A Clinical Perspective of Sleep and Andrological Health: Assessment, Treatment Considerations, and Future Research

• Published in: The journal of clinical endocrinology and metabolism Vol. 104; no. 10; pp. 4398 - 4417
• Main Author: Liu, Peter Y
• Format: Journal Article
• Language: English
• Published: Washington, DC Endocrine Society 01.10.2019; Oxford University Press
• Subjects: Age Factors; Androgens - metabolism; Apnea; Biological clocks; Care and treatment; Circadian rhythms; Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Diurnal; Epidemiology; Erectile dysfunction; Erectile Dysfunction - diagnosis; Erectile Dysfunction - epidemiology; Fecundity; Health aspects; Hormone Replacement Therapy - methods; Humans; Hypertension; Hypertension - diagnosis; Hypertension - epidemiology; Hypogonadism; Hypogonadism - diagnosis; Hypogonadism - epidemiology; Impotence; Infertility; Insulin; Insulin resistance; Literature reviews; Male; Mini-Review; Mortality; Prevalence; Prognosis; Quality of Life; Risk Assessment; Sleep; Sleep - physiology; Sleep apnea syndromes; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleep Apnea, Obstructive - therapy; Sleep deprivation; Sleep disorders; Sleep Wake Disorders - diagnosis; Sleep Wake Disorders - epidemiology; Sleep Wake Disorders - therapy; Testosterone; Type 2 diabetes
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2019-00683

Abstract Context Sleep that is insufficient, misaligned, or disrupted causes hypersomnolence and neuropsychological deficits, adversely affects cardiometabolic health, and is increasingly recognized to impair other biological processes that lead to conditions important to men, such as hypogonadism, erectile dysfunction, and infertility. Evidence Acquisition Literature review from 1970 to December 2018. Evidence Synthesis High-quality and complementary epidemiological and interventional studies establish that abnormal sleep is associated with increased mortality, hypertension, and other cardiometabolic disorders (insufficient, disrupted, and misaligned sleep), as well as reduced fecundity and total sperm count (insufficient sleep), erectile dysfunction (disrupted sleep), and low testosterone (both). Circadian misalignment shifts the peak of testosterone’s diurnal rhythm to occur soon after waking up, irrespective of the biological clock time, but it does not change the mean concentration. Preliminary studies show that extending sleep in individuals who are chronically sleep deprived may become a strategy to reduce insulin resistance and hypertension. Continuous positive airway pressure therapy can improve erectile function, and possibly systemic testosterone exposure, but only when used adherently by men with obstructive sleep apnea. Both high-dose and replacement-dose testosterone therapies modestly worsen sleep-disordered breathing, but they also improve cardiometabolic function and sexual desire. Persistence of either the adverse or beneficial outcomes over the longer term requires further investigation. Conclusions Sleep is increasingly recognized to be essential for healthy living. Establishing the effect of abnormal sleep, and of improving sleep, on andrological issues of prime interest to men will promote prioritization of sleep, and may thereby improve overall long-term health outcomes. Sleep is essential for healthy living. Establishing the effect of abnormal sleep on andrological issues will promote prioritization of sleep, and may thereby improve overall long-term health outcomes.