Liu Peter Y, Yee Brendon, Wishart Susan M, Jimenez Mark, Jung Dae Gun, Grunstein Ronald R, Handelsman David J
Department of Andrology, ANZAC Research Institute and Concord Hospital, University of Sydney, Sydney, 2139 Australia.
J Clin Endocrinol Metab. 2003 Aug;88(8):3605-13. doi: 10.1210/jc.2003-030236.
Androgen therapy may precipitate obstructive sleep apnea in men. Despite increasing androgen use in older men, few studies have examined sleep and breathing. Randomized, double-blind, placebo-controlled studies examining effects of testosterone simultaneously on sleep, breathing, and function in older men are not available. Seventeen community-dwelling healthy men over the age of 60 yr were randomized to receive three injections of im testosterone esters at weekly intervals (500 mg, 250 mg, and 250 mg) or matching oil-based placebo and then crossed over to the other treatment after 8 wk of washout. Polysomnography, anthropometry, and physical, mental, and metabolic function were assessed at baseline and after each treatment period. Testosterone treatment reduced total time slept ( approximately 1 h), increased the duration of hypoxemia ( approximately 5 min/night), and disrupted breathing during sleep (total and non-rapid eye movement respiratory disturbance indices both increased by approximately seven events per hour) (all P < 0.05). Despite expected effects on body composition (increase in total and lean mass, reduction in fat mass, P < 0.05, bioimpedance method), upper airway dimensions did not change (acoustic reflectometry). Driving ability (computer simulation), physical activity (accelerometry, Physical Activity Scale in the Elderly), quality of life (SF36, Functional Outcomes of Sleep Questionnaire), mood (Profile of Mood States Questionnaire), sleepiness (Epworth, Stanford scales), and insulin resistance (homeostasis model) also were not changed by treatment. Short-term administration of high-dose testosterone shortens sleep and worsens sleep apnea in older men but did not alter physical, mental, or metabolic function. These changes did not appear to be due to upper airway narrowing. Further study of longer-term lower-dose androgen therapy on sleep and breathing is needed to evaluate its safety in older men.
雄激素治疗可能会使男性出现阻塞性睡眠呼吸暂停。尽管老年男性中雄激素的使用日益增加，但很少有研究关注睡眠和呼吸情况。目前尚无随机、双盲、安慰剂对照研究来考察睾酮对老年男性睡眠、呼吸及功能的同时影响。17名年龄超过60岁的社区健康男性被随机分为两组，一组接受每周一次共三次的睾酮酯皮下注射（500毫克、250毫克、250毫克），另一组接受匹配的油基安慰剂注射，8周洗脱期后两组交叉接受另一种治疗。在基线期及每个治疗期结束后，对受试者进行多导睡眠图监测、人体测量以及身体、心理和代谢功能评估。睾酮治疗使总睡眠时间减少（约1小时），低氧血症持续时间增加（约每晚5分钟），并扰乱睡眠期间的呼吸（总呼吸紊乱指数和非快速眼动期呼吸紊乱指数均增加约每小时7次事件）（所有P<0.05）。尽管睾酮治疗对身体成分有预期影响（总体重和瘦体重增加，脂肪量减少，P<0.05，生物电阻抗法），但上气道尺寸未发生改变（声学反射测量法）。治疗对驾驶能力（计算机模拟）﹑身体活动（加速度计、老年人身体活动量表）、生活质量（SF36、睡眠功能结局问卷）、情绪（情绪状态剖面图问卷）、嗜睡程度（爱泼沃斯嗜睡量表、斯坦福嗜睡量表）及胰岛素抵抗（稳态模型）均无影响。短期大剂量睾酮给药会缩短老年男性的睡眠时间并加重睡眠呼吸暂停，但不改变其身体、心理或代谢功能。这些变化似乎并非由上气道狭窄所致。需要进一步研究长期低剂量雄激素治疗对睡眠和呼吸的影响，以评估其在老年男性中的安全性。
