Endocrine and Cardiometabolic Research Group, NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.
Eur J Endocrinol. 2012 Oct;167(4):531-41. doi: 10.1530/EJE-12-0525. Epub 2012 Jul 30.
The combination of male gender, obstructive sleep apnoea (OSA) and obesity magnifies cardiometabolic risk. There has been no systematic study evaluating whether testosterone therapy can improve cardiometabolic health in obese men with OSA by improving body composition, visceral abdominal fat and insulin sensitivity.
To assess body compositional and cardiometabolic effects of testosterone treatment in obese men with severe OSA.
An 18-week randomised, double-blind, placebo-controlled and parallel group trial in 67 men.
Participants (age=49 ± 12 years, apnoea hypopnoea index=39.9 ± 17.7 events/h, BMI=31.3 ± 5.2 kg/m(2)) were placed on a hypocaloric diet and received i.m. injections of either 1000 mg testosterone undecanoate (n=33) or placebo (n=34) for 18 weeks. Outcomes were the changes in body composition (total muscle mass, total and abdominal fat, total body dual-energy X-ray absorptiometry and computerised tomography (CT)), weight, insulin sensitivity (homeostasis model assessment), abdominal liver fat (CT), arterial stiffness (pulse wave analysis), resting metabolic rate and respiratory quotient (indirect calorimetry) and blood lipids and metabolic syndrome from baseline to week 18.
After 18 weeks, testosterone treatment increased insulin sensitivity (-1.14 units, 95% confidence interval (95% CI) -2.27 to -0.01, P<0.05), reduced liver fat (0.09 Hounsfield attenuation ratio, 95% CI 0.009 to 0.17, P=0.03) and increased muscle mass (1.6 kg, 95% CI 0.69 to 2.5, P=0.0009) to a greater extent than placebo. Other measures of body composition and regional adiposity as well as the number of participants with metabolic syndrome did not change. Testosterone also decreased arterial stiffness (augmentation index) by 3.2% (95% CI -6.01 to -0.46%, P=0.02) and decreased the respiratory quotient (95% CI -0.04, -0.08 to -0.001, P=0.04) after 18 weeks compared with placebo.
Eighteen weeks of testosterone therapy in obese men with OSA improved several important cardiometabolic parameters but did not differentially reduce overall weight or the metabolic syndrome. Longer term studies are required.
男性、阻塞性睡眠呼吸暂停（OSA）和肥胖症会使心脏代谢风险加剧。目前还没有系统的研究评估睾丸激素治疗是否可以通过改善身体成分、内脏腹部脂肪和胰岛素敏感性来改善肥胖症合并 OSA 男性的心脏代谢健康。
评估睾丸激素治疗对肥胖合并严重 OSA 男性的身体成分和心脏代谢的影响。
67 名男性的 18 周随机、双盲、安慰剂对照和平行组试验。
参与者（年龄=49 ± 12 岁，呼吸暂停低通气指数=39.9 ± 17.7 次/小时，BMI=31.3 ± 5.2kg/m2）接受低热量饮食，并接受肌内注射 1000mg 十一酸睾酮（n=33）或安慰剂（n=34）18 周。结果是从基线到第 18 周的身体成分变化（总肌肉量、总脂肪和腹部脂肪、全身双能 X 射线吸收测定和计算机断层扫描（CT））、体重、胰岛素敏感性（稳态模型评估）、腹部肝脂肪（CT）、动脉僵硬（脉搏波分析）、静息代谢率和呼吸商（间接测热法）以及血脂和代谢综合征。
18 周后，睾丸激素治疗组胰岛素敏感性增加（-1.14 个单位，95%置信区间（95%CI）-2.27 至-0.01，P<0.05），肝脂肪减少（0.09 亨氏衰减比，95%CI 0.009 至 0.17，P=0.03），肌肉量增加（1.6kg，95%CI 0.69 至 2.5，P=0.0009），而安慰剂组无明显变化。身体成分和局部脂肪堆积的其他指标以及代谢综合征的患者数量也没有变化。与安慰剂相比，睾丸激素治疗还可使动脉僵硬（增强指数）降低 3.2%（95%CI-6.01 至-0.46%，P=0.02），并使呼吸商（95%CI-0.04，-0.08 至-0.001，P=0.04）降低 18 周。
肥胖合并 OSA 男性的睾丸激素治疗 18 周可改善多项重要的心脏代谢参数，但不能降低总体体重或代谢综合征的发生率。需要进行更长期的研究。
