TY - JOUR
T1 - The association of testosterone levels with overall sleep quality, sleep architecture, and sleep-disordered breathing
AU - Barrett-Connor, Elizabeth
AU - Dam, Thuy Tien
AU - Stone, Katie
AU - Harrison, Stephanie Litwack
AU - Redline, Susan
AU - Orwoll, Eric
N1 - Funding Information:
This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; the National Institute on Aging; the National Center for Research Resources; and National Institutes of Health Roadmap for Medical Research under Grants U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01-AG027810, and UL1 RR024140. The National Heart, Lung, and Blood Institute provides funding for the MrOS Sleep ancillary study, Outcomes of Sleep Disorders in Older Men, under Grants R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding.
PY - 2008/7
Y1 - 2008/7
N2 - Context: Little is known about the association of low endogenous testosterone levels and abnormal sleep patterns in older men, although pharmacological doses of testosterone are associated with increased severity of sleep apnea and other sleep disturbances. Objective: The objective of the study was to examine the association between serum testosterone levels with objectively measured sleep characteristics. Design: This was a cohort study. Setting: Community-dwelling men aged 65 yr or older from six clinical centers in the United States participated in the study. Participants and Main Outcome Measures: A total of 1312 men had baseline total testosterone levels measured in 2000-2002, followed 3.4 yr later by 72-h (minimum) actigraphy and one-night in-home polysomnography to assess sleep duration, sleep fragmentation, and sleep apnea. Analyses were performed by quartile of total testosterone and categorically defined low vs. higher total testosterone (<250 ng/dl vs. ≥250 ng/dl). Lifestyle and body size were covariates. Results: Total testosterone levels were unrelated to age or duration of sleep. Men with lower testosterone levels had lower sleep efficiency, with increased nocturnal awakenings and less time in slow-wave sleep as well as a higher apnea-hypopnea index and more sleep time with O2 saturation levels below 90%. Low testosterone levels were associated with overweight, and all significant associations were attenuated or absent after adjusting for body mass index or waist circumference. In a post hoc analysis in men with higher body mass index (>27 kg/m2), testosterone was significantly associated with more periods awake after sleep onset and lower sleep efficiency. Conclusion: Low total testosterone levels are associated with less healthy sleep in older men. This association is largely explained by adiposity. Clinical trials are necessary to determine whether body weight acts directly or indirectly (via low testosterone) in the causal pathway for sleep-disordered breathing in older men.
AB - Context: Little is known about the association of low endogenous testosterone levels and abnormal sleep patterns in older men, although pharmacological doses of testosterone are associated with increased severity of sleep apnea and other sleep disturbances. Objective: The objective of the study was to examine the association between serum testosterone levels with objectively measured sleep characteristics. Design: This was a cohort study. Setting: Community-dwelling men aged 65 yr or older from six clinical centers in the United States participated in the study. Participants and Main Outcome Measures: A total of 1312 men had baseline total testosterone levels measured in 2000-2002, followed 3.4 yr later by 72-h (minimum) actigraphy and one-night in-home polysomnography to assess sleep duration, sleep fragmentation, and sleep apnea. Analyses were performed by quartile of total testosterone and categorically defined low vs. higher total testosterone (<250 ng/dl vs. ≥250 ng/dl). Lifestyle and body size were covariates. Results: Total testosterone levels were unrelated to age or duration of sleep. Men with lower testosterone levels had lower sleep efficiency, with increased nocturnal awakenings and less time in slow-wave sleep as well as a higher apnea-hypopnea index and more sleep time with O2 saturation levels below 90%. Low testosterone levels were associated with overweight, and all significant associations were attenuated or absent after adjusting for body mass index or waist circumference. In a post hoc analysis in men with higher body mass index (>27 kg/m2), testosterone was significantly associated with more periods awake after sleep onset and lower sleep efficiency. Conclusion: Low total testosterone levels are associated with less healthy sleep in older men. This association is largely explained by adiposity. Clinical trials are necessary to determine whether body weight acts directly or indirectly (via low testosterone) in the causal pathway for sleep-disordered breathing in older men.
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U2 - 10.1210/jc.2007-2622
DO - 10.1210/jc.2007-2622
M3 - Article
C2 - 18413429
AN - SCOPUS:47549089695
SN - 0021-972X
VL - 93
SP - 2602
EP - 2609
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 7
ER -