Obstructive Sleep Apnea and Testosterone Therapy.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing existing case reports, cohort studies, and trials
PubMed 32636155 · doi:10.1016/j.sxmr.2020.04.004
What was done
The authors conducted a literature search using terms such as "obstructive sleep apnea" and "testosterone replacement therapy," supplemented by citation tracking, to review the evidence connecting testosterone therapy (TTh) and obstructive sleep apnea (OSA).
What was found
Early case reports and series described worsened nocturnal apneas with testosterone. A retrospective analysis and an RCT in the 1990s found no increased incidence of OSA. A 2012 RCT found elevated OSA measures at 7 weeks that resolved to baseline by 18 weeks of TTh. A cohort study showed OSA incidence was 16.5% on TTh versus 12.7% in controls. Proposed mechanisms involving airway patency or sleep architecture have been largely disproven, favoring altered neural responses to hypoxemia.
Why it matters
This review indicates that testosterone therapy's adverse impact on sleep apnea is modest and potentially transient, helping inform risk discussions for hypogonadal men with sleep-disordered breathing.
Limits
This is a narrative review rather than a systematic review or meta-analysis. The abstract omits total patient counts, search dates, and statistical confidence intervals for the cited findings.
Cited by
- supports Testosterone therapy can exacerbate obstructive sleep apnea.