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

Liu, Peter Y

doi:10.1210/jc.2019-00683

Cited by 55Sleep and related disordersHormonal and reproductive studiesCircadian rhythm and melatonin

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

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Liu, Peter Y·2019·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2019-00683PMC PMC6735730

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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.

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Sleep debt accumulates throughout life from repetitive episodes of insufficient sleep, misaligned sleep, and disrupted sleep.
“Sleep debt accumulates throughout life from repetitive episodes of insufficient sleep (not sleeping for an adequate amount of time), misaligned sleep (as occurs with jetlag or night shiftwork), and disrupted sleep (from obstructive sleep apnea, nocturia associated with ageing or sporadic environmental noise) [4].”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [4]
The Sleep Physiology section identifies insufficient, misaligned, and disrupted sleep as forms of abnormal sleep. The sections on circadian misalignment and disrupted sleep also name jet lag, shift work, obstructive sleep apnea, nocturia, and environmental noise as examples or causes. Our copy does not say that these episodes cause sleep debt to accumulate throughout life. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Sleep restriction imbalances both testosterone and cortisol signaling.
“This is because the hypothalamo-pituitary testicular and hypothalamo-pituitary adrenal axes that respectively control testosterone, the major anabolic hormone in men (but not women) and cortisol, a key catabolic signal, are intertwined in their regulation and sleep restriction imbalances both their signaling [4].”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [4]
The 'Sleep duration and testosterone' section says that experimentally restricting sleep in men generally reduces blood testosterone concentrations. The 'Circadian physiology relevant to endocrinologists' section describes interactions between the testosterone and cortisol axes, but does not say that sleep restriction disrupts cortisol signaling. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Stage 3 NREM sleep mostly occurs during the first half of the biological night and is the stage of sleep that is most metabolically and hormonally active.
“Stage 3 NREM sleep, also named slow wave sleep (SWS), mostly occurs during the first half of the biological night and is the stage of sleep that is most metabolically and hormonally active [4].”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [4]
The hypothalamo-pituitary testicular and hypothalamo-pituitary adrenal axes are intertwined in their regulation.
“This is because the hypothalamo-pituitary testicular and hypothalamo-pituitary adrenal axes that respectively control testosterone, the major anabolic hormone in men (but not women) and cortisol, a key catabolic signal, are intertwined in their regulation and sleep restriction imbalances both their signaling [4].”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [4]
Circadian misalignment induces insulin resistance.
“Circadian misalignment is harmful. It induces insulin resistance”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [4]

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Sleep disturbances and semen quality in an Italian cross sectional study
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Effects of Surgical vs. Nonsurgical Therapy on Erectile Dysfunction and Quality of Life in Obstructive Sleep Apnea Syndrome: A Pilot Study
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Timing Modulates the Effect of Sleep Loss on Glucose Homeostasis
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Influence of Nocturnal Oxygen Desaturation on Circadian Rhythm of Testosterone Secretion
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The impact of long-term conventional treatment for overlap syndrome (obstructive sleep apnea and chronic obstructive pulmonary disease) on concurrent erectile dysfunction
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Sleep duration is associated with sperm chromatin integrity among young men in Chongqing, China
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CPAP therapy improves erectile function in patients with severe obstructive sleep apnea
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Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study
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Junior doctors and the full shift rota – psychological and hormonal changes: a comparative cross-sectional study
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Serum urate levels are unchanged with continuous positive airway pressure therapy for obstructive sleep apnea: a randomized controlled trial
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Sleep Duration Is Associated With Testis Size in Healthy Young Men
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[2]2. McMenamin TM. A time to work: recent trends in shift work and flexible schedules. Mon Labor Rev. 2007;130:3-15.

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“This is because the hypothalamo-pituitary testicular and hypothalamo-pituitary adrenal axes that respectively control testosterone, the major anabolic hormone in men (but not women) and cortisol, a key catabolic signal, are intertwined in their regulation and sleep restriction imbalances both their signaling [4].”
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Clamping Cortisol and Testosterone Mitigates the Development of Insulin Resistance during Sleep Restriction in Men
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Pharmacokinetics of testosterone therapies in relation to diurnal variation of serum testosterone levels as men age
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Daytime Napping Duration Is Positively Associated With Risk of Hyperuricemia in a Chinese Population
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Authors: Liu, P. Y.
Affiliations: University of California, Los Angeles (US)
Corresponding author: Liu, Peter Y
ORCID: Liu, Peter Y
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2019-05-01
Volume: 104
Issue: 10
Pages: 4398-4417
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2019-00683
PMC: PMC6735730
OpenAlex: W2942504831
Semantic Scholar: 007f0b0d8ad54b44352e33319912a9b77d6f9d53
Cited by: 55
References: 193
Citations by year: 2026: 8 · 2025: 6 · 2024: 1 · 2023: 9 · 2022: 13 · 2021: 12 · 2020: 4 · 2019: 1 · 2018: 1
FWCI: 1.11
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Heart, Lung, and Blood Institute (K24HL138632, R01HL124211)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords: sleep, circadian misalignment, sleep deprivation, erectile dysfunction, hypogonadism, testosterone, infertility, sperm count, obstructive sleep apnea, continuous positive airway pressure, sleep-disordered breathing, cardiometabolic health, insulin resistance, hypertension, sleep extension
MeSH terms: Age Factors, Androgens, Humans, Hypertension, Hypogonadism, Erectile Dysfunction, Male, Prognosis, Quality of Life, Sleep, Sleep Wake Disorders, Prevalence, Risk Assessment, Sleep Apnea, Obstructive, Hormone Replacement Therapy, Continuous Positive Airway Pressure

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