Association between obstructive sleep apnea and male serum testosterone: A systematic review and meta-analysis

Abstract

Background: Currently, there is no consensus on the effect of obstructive sleep apnea on male serum testosterone levels. This systematic review and meta-analysis aimed to determine the association between obstructive sleep apnea and male serum testosterone level. Methods: The literature related to obstructive sleep apnea and male serum testosterone in the PubMed, Embase, and Cochrane Library databases were searched from their inception to June 10, 2021. Data were pooled using the Stata 15 software. We performed a subgroup analysis of studies after matching the age and body mass index, as well as according to the severity of obstructive sleep apnea. Results: Eighteen studies involving 1823 men were included in the systematic review and meta-analysis. A significant inverse association between obstructive sleep apnea and male serum testosterone (SMD = −0.76; 95% CI: −1.18, −0.33; p = 0.001) was found. After adjusting for age and body mass index, this inverse association still existed (SMD = −0.8; 95% CI = −1.41, −0.18, p = 0.012). According to the subgroup analysis of obstructive sleep apnea severity, our results showed that serum testosterone was not significantly decreased in mild (SMD = −0.58; 95% CI = −1.88, 0.73, p = 0.386) and moderate obstructive sleep apnea patients (SMD = −0.94; 95% CI = −2.04, 0.15, p = 0.092), whereas it was significantly reduced in patients with severe obstructive sleep apnea (SMD = −1.21; 95% CI = −2.02, −0.41, p = 0.003). Conclusions: Obstructive sleep apnea is inversely associated with male serum testosterone levels, independent of body mass index and age. Notably, the severity of obstructive sleep apnea is also correlated with male serum testosterone, which is significantly reduced in patients with severe obstructive sleep apnea.