Carla Wang-Kocik, MD

Obstructive sleep apnea (OSA) is a common chronic sleep disorder characterized by recurrent episodes of complete or partial upper airway obstruction during sleep. This obstruction often is not perceived while we sleep, but results in oxygen desaturation (low oxygen), sleep fragmentation (interrupted sleep) and daytime sleepiness or non-restorative sleep.¹ Men with OSA also are more prone to suffering from associated complications like low libido, impotence and erectile dysfunction (ED).

Risk factors of obstructive sleep apnea

Untreated OSA has been shown to be an independent risk factor for increased rates of death, cardiovascular disease including hypertension, coronary heart disease, congestive heart failure, arrhythmias, heart attacks, stroke, pulmonary hypertension, sudden death, insulin resistance, gastroesophageal reflux disease and neurocognitive difficulties associated with poor memory and lack of concentration.²

There is also a confirmed correlation between OSA and low testosterone.³

Signs of sleep apnea

· Frequent urination

· Morning headaches

· Daytime sleepiness

· Loud snoring

· Night sweats

· Making gasping or choking sounds

· Weight gain

· Moodiness

· Impaired memory

What is hypogonadism?

Hypogonadism occurs when the sex glands produce little or no sex hormones. Obstructive sleep apnea represents a frequent complication among patients with obesity and has been associated with neuroendocrine changes, including hypogonadism.⁴ Testosterone has shown to be lower in men with OSA. Treatment of OSA may help improve hypogonadism and sexual function.⁶

Testosterone production

Both the quantity and quality of sleep affect testosterone levels. Patients with OSA have less REM sleep, reduced deep sleep time, increased nighttime awakenings, sleep fragmentation and reduced sleep efficiency leading to low testosterone level.¹⁰

Typically, testosterone levels begin to rise upon falling asleep, peak at about the time of the first episode of REM sleep and remain at the same level until awakening.⁷ Sleep fragmentation, or interrupted sleep, disrupts the testosterone rhythm with considerable decline or cessation of the nocturnal increase in testosterone. ⁸

Aging is an important factor associated with the morning testosterone level. Generally, middle-aged men have lower morning testosterone levels than healthy younger men, due to a decline in nocturnal testosterone secretion and the amount of nighttime sleep in older men.⁹

The severity of apnea is related to decreased testosterone secretions in patients with OSA.¹¹ Obesity is strongly linked to low testosterone levels in men, especially abdominal fat. ¹²

In current guidelines, testosterone replacement therapy is contradicted in the presence of untreated OSA as it exacerbates sleep apnea.¹³ If left untreated, testosterone replacement therapy exacerbates OSA symptoms, the increase in the AHI, and the decrease in oxygen saturation, which can be very detrimental.¹⁴

If you are experiencing excessive daytime sleepiness, non-restorative sleep, erectile dysfunction and low libido, you may have sleep apnea associated with low testosterone. Ask to be referred to the UT Health East Texas Sleep Disorders Center by your physician or call 903-531-8079 to begin the referral process.

Information provided by board-certified pulmonologist, sleep medicine and critical care physician, Carla Wang-Kocik, MD, at the UT Health East Texas Pulmonary Institute – A department of UT Health Tyler.

Sources

1. Park CY, Hong JH, Lee JH, Lee KE, Cho HS, Lim SJ, et al. Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome. PLoS One. 2014;9:e98765.

2. 5. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829–183

3. Urol Clin North Am. 2016 May;43(2):233-7. doi: 10.1016/j.ucl.2016.01.012. Epub 2016 Mar 21

4. Front Endocrinol (Lausanne). 2019 Aug 21;10:551. doi: 10.3389/fendo.2019.00551. eCollection 2019

6. Fatigue and serum testosterone in obstructive sleep apnea patients. Bercea RM, Mihaescu T, Cojocaru C, Bjorvatn B. Clin Respir J. 2015 Jul; 9(3):342-9

7. Relationship between rapid eye movement sleep and testosterone secretion in normal men. Luboshitzky R, Herer P, Levi M, Shen-Orr Z, Lavie P J Androl. 1999 Nov-Dec; 20(6):731-7

8. Luboshitzky R, Zabari Z, Shen-Orr Z, Herer P, Lavie P. Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab. 2001;86:1134–1139.

9. Soukhova-O'Hare GK, Shah ZA, Lei Z, Nozdrachev AD, Rao CV, Gozal D. Erectile dysfunction in a murine model of sleep apnea. Am J Respir Crit Care Med. 2008;178:644–650

110. The relationship between sleep disorders and testosterone. Wittert G. Curr Opin Endocrinol Diabetes Obes. 2014 Jun; 21(3):239-43

11. Testosterone levels in obese male patients with obstructive sleep apnea syndrome: relation to oxygen desaturation, body weight, fat distribution and the metabolic parameters. Gambineri A, Pelusi C, Pasquali R. Endocrinol Invest. 2003 Jun; 26(6):493-8

12. Aromatase--a brief overview. Simpson ER, Clyne C, Rubin G, Boon WC, Robertson K, Britt K, Speed C, Jones M. Annu Rev Physiol. 2002; 64():93-127

13. Testosterone therapy and obstructive sleep apnea: is there a real connection? Hanafy HMJ Sex Med. 2007 Sep; 4(5):1241-6.

14. Margel D, Cohen M, Livne PM, Pillar G. Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology. 2004;63:545–549

Carla Wang-Kocik MD, board-certified in pulmonary disease, critical care and sleep medicine at UT Health East Texas Pulmonary Institute - A department of UT Health Tyler discusses facts about sleep.

Chronic Obstructive Pulmonary Disease, commonly referred to as COPD, is a term used to describe several different lung diseases that affect the lung functionality of over 16 million Americans. Even more suffer from COPD without being diagnosed. Although there is no cure, this disease progresses slowly and patients who seek out help can be prescribed treatments that will slow the disease and make it easier to breathe.

UT Health East Texas North Campus Pulmonary Clinic has many physicians with expert knowledge and experience in treating COPD. These pulmonary experts share their knowledge in hopes of bettering the quality of life for people with COPD.

The Effects of COPD on Your Lungs

Within normal lungs, the bronchial tubes branch into thousands of smaller, thinner tubes called bronchioles that end in bunches of tiny, round air sacs called alveoli. Small blood vessels, called capillaries, run through the walls of the alveoli. When air reaches the alveoli, oxygen passes through the walls into the blood in the capillaries. At the same time, carbon dioxide moves from the capillaries into the alveoli. This processes is called air exchange. The bronchioles and alveoli are elastic. With inspiration (inhaling or breathing in), each alveoli fills up with air like a small balloon. With expiration (exhaling or breathing out), they deflate and the air goes out. In COPD, less air flows in and out of the airways because of one or more of the following:

1.            The bronchioles and alveoli lose their elastic quality.

2.            The walls between many of the alveoli are destroyed.

3.            The walls of the bronchioles become thick and inflamed.

4.            The bronchioles make more mucus than usual, which can clog them.

Symptoms of COPD

COPD can have seemingly benign symptoms, such as a nagging cough, so people suffering from this disease often avoid seeing a physician. However, since treatments can slow the disease and improve quality of life, it’s important to know what to look out for and get tested.

COPD is diagnosed based on signs and symptoms. Be aware if it’s an ongoing cough, how long it’s been present, how much or how often you cough, and how much mucus is produced. Recall details such as medical and family histories, including questions regarding smoking history, contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes or dust. The main test for COPD is spirometry, which measures the amount of air and how fast the air can be breathed out. Other tests include a chest XRAY or a CT scan that can show signs of COPD. An arterial blood gas test (ABG) helps determine the severity of COPD and whether oxygen therapy is needed. Also, a six-minute test is used to determine exercise tolerance and to qualify a patient for oxygen therapy.

After getting tested, there are a lot of lifestyle changes a patient can make that will improve their functionality and overall health.

After Being Diagnosed

The first step in slowing disease’s progression is to prevent exposure to harmful lung irritants, such as cigarette smoke, heavy dust, fumes and air pollution. After that, slow changes should be adopted into your everyday routine, including how you eat, exercise and get around your home.

You should eat smaller, more frequent meals; rest before eating, and take vitamins or nutritional supplements as well. Physical activity can strengthen the muscles that help with breathing and improve overall wellness, but do activities slowly. Put frequently used items in one place that’s easy to reach, find simple ways to cook, clean and do other chores. Use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help moving things around your house so that you don’t have to climb stairs as often. Keep clothing loose, and wear clothes and shoes that are easy to put on and take off. Don’t forget to also ask friends and family for help with daily tasks.

Help from Your Community Providers

There are whole programs, departments and providers dedicated to helping those who are affected by COPD and other lung diseases. Our physicians, along with many other experts, are continually researching COPD, looking for ways to relieve symptoms, slow and eventually eliminate this disease.

UT Health East Texas has a lung (pulmonary) rehab program with the physical therapy department that can help patients learn to manage the disease. A team of health professionals can provide counseling, teaching and research for patients diagnosed with COPD. We are always looking for research participants to assist our organization in finding better treatments and even cures for disease processes. I would highly encourage anyone who might be interested in being involved with pulmonary research to contact our clinic or hospital so that we can assist in getting them enrolled in research studies.

If you are having trouble breathing, or are worried about your lung health, please make an appointment with a physician. To find a physician, please call 903-596-DOCS. If you are interested in joining a research study, talk to your physician. Most importantly, if you are a smoker struggling to quit, please contact a physician. There are many services and providers at UT Health East Texas that are there for you. For more information about UT Health East Texas Pulmonary Institute visit uthealtheasttexas.com/services/lung-care.