Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Harbor UCLA Medical Center and The Lundquist Institute, 1124 W Carson St., Box 446, Torrance, CA, 90502, USA.
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Rev Endocr Metab Disord. 2022 Dec;23(6):1323-1339. doi: 10.1007/s11154-022-09755-4. Epub 2022 Sep 24.
Sleep serves important biological functions, and influences health and longevity through endocrine and metabolic related systems. Sleep debt, circadian misalignment and sleep disruption from obstructive sleep apnea is widespread in modern society and accumulates with life because recovery sleep is not completely restorative. Accumulated disordered sleep throughout life impacts the ageing process and the development of age-related diseases. When epidemiological and interventional studies are considered collectively, sleep loss and lower sleep duration are associated with lower morning, afternoon and 24-h testosterone; as well as higher afternoon, but not morning or 24-h cortisol. These reciprocal changes imbalances anabolic-catabolic signaling because testosterone and cortisol are respectively the main anabolic and catabolic signals in man. Fixing testosterone-cortisol balance by means of a novel dual-hormone clamp mitigates the induction of insulin resistance by sleep restriction and provided the first proof-of-concept that the metabolic harm from sleep loss can be ameliorated by approaches that do not require sleeping more. Obstructive sleep apnea is associated with lower testosterone, even after controlling for age and obesity whereas the conclusion that continuous positive airway pressure therapy has no effect on testosterone is premature because available studies are underpowered and better-quality studies suggest otherwise. High dose testosterone therapy induces OSA, but more physiological dosing may not; and this effect may be transient or may dissipate with longer term therapy. Studies investigating the origin of the diurnal testosterone rhythm, the effect of circadian misalignment on testosterone-cortisol balance, and methods to mitigate metabolic harm, are required.
睡眠对人体健康起着至关重要的作用，通过内分泌和代谢相关系统影响着人们的健康和寿命。在现代社会中，睡眠债、昼夜节律紊乱和阻塞性睡眠呼吸暂停引起的睡眠中断非常普遍，而且会随着时间的推移而积累，因为恢复性睡眠并不能完全恢复身体机能。长期睡眠紊乱会影响衰老过程和与年龄相关疾病的发展。当综合考虑流行病学和干预性研究时，睡眠缺失和睡眠时间较短与早晨、下午和 24 小时的睾酮水平降低有关；而与下午的皮质醇水平升高有关，但与早晨或 24 小时的皮质醇水平无关。这些相互矛盾的变化打破了合成代谢与分解代谢信号的平衡，因为睾酮和皮质醇分别是人体的主要合成代谢和分解代谢信号。通过一种新的双激素夹钳来修复睾酮-皮质醇平衡，可以缓解睡眠限制引起的胰岛素抵抗，这首次证明了通过不需要增加睡眠时间的方法就可以改善睡眠不足带来的代谢危害。阻塞性睡眠呼吸暂停与较低的睾酮水平有关，即使在控制年龄和肥胖因素后也是如此，而持续气道正压通气治疗对睾酮没有影响的结论还为时过早，因为现有的研究力度不够，而且更好质量的研究表明并非如此。大剂量睾酮治疗会引起阻塞性睡眠呼吸暂停，但更生理剂量的睾酮可能不会；而且这种效应可能是短暂的，或者随着长期治疗而消散。需要研究昼夜睾酮节律的起源、昼夜节律紊乱对睾酮-皮质醇平衡的影响以及减轻代谢危害的方法。
