Efficacy of Continuous Positive Airway Pressure on Testosterone in Men with Obstructive Sleep Apnea: A Meta-Analysis

<div><p>Objective</p><p>To evaluate the efficacy of continuous positive airway pressure (CPAP) on serum testosterone in men with obstructive sleep apnea (OSA).</p><p>Methods</p><p>Two reviewers independently searched PubMed, Cochrane library, Embase and Web of Science before June 2014. Information on characteristics of subjects, study design, pre- and post-CPAP treatment of serum total testosterone, free testosterone and sexual hormone blinding protein (SHBG) was extracted for analysis.</p><p>Results</p><p>A total of 7 studies with 9 cohorts that included 232 men were pooled into meta-analysis. There was no change of total testosterone levels before and after CPAP treatment in OSA men (standardized mean difference (SMD) = −0.14, 95%<i>CI</i>: −0.63 to 0.34, z = 0.59, <i>p</i> = 0.558), even subdivided by CPAP therapeutic duration (>3 months). Meanwhile, no significant differences in free testosterone and SHBG were detected after CPAP treatment (SMD =  0.16, 95%<i>CI</i>: −0.09 to 0.40, z = 1.25, <i>p</i> = 0.211 and SMD = −0.58, 95%<i>CI</i>: −1.30 to 0.14, z = 1.59, <i>p</i> = 0.112, respectively).</p><p>Conclusion</p><p>CPAP has no influence on testosterone levels in men with OSA, further large-scale, well-design interventional investigation is needed.</p></div

Forest plot for the change in free testosterone before and after CPAP treatment.

<p>Forest plot for the change in free testosterone before and after CPAP treatment.</p

Study flow diagram.

<p>Study flow diagram.</p

Characteristics of include studies (7 studies, 9 cohorts).

<p>SHGB:sex hormone binding protein; RCT: randomized controlled trial. *:Presented as respiratory disturbance index(RDI), #: Presented as median (interquartile range), &:n = 16, ^∧: Jadad score of both RCT>3, @:the CPAP duration in the original article was 76 days.</p><p>Characteristics of include studies (7 studies, 9 cohorts).</p

Forest plot for the change in total testosterone before and after CPAP treatment.

<p>Forest plot for the change in total testosterone before and after CPAP treatment.</p

Forest plot for the change in SHBG before and after CPAP treatment.

<p>Forest plot for the change in SHBG before and after CPAP treatment.</p

Publication bias.

<p>Publication bias.</p

Forest plot for the change in total testosterone between CPAP treatment group and control group in two RCTs.

<p>Forest plot for the change in total testosterone between CPAP treatment group and control group in two RCTs.</p

Sensitivity analysis of 7 including studies (9 cohorts).

<p>Sensitivity analysis of 7 including studies (9 cohorts).</p

Characteristics of two randomized controlled trials.

<p>Characteristics of two randomized controlled trials.</p