Body compositional and cardiometabolic effects of testosterone therapy in obese men with severe obstructive sleep apnoea: a randomised placebo-controlled trial
European journal of endocrinology, 2012•academic.oup.com
Background The combination of male gender, obstructive sleep apnoea (OSA) and obesity
magnifies cardiometabolic risk. There has been no systematic study evaluating whether
testosterone therapy can improve cardiometabolic health in obese men with OSA by
improving body composition, visceral abdominal fat and insulin sensitivity. Objective To
assess body compositional and cardiometabolic effects of testosterone treatment in obese
men with severe OSA. Design An 18-week randomised, double-blind, placebo-controlled�…
magnifies cardiometabolic risk. There has been no systematic study evaluating whether
testosterone therapy can improve cardiometabolic health in obese men with OSA by
improving body composition, visceral abdominal fat and insulin sensitivity. Objective To
assess body compositional and cardiometabolic effects of testosterone treatment in obese
men with severe OSA. Design An 18-week randomised, double-blind, placebo-controlled�…
Background
The combination of male gender, obstructive sleep apnoea (OSA) and obesity magnifies cardiometabolic risk. There has been no systematic study evaluating whether testosterone therapy can improve cardiometabolic health in obese men with OSA by improving body composition, visceral abdominal fat and insulin sensitivity.
Objective
To assess body compositional and cardiometabolic effects of testosterone treatment in obese men with severe OSA.
Design
An 18-week randomised, double-blind, placebo-controlled and parallel group trial in 67 men.
Methods
Participants (age=49�12 years, apnoea hypopnoea index=39.9�17.7 events/h, BMI=31.3�5.2 kg/m2) were placed on a hypocaloric diet and received i.m. injections of either 1000 mg testosterone undecanoate (n=33) or placebo (n=34) for 18 weeks. Outcomes were the changes in body composition (total muscle mass, total and abdominal fat, total body dual-energy X-ray absorptiometry and computerised tomography (CT)), weight, insulin sensitivity (homeostasis model assessment), abdominal liver fat (CT), arterial stiffness (pulse wave analysis), resting metabolic rate and respiratory quotient (indirect calorimetry) and blood lipids and metabolic syndrome from baseline to week 18.
Results
After 18 weeks, testosterone treatment increased insulin sensitivity (−1.14 units, 95% confidence interval (95% CI) −2.27 to −0.01, P<0.05), reduced liver fat (0.09 Hounsfield attenuation ratio, 95% CI 0.009 to 0.17, P=0.03) and increased muscle mass (1.6 kg, 95% CI 0.69 to 2.5, P=0.0009) to a greater extent than placebo. Other measures of body composition and regional adiposity as well as the number of participants with metabolic syndrome did not change. Testosterone also decreased arterial stiffness (augmentation index) by 3.2% (95% CI −6.01 to −0.46%, P=0.02) and decreased the respiratory quotient (95% CI −0.04, −0.08 to −0.001, P=0.04) after 18 weeks compared with placebo.
Conclusion
Eighteen weeks of testosterone therapy in obese men with OSA improved several important cardiometabolic parameters but did not differentially reduce overall weight or the metabolic syndrome. Longer term studies are required.
Oxford University Press