Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
J Sex Med. 2020 Jul;17(7):1297-1303. doi: 10.1016/j.jsxm.2020.03.006. Epub 2020 Apr 16.
Polycythemia (erythrocytosis) is a known side effect of testosterone (T) replacement therapy (TRT) and appears to correlate with maximum T levels. There is also a well-established association between obstructive sleep apnea (OSA) and the development of polycythemia, which confers additional long-term cardiovascular morbidity. Synergy between TRT and OSA in the development of polycythemia remains poorly understood.
The objective of this study was to retrospectively assess the relationship of OSA and secondary polycythemia in hypogonadal men receiving TRT.
We performed a retrospective chart review of all men treated by a single provider from 2015 to 2019 for the diagnosis of hypogonadism. Patients who developed a hematocrit of 52% or greater were classified as having polycythemia. OSA was identified via clinical documentation or use of nocturnal continuous positive airway pressure. Demographics, laboratory values, treatment details, and comorbidities were recorded. Data were reported as mean ± SD for parametric variables and median [interquartile range] for non-parametric values.
The primary outcome of this study was the association between OSA and polycythemia in hypogonadal men on TRT.
474 men were included in this study. 62/474 (13.1%) men met the criteria for the diagnosis of polycythemia with a median hematocrit of 53.6 [interquartile range 52.6, 55.5]. Univariate analysis demonstrated a strong positive association between polycythemia and the concomitant diagnosis of OSA in hypogonadal men (P = .002). Even after correcting for age, body mass index (BMI), and peak T levels in the multivariate analysis (P = .01), this relationship remained significant with an odds ratio of 2.09 [95% CI 1.17, 3.76]. 37 men on TRT with polycythemia and OSA were included in the final cohort with a mean age of 59.2 ± 11.4 years, mean BMI of 32.4 ± 6.0, and median time from TRT initiation to polycythemia diagnosis of 3 years. All patients diagnosed with OSA were prescribed continuous positive airway pressure with poor compliance noted in 52.8% of men. 37.8% were managed via phlebotomy and 59.5% were managed via dose de-escalation of TRT. In hypogonadal men on TRT with polycythemia, BMI was the only risk factor strongly associated with OSA (P = .013).
In hypogonadal men (particularly those with elevated BMI) on TRT who develop secondary polycythemia, a diagnosis of OSA should be strongly considered.
STRENGTHS & LIMITATIONS: This is a single provider retrospective study and further studies are needed to assess generalizability.
In this retrospective single-center cohort, the development of polycythemia in hypogonadal men on TRT was associated with an increased prevalence of OSA. Lundy SD, Parekh NV, Shoskes DA. Obstructive Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy. J Sex Med 2020;17:1297-1303.
多血症（红细胞增多症）是睾酮（T）替代疗法（TRT）的已知副作用，似乎与最大 T 水平相关。阻塞性睡眠呼吸暂停（OSA）与多血症的发展之间也存在明确的关联，这会带来额外的长期心血管发病率。TRT 和 OSA 在多血症发展中的协同作用仍知之甚少。
本研究旨在回顾性评估接受 TRT 的性腺功能减退男性的 OSA 和继发性多血症之间的关系。
我们对 2015 年至 2019 年间由一名医生治疗的所有患有性腺功能减退症的男性进行了回顾性图表审查。血细胞比容达到 52%或更高的患者被归类为患有多血症。通过临床记录或使用夜间持续气道正压通气来识别 OSA。记录人口统计学、实验室值、治疗细节和合并症。数据以参数变量的平均值±标准差和非参数值的中位数[四分位距]报告。
本研究的主要结局是 OSA 与接受 TRT 的性腺功能减退男性多血症之间的关联。
在接受 TRT 的性腺功能减退男性中，多血症的发生与 OSA 密切相关。（特别是那些 BMI 升高的患者）应强烈考虑 OSA 的诊断。
