Ghiciuc Cristina Mihaela, Dima-Cozma Lucia Corina, Bercea Raluca Mihaela, Lupusoru Catalina Elena, Mihaescu Traian, Cozma Sebastian, Patacchioli Francesca Romana
University of Medicine and Pharmacy Grigore T. Popa, Department of Pharmacology, Iasi, Romania.
University of Medicine and Pharmacy Grigore T. Popa, School of Medicine, Department of Internal Medicine, Iasi, Romania.
Braz J Otorhinolaryngol. 2016 Sep-Oct;82(5):529-35. doi: 10.1016/j.bjorl.2015.09.004. Epub 2015 Dec 17.
The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients.
The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C).
Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities.
The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.
睡眠障碍与激素之间的复杂关系可能导致阻塞性睡眠呼吸暂停（OSA）患者的皮质醇和睾酮分泌发生改变。
本研究旨在确定唾液游离睾酮、游离皮质醇及其比值（T/C）的昼夜变化轨迹。
基于夜间多导睡眠图评估和日间过度嗜睡，连续招募了10名新诊断为OSA的受试者以及7名匹配的对照组。在受试者醒来时、中午和晚上采集唾液样本，测量其中的皮质醇和睾酮水平。对焦虑/抑郁进行心理测量评估，并询问性功能障碍情况，以评估神经心理共病的存在。
主要发现是，与对照组相比，OSA受试者醒来时表现为皮质醇分泌不足，晚上睾酮浓度显著降低，而对照组维持了生理状态下睾酮和皮质醇的昼夜波动，即早晨激素浓度较高，晚上较低。使用多次昼夜测量的数据而非单点数据，能够检测到一天开始和结束时T/C比值出现相反方向的变化：OSA受试者早晨的T/C比值高于对照组，而晚上其T/C比值显著低于对照组。合成代谢 - 分解代谢昼夜平衡的失衡表明，OSA与下丘脑 - 垂体 - 肾上腺轴和下丘脑 - 垂体 - 性腺轴的调节异常有关，这可能是OSA患者中观察到的一些神经心理共病的潜在原因。
