Vol. 66, 2024 > Iss. 1, June
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  • Orignal article

CPAP, Obesity, and Testosterone: Trajectories of Nocturnal Hypoxia After TRT in Men with Obstructive Sleep Apnea
Vol. 66, 2024 - Iss. 1, June

Authors: Carlos Eduardo da Silva1
1Instituto Nacional de Salud del Perú (INS)

Abstract

Background: Obstructive sleep apnea (OSA) and male hypogonadism frequently co-occur. Testosterone replacement therapy (TRT) improves sexual and general health outcomes but has been flagged for possible short-term worsening of nocturnal oxygenation in OSA, while longer-term effects may be neutral or beneficial. Whether these trajectories are modified by objective continuous positive airway pressure (CPAP) adherence and obesity class remains unclear.

Objective: To characterize time-dependent trajectories of nocturnal hypoxia after TRT initiation in men with OSA, and to test whether CPAP adherence and body mass index (BMI) class modify these trajectories.

Methods: Prospective cohort of hypogonadal men with polysomnography- or HSAT-confirmed OSA initiating guideline-concordant TRT. Assessments at baseline, 6–8 weeks, 3, 6, and 12 months. Primary outcome: percentage of total sleep time with oxygen saturation  < 90% (T90). Secondary outcomes: apnea–hypopnea index (AHI), oxygen desaturation index (ODI), nadir SpO2, Epworth Sleepiness Scale (ESS), hematocrit/erythrocytosis, erectile function indices. CPAP adherence defined a priori ( ≥ 4 h/night on ≥70% of nights vs lower). Mixed-effects models estimate time-by-adherence-by-BMI interactions adjusted for age, baseline OSA severity, TRT route/dose, and comorbidities.

Expected results: We hypothesize a transient T90 worsening at 6–8 weeks that attenuates by 3–6 months, with attenuation strongest among CPAP-adherent participants and lowest obesity classes.

Conclusions: Mapping oxygenation trajectories after TRT—stratified by CPAP adherence and obesity—could refine risk communication, monitoring schedules, and therapeutic sequencing for men with OSA and hypogonadism.

Keywords: obstructive sleep apnea, hypogonadism, testosterone replacement therapy, CPAP adherence, obesity, nocturnal hypoxia, T90, AHI, ODI

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