.40, z = 1.25, p = 0.211) or SHBG (SMD = -0.58, 95% CI: -1.30 to 0.14, z = 1.59, p = 0.112).
Why it matters
Despite hypotheses that relieving sleep apnea-related hypoxia and sleep fragmentation restores endocrine function, pooled data show CPAP does not meaningfully alter male androgen levels.
Limits
The total sample size was small (232 participants across 7 studies). The included data relied on pre- and post-treatment cohort comparisons rather than randomized sham-controlled designs, and compliance data or baseline hypogonadism status were not reported in the abstract.
Cited by
- contradicts Treating sleep apnea can increase testosterone levels by up to 200 ng/dL.