title: Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study.
abstract: BACKGROUND
  The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients.
  
  
  OBJECTIVE
  The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C).
  
  
  METHODS
  Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities.
  
  
  CONCLUSIONS
  The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.
authors.affiliation: University of Medicine and Pharmacy Grigore T. Popa, Department of Pharmacology, Iasi, Romania.
authors.forename: Cristina Mihaela
authors.initials: CM
authors.lastname: Ghiciuc
authors.affiliation: University of Medicine and Pharmacy Grigore T. Popa, School of Medicine, Department of Internal Medicine, Iasi, Romania.
authors.forename: Lucia Corina
authors.initials: LC
authors.lastname: Dima-Cozma
authors.affiliation: University of Medicine and Pharmacy Grigore T. Popa, Clinic of Pulmonary Diseases, Iasi, Romania.
authors.forename: Raluca Mihaela
authors.initials: RM
authors.lastname: Bercea
authors.affiliation: University of Medicine and Pharmacy Grigore T. Popa, Department of Pharmacology, Iasi, Romania.
authors.forename: Catalina Elena
authors.initials: CE
authors.lastname: Lupusoru
authors.affiliation: University of Medicine and Pharmacy Grigore T. Popa, Clinic of Pulmonary Diseases, Iasi, Romania.
authors.forename: Traian
authors.initials: T
authors.lastname: Mihaescu
authors.affiliation: University of Medicine and Pharmacy Grigore T. Popa, Department of Otorhinolaryngology, Iasi, Romania.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Cozma
authors.affiliation: Sapienza University of Rome, Department of Physiology and Pharmacology "V. Erspamer", Rome, Italy. Electronic address: francesca.patacchioli@uniroma1.it.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Patacchioli
mesh_terms: D000328:Adult; D001007:Anxiety / Q000378:metabolism / Q000503:physiopathology; D016022:Case-Control Studies; D002940:Circadian Rhythm; D003863:Depression / Q000378:metabolism / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology; D017286:Polysomnography; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000378:metabolism* / Q000503:physiopathology; D013739:Testosterone / Q000378:metabolism*
chemical_list: D013739:Testosterone; D006854:Hydrocortisone
keywords: Apneia obstrutiva do sono; Cortisol; Obstructive sleep apnea; Saliva; Testosterona; Testosterone