الفهرس | Only 14 pages are availabe for public view |
Abstract Obstructive sleep apnea (OSA), also referred to as obstructive sleep apnea-hypopnea syndrome is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It is characterized by repetitive partial or complete obstruction of the upper airway during sleep that results in disruptions of normal sleep architecture and intermittent nocturnal hypoxia. OSA is prevalent in both adults and children in modern society. The estimated prevalence has been 2% for women and 4% for men. Definite risk factors for OSA include obesity and craniofacial or upper airway soft tissue abnormalities. Potential risk factors include heredity, smoking, and nasal congestion. Obesity is the best documented risk factor for OSA. The prevalence of OSA progressively increases as body mass index and associated markers (e.g., neck circumference, waist-to-hip ratio) increase. A centripetal pattern of obesity with fat preferentially distributed to the abdominal viscera, upper body and neck is more closely linked to OSA than a peripheral pattern of obesity. Obstructive sleep apnea is associated with clinical complications such as daytime somnolence, hypertension, ischemic heart disease, and increased risk of stroke. The mechanisms resulting in these complications include recurrent intermittent hypoxemia and increased sympathetic activation, primarily at the termination of apneic events. In men, testes have two functions: production of testosterone, which is the predominant circulating androgen by the Leydig cells and spermatogenesis which takes place within the seminiferous tubules. Summary 87 Male hypogonadism refers to impairment of one or both of these functions. It may arise from testicular disease (primary hypogonadism) where the testes are primarily affected and thus concentrations of gonadotropins are raised (hypergonadotropic hypogonadism) or dysfunction of the hypothalamic-pituitary unit (secondary hypogonadism) and thus concentrations of gonadotropins are lowered (hypogonadotropic hypogonadism). Recent literature has shown that OSA is associated with the development of male hypogonadism. Several studies have confirmed a strong relationship between OSA and low testosterone. Both the quantity and quality of sleep affect testosterone levels. Patients with OSA have less REM sleep, reduced deep sleep time, increased nighttime awakenings, sleep fragmentation, reduced sleep efficiency and hypoxia resulting from apnea and hypopnea episodes, all of which lead to a low testosterone level. The aim of our study was to investigate hypogonadism in men with obstructive sleep apnea and its related risk factors including : age of the patient, body mass index (BMI), severity of obstructive sleep apnea, smoking, positive family history and associated medical conditions. This case control study was carried out in Chest Diseases outpatient clinics, Sleep Laboratory unit & Medical Biochemistry Department, Faculty of Medicine, Menoufia University in the period between December 2021 to June 2022 on 32 subjects, classified into 2 groups: group 1: patients diagnosed as having obstructive sleep apnea. group 2: healthy controls. Summary 88 Subjects enrolled in this study, after taking written consent, underwent history taking, assessment by sleep questionnaire (Epworth Sleepiness Scale (ESS)), measurement of body mass index and neck circumference, full night Polysomnography (PSG) and laboratory investigations including serum LH & total testosterone levels. In the present work, OSA patients had significantly higher prevalence of associated chronic diseases (diabetes, hypertension and irritable bowel syndrome), and taking antidiabetic and antihypertensive medications and had significantly higher prevalence of day time sleepiness than the controls (P = 0.030, 0.025 and <0.001 respectively). OSA patients had significantly higher mean values of weight, BMI and neck circumference than the control group (p<0.001). Also, OSA patients had significantly higher mean values of serum LH levels than the control group (p=0.031). Total testosterone levels were lower in OSA patients than controls but it did not reach the significant level. Furthermore, There was a significant negative correlation between Epworth sleepiness scale and total testosterone levels in obstructive sleep apnea patients (p=0.025). |