The Association of Testosterone Levels with Overall Sleep Quality, Sleep Architecture, and Sleep-Disordered Breathing
Open accessAbstract
Context: Little is known about the association of low endogenous testosterone levels and abnormal sleep patterns in older men, although pharmacological doses of testosterone are associated with increased severity of sleep apnea and other sleep disturbances. Objective: The objective of the study was to examine the association between serum testosterone levels with objectively measured sleep characteristics. Design: This was a cohort study. Setting: Community-dwelling men aged 65 yr or older from six clinical centers in the United States participated in the study. Participants and Main Outcome Measures: A total of 1312 men had baseline total testosterone levels measured in 2000–2002, followed 3.4 yr later by 72-h (minimum) actigraphy and one-night in-home polysomnography to assess sleep duration, sleep fragmentation, and sleep apnea. Analyses were performed by quartile of total testosterone and categorically defined low vs. higher total testosterone (<250 ng/dl vs. ≥250 ng/dl). Lifestyle and body size were covariates. Results: Total testosterone levels were unrelated to age or duration of sleep. Men with lower testosterone levels had lower sleep efficiency, with increased nocturnal awakenings and less time in slow-wave sleep as well as a higher apnea-hypopnea index and more sleep time with O2 saturation levels below 90%. Low testosterone levels were associated with overweight, and all significant associations were attenuated or absent after adjusting for body mass index or waist circumference. In a post hoc analysis in men with higher body mass index (>27 kg/m2), testosterone was significantly associated with more periods awake after sleep onset and lower sleep efficiency. Conclusion: Low total testosterone levels are associated with less healthy sleep in older men. This association is largely explained by adiposity. Clinical trials are necessary to determine whether body weight acts directly or indirectly (via low testosterone) in the causal pathway for sleep-disordered breathing in older men.
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A consistent relationship between sleep duration and testosterone has not been apparent in large cross-sectional studies of healthy community-dwelling older and young and older men.
“A consistent relationship between sleep duration and testosterone has not been apparent in large cross-sectional studies of healthy community-dwelling older [37, 38] and young and older [39] men when divided according to studies that objectively measured sleep by actigraphy (a method to infer sleep from wrist-worn devices that detect motion) or polysomnography [37] from those obtained by self-”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [37]
The Discussion (p. 5) reports no significant association between sleep duration and testosterone in older community-dwelling men, supporting the finding attributed to this source. But the study is described as cross-sectional in the citing sentence, whereas the study description (p. 1) says testosterone was measured at baseline and sleep was measured 3.4 years later. The claim about younger men is attached to a different citation. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn older men, higher degrees of hypoxemia, as a marker of more severe OSA, are associated with lower testosterone concentrations.
“higher degrees of hypoxemia, as a marker of more severe OSA, are associated with lower testosterone concentrations [37, 104–106].”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [37]
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“A consistent relationship between sleep duration and testosterone has not been apparent in large cross-sectional studies of healthy community-dwelling older [37, 38] and young and older [39] men when divided according to studies that objectively measured sleep by actigraphy (a method to infer sleep from wrist-worn dev…”
BackgroundMethodThe relationship between sleep disorders and testosterone
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- Authors
- Barrett-Connor, E., Dam, T.-T., Stone, K., Harrison, S. L., Redline, S., Orwoll, E., & for the Osteoporotic Fractures in Men Study Group
- Affiliations
- University of California San Diego (US)
- California Pacific Medical Center (US)
- Case Western Reserve University (US)
- Oregon Health & Science University (US)
- Corresponding author
- Barrett-Connor, Elizabeth
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-07-01
- Volume
- 93
- Issue
- 7
- Pages
- 2602-2609
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC2453053
- OpenAlex
- W2160063534
- Cited by
- 158
- References
- 37
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 13 · 2023: 10 · 2022: 9 · 2021: 11 · 2020: 8 · 2019: 12 · 2018: 9 · 2017: 11 · 2016: 11 · 2015: 9 · 2014: 8 · 2013: 9 · 2012: 5
- FWCI
- 3.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (U01-AG-18197, U01AG018197, U01AG027810)
- National Heart, Lung, and Blood Institute (R01HL070847, R01HL070839, R01HL070838, R01HL070841, R01HL070848, R01HL071194, R01HL070837, R01HL070842)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR45614, U01-AR45632, U01 AR45647, U01AR045583, U01 AR-45583, U01-AR-45654, U01AR045580, U01AR045632, U01AR045654, U01AR045614, U01AR045647, U01AR45580)
- National Center for Research Resources (UL1RR024140)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- testosterone, sleep quality, sleep architecture, sleep-disordered breathing, sleep apnea, older men, sleep efficiency, slow-wave sleep, nocturnal awakenings, adiposity, body mass index, hypogonadism, actigraphy, polysomnography
- MeSH terms
- Aged, Humans, Male, Respiration, Sleep, Testosterone, Cohort Studies, Body Mass Index
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