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Yeap BB, Marriott RJ, Dwivedi G, Adams RJ, Antonio L, Ballantyne CM, Bauer DC, Bhasin S, Biggs ML, Cawthon PM, Couper DJ, Dobs AS, Flicker L, Handelsman DJ, Hankey GJ, Hannemann A, Haring R, Hsu B, Martin SA, Matsumoto AM, Mellström D, Ohlsson C, O'Neill TW, Orwoll ES, Quartagno M, Shores MM, Steveling A, Tivesten Å, Travison TG, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men : Individual Participant Data Meta-analyses. Ann Intern Med 2024. [PMID: 38739921 DOI: 10.7326/m23-2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Whether circulating sex hormones modulate mortality and cardiovascular disease (CVD) risk in aging men is controversial. PURPOSE To clarify associations of sex hormones with these outcomes. DATA SOURCES Systematic literature review to July 2019, with bridge searches to March 2024. STUDY SELECTION Prospective cohort studies of community-dwelling men with sex steroids measured using mass spectrometry and at least 5 years of follow-up. DATA EXTRACTION Independent variables were testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone (DHT), and estradiol concentrations. Primary outcomes were all-cause mortality, CVD death, and incident CVD events. Covariates included age, body mass index, marital status, alcohol consumption, smoking, physical activity, hypertension, diabetes, creatinine concentration, ratio of total to high-density lipoprotein cholesterol, and lipid medication use. DATA SYNTHESIS Nine studies provided individual participant data (IPD) (255 830 participant-years). Eleven studies provided summary estimates (n = 24 109). Two-stage random-effects IPD meta-analyses found that men with baseline testosterone concentrations below 7.4 nmol/L (<213 ng/dL), LH concentrations above 10 IU/L, or estradiol concentrations below 5.1 pmol/L had higher all-cause mortality, and those with testosterone concentrations below 5.3 nmol/L (<153 ng/dL) had higher CVD mortality risk. Lower SHBG concentration was associated with lower all-cause mortality (median for quintile 1 [Q1] vs. Q5, 20.6 vs. 68.3 nmol/L; adjusted hazard ratio [HR], 0.85 [95% CI, 0.77 to 0.95]) and lower CVD mortality (adjusted HR, 0.81 [CI, 0.65 to 1.00]). Men with lower baseline DHT concentrations had higher risk for all-cause mortality (median for Q1 vs. Q5, 0.69 vs. 2.45 nmol/L; adjusted HR, 1.19 [CI, 1.08 to 1.30]) and CVD mortality (adjusted HR, 1.29 [CI, 1.03 to 1.61]), and risk also increased with DHT concentrations above 2.45 nmol/L. Men with DHT concentrations below 0.59 nmol/L had increased risk for incident CVD events. LIMITATIONS Observational study design, heterogeneity among studies, and imputation of missing data. CONCLUSION Men with low testosterone, high LH, or very low estradiol concentrations had increased all-cause mortality. SHBG concentration was positively associated and DHT concentration was nonlinearly associated with all-cause and CVD mortality. PRIMARY FUNDING SOURCE Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).
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Affiliation(s)
- Bu B Yeap
- Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia (B.B.Y.)
| | - Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Girish Dwivedi
- Medical School, University of Western Australia; Harry Perkins Institute of Medical Research; and Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia (G.D.)
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia (R.J.A.)
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (L.A., D.V.)
| | | | - Douglas C Bauer
- General Internal Medicine, University of California, San Francisco, San Francisco, California (D.C.B.)
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.B.)
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (M.L.B.)
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California (P.M.C.)
| | - David J Couper
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (D.J.C.)
| | - Adrian S Dobs
- School of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, Maryland (A.S.D.)
| | - Leon Flicker
- Medical School, University of Western Australia, and Western Australian Centre for Healthy Ageing, University of Western Australia, Perth, Western Australia, Australia (L.F.)
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia (D.J.H.)
| | - Graeme J Hankey
- Medical School, University of Western Australia, and Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia (G.J.H.)
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, and German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany (A.H.)
| | - Robin Haring
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany (R.H.)
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia (B.H.)
| | - Sean A Martin
- Australian Institute of Family Studies, Southbank, Victoria, Australia (S.A.M.)
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington (A.M.M.)
| | - Dan Mellström
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden (D.M., C.O.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden (D.M., C.O.)
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom (T.W.O.)
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon (E.S.O.)
| | - Matteo Quartagno
- MRC Clinical Trials Unit, University College London, London, United Kingdom (M.Q.)
| | - Molly M Shores
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington (M.M.S.)
| | - Antje Steveling
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany (A.S.)
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (Å.T.)
| | - Thomas G Travison
- Brigham and Women's Hospital, Harvard Medical School, and Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, Massachusetts (T.G.T.)
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium (L.A., D.V.)
| | - Gary A Wittert
- Freemasons Centre for Men's Health and Wellbeing, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia (G.A.W.)
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom (F.C.W.W.)
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
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Parker JL, Vakulin A, Naik G, Melaku YA, Stevens D, Wittert GA, Martin SA, Catcheside PG, Toson B, Appleton SL, Adams RJ. Associations of baseline obstructive sleep apnea and sleep macroarchitecture with cognitive function after 8 years in middle-aged and older men from a community-based cohort study. J Sleep Res 2024; 33:e14078. [PMID: 37859564 DOI: 10.1111/jsr.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Previous prospective studies examining associations of obstructive sleep apnea and sleep macroarchitecture with future cognitive function recruited older participants, many demonstrating baseline cognitive impairment. This study examined obstructive sleep apnea and sleep macroarchitecture predictors of visual attention, processing speed, and executive function after 8 years among younger community-dwelling men. Florey Adelaide Male Ageing Study participants (n = 477) underwent home-based polysomnography, with 157 completing Trail-Making Tests A and B and the Mini-Mental State Examination. Associations of obstructive sleep apnea (apnea-hypopnea index, oxygen desaturation index, and hypoxic burden index) and sleep macroarchitecture (sleep stage percentages and total sleep time) parameters with future cognitive function were examined using regression models adjusted for baseline demographic, biomedical, and behavioural factors, and cognitive task performance. The mean (standard deviation) age of the men at baseline was 58.9 (8.9) years, with severe obstructive sleep apnea (apnea-hypopnea index ≥30 events/h) in 9.6%. The median (interquartile range) follow-up was 8.3 (7.9-8.6) years. A minority of men (14.6%) were cognitively impaired at baseline (Mini-Mental State Examination score <28/30). A higher percentage of light sleep was associated with better Trail-Making Test A performance (B = -0.04, 95% confidence interval [CI] -0.06, -0.01; p = 0.003), whereas higher mean oxygen saturation was associated with worse performance (B = 0.11, 95% CI 0.02, 0.19; p = 0.012). While obstructive sleep apnea and sleep macroarchitecture might predict cognitive decline, future studies should consider arousal events and non-routine hypoxaemia measures, which may show associations with cognitive decline.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ganesh Naik
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - David Stevens
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Australian Institute of Family Studies, Melbourne, Victoria, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Barbara Toson
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Marriott RJ, Murray K, Adams RJ, Antonio L, Ballantyne CM, Bauer DC, Bhasin S, Biggs ML, Cawthon PM, Couper DJ, Dobs AS, Flicker L, Handelsman DJ, Hankey GJ, Hannemann A, Haring R, Hsu B, Karlsson M, Martin SA, Matsumoto AM, Mellström D, Ohlsson C, O'Neill TW, Orwoll ES, Quartagno M, Shores MM, Steveling A, Tivesten Å, Travison TG, Vanderschueren D, Wittert GA, Wu FCW, Yeap BB. Factors Associated With Circulating Sex Hormones in Men : Individual Participant Data Meta-analyses. Ann Intern Med 2023; 176:1221-1234. [PMID: 37639720 PMCID: PMC10995451 DOI: 10.7326/m23-0342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Various factors modulate circulating testosterone in men, affecting interpretation of testosterone measurements. PURPOSE To clarify factors associated with variations in sex hormone concentrations. DATA SOURCES Systematic literature searches (to July 2019). STUDY SELECTION Prospective cohort studies of community-dwelling men with total testosterone measured using mass spectrometry. DATA EXTRACTION Individual participant data (IPD) (9 studies; n = 21 074) and aggregate data (2 studies; n = 4075). Sociodemographic, lifestyle, and health factors and concentrations of total testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), dihydrotestosterone, and estradiol were extracted. DATA SYNTHESIS Two-stage random-effects IPD meta-analyses found a nonlinear association of testosterone with age, with negligible change among men aged 17 to 70 years (change per SD increase about the midpoint, -0.27 nmol/L [-7.8 ng/dL] [CI, -0.71 to 0.18 nmol/L {-20.5 to 5.2 ng/dL}]) and decreasing testosterone levels with age for men older than 70 years (-1.55 nmol/L [-44.7 ng/dL] [CI, -2.05 to -1.06 nmol/L {-59.1 to -30.6 ng/dL}]). Testosterone was inversely associated with body mass index (BMI) (change per SD increase, -2.42 nmol/L [-69.7 ng/dL] [CI, -2.70 to -2.13 nmol/L {-77.8 to -61.4 ng/dL}]). Testosterone concentrations were lower for men who were married (mean difference, -0.57 nmol/L [-16.4 ng/dL] [CI, -0.89 to -0.26 nmol/L {-25.6 to -7.5 ng/dL}]); undertook at most 75 minutes of vigorous physical activity per week (-0.51 nmol/L [-14.7 ng/dL] [CI, -0.90 to -0.13 nmol/L {-25.9 to -3.7 ng/dL}]); were former smokers (-0.34 nmol/L [-9.8 ng/dL] [CI, -0.55 to -0.12 nmol/L {-15.9 to -3.5 ng/dL}]); or had hypertension (-0.53 nmol/L [-15.3 ng/dL] [CI, -0.82 to -0.24 nmol/L {-23.6 to -6.9 ng/dL}]), cardiovascular disease (-0.35 nmol/L [-10.1 ng/dL] [CI, -0.55 to -0.15 nmol/L {-15.9 to -4.3 ng/dL}]), cancer (-1.39 nmol/L [-40.1 ng/dL] [CI, -1.79 to -0.99 nmol/L {-51.6 to -28.5 ng/dL}]), or diabetes (-1.43 nmol/L [-41.2 ng/dL] [CI, -1.65 to -1.22 nmol/L {-47.6 to -35.2 ng/dL}]). Sex hormone-binding globulin was directly associated with age and inversely associated with BMI. Luteinizing hormone was directly associated with age in men older than 70 years. LIMITATION Cross-sectional analysis, heterogeneity between studies and in timing of blood sampling, and imputation for missing data. CONCLUSION Multiple factors are associated with variation in male testosterone, SHBG, and LH concentrations. Reduced testosterone and increased LH concentrations may indicate impaired testicular function after age 70 years. Interpretation of individual testosterone measurements should account particularly for age older than 70 years, obesity, diabetes, and cancer. PRIMARY FUNDING SOURCE Medical Research Future Fund, Government of Western Australia, and Lawley Pharmaceuticals. (PROSPERO: CRD42019139668).
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Affiliation(s)
- Ross J Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia (R.J.M., K.M.)
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia (R.J.A.)
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (L.A., D.V.)
| | | | - Douglas C Bauer
- General Internal Medicine, University of California, San Francisco, San Francisco, California (D.C.B.)
| | - Shalender Bhasin
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.B.)
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (M.L.B.)
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California (P.M.C.)
| | - David J Couper
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (D.J.C.)
| | - Adrian S Dobs
- School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland (A.S.D.)
| | - Leon Flicker
- Medical School and Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia (L.F.)
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia (D.J.H.)
| | - Graeme J Hankey
- Medical School, University of Western Australia, and Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia (G.J.H.)
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, and DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany (A.H.)
| | - Robin Haring
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and Faculty of Applied Public Health, European University of Applied Sciences, Rostock, Germany (R.H.)
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia (B.H.)
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden (M.K.)
| | - Sean A Martin
- Australian Institute of Family Studies, Southbank, Victoria, Australia (S.A.M.)
| | - Alvin M Matsumoto
- Department of Medicine, University of Washington School of Medicine, and Geriatric Research Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington (A.M.M.)
| | - Dan Mellström
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Göteborg, Sweden (D.M., C.O.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Göteborg, Sweden (D.M., C.O.)
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester and National Institute for Health and Care Research Manchester Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom (T.W.O.)
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon (E.S.O.)
| | - Matteo Quartagno
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom (M.Q.)
| | - Molly M Shores
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington (M.M.S.)
| | - Antje Steveling
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany (A.S.)
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, Göteborg, Sweden (Å.T.)
| | - Thomas G Travison
- Brigham and Women's Hospital and Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (T.G.T.)
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (L.A., D.V.)
| | - Gary A Wittert
- Freemasons Centre for Male Health & Wellbeing, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia (G.A.W.)
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom (F.C.W.W.)
| | - Bu B Yeap
- Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Perth, Australia (B.B.Y.)
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Parker JL, Vakulin A, Melaku YA, Wittert GA, Martin SA, D’Rozario AL, Catcheside PG, Lechat B, Toson B, Teare AJ, Appleton SL, Adams RJ. Associations of Baseline Sleep Microarchitecture with Cognitive Function After 8 Years in Middle-Aged and Older Men from a Community-Based Cohort Study. Nat Sci Sleep 2023; 15:389-406. [PMID: 37252206 PMCID: PMC10225127 DOI: 10.2147/nss.s401655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Prospective studies examining associations between baseline sleep microarchitecture and future cognitive function recruited from small samples with predominantly short follow-up. This study examined sleep microarchitecture predictors of cognitive function (visual attention, processing speed, and executive function) after 8 years in community-dwelling men. Patients and Methods Florey Adelaide Male Ageing Study participants (n=477) underwent home-based polysomnography (2010-2011), with 157 completing baseline (2007-2010) and follow-up (2018-2019) cognitive assessments (trail-making tests A [TMT-A] and B [TMT-B] and the standardized mini-mental state examination [SMMSE]). Whole-night F4-M1 sleep EEG recordings were processed following artifact exclusion, and quantitative EEG characteristics were obtained using validated algorithms. Associations between baseline sleep microarchitecture and future cognitive function (visual attention, processing speed, and executive function) were examined using linear regression models adjusted for baseline obstructive sleep apnoea, other risk factors, and cognition. Results The final sample included men aged (mean [SD]) 58.9 (8.9) years at baseline, overweight (BMI 28.5 [4.2] kg/m2), and well educated (75.2% ≥Bachelor, Certificate, or Trade), with majorly normal baseline cognition. Median (IQR) follow-up was 8.3 (7.9, 8.6) years. In adjusted analyses, NREM and REM sleep EEG spectral power was not associated with TMT-A, TMT-B, or SMMSE performance (all p>0.05). A significant association of higher N3 sleep fast spindle density with worse TMT-B performance (B=1.06, 95% CI [0.13, 2.00], p=0.026) did not persist following adjustment for baseline TMT-B performance. Conclusion In this sample of community-dwelling men, sleep microarchitecture was not independently associated with visual attention, processing speed, or executive function after 8 years.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Angela L D’Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Alison J Teare
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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Laslett LL, Honan C, Turner JA, Dagnew B, Campbell JA, Gill TK, Appleton S, Blizzard L, Taylor BV, van der Mei I. Poor sleep and multiple sclerosis: associations with symptoms of multiple sclerosis and quality of life. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329227. [PMID: 35896381 DOI: 10.1136/jnnp-2022-329227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/07/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sleep difficulties are common in people with multiple sclerosis (MS), but whether associations between poor sleep quality and quality of life are independent of MS symptoms, obesity and other MS-related factors remains unclear. METHODS Cross-sectional analyses of data from the Australian MS Longitudinal Study (n=1717). Sleep was assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and International Restless Legs Syndrome Study Group Rating Scale; health-related quality of life using the Assessment of Quality-of-Life 8-D. RESULTS Poor sleep quality was common (67%), and more common than in community samples. Sleep measures clustered independently within MS symptoms. The clusters 'fatigue and cognitive', 'feelings of anxiety and depression', 'pain and sensory', were independently associated with poor sleep quality. Quality-of-Life utility scores were a clinically meaningful 0.19 units lower in those with poor sleep. Sleep quality, daytime sleepiness and restless leg syndrome were associated with reduced quality of life, independent of MS-related symptoms and body mass index. CONCLUSION Poor sleep quality is common in MS and was strongly associated with worse health-related quality of life, independent of other MS symptoms and did not cluster with other common MS symptoms. Improving sleep quality may substantially improve quality of life in people with MS.
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Affiliation(s)
- Laura L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Cynthia Honan
- School of Psychological Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Jason A Turner
- School of Psychological Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Baye Dagnew
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah Appleton
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, South Australia, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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6
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Lechat B, Hirotsu C, Appleton S, Younes M, Adams RJ, Vakulin A, Hansen K, Zajamsek B, Wittert G, Catcheside P, Heinzer R, Eckert DJ. A novel EEG marker predicts perceived sleepiness and poor sleep quality. Sleep 2022; 45:zsac051. [PMID: 35554584 DOI: 10.1093/sleep/zsac051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/16/2022] [Indexed: 09/21/2023] Open
Abstract
STUDY OBJECTIVES To determine if a novel EEG-derived continuous index of sleep depth/alertness, the odds ratio product (ORP), predicts self-reported daytime sleepiness and poor sleep quality in two large population-based cohorts. METHODS ORP values which range from 0 (deep sleep) to 2.5 (fully alert) were calculated in 3s intervals during awake periods (ORPwake) and NREM sleep (ORPNREM) determined from home sleep studies in the HypnoLaus (N = 2162: 1106 females, 1056 males) and men androgen inflammation lifestyle environment and stress (MAILES) cohorts (N = 754 males). Logistic regression was used to examine associations between ORPwake, ORPNREM, and traditional polysomnography measures (as comparators) with excessive sleepiness (Epworth sleepiness scale >10) and poor sleep quality (Pittsburgh sleep quality index >5) and insomnia symptoms. RESULTS High ORPwake was associated with a ~30% increase in poor sleep quality in both HypnoLaus (odds ratio, OR, and 95% CI) 1.28 (1.09, 1.51), and MAILES 1.36 (1.10, 1.68). High ORPwake was also associated with a ~28% decrease in excessive daytime sleepiness in the MAILES dataset. ORPNREM was associated with a ~30% increase in poor sleep quality in HypnoLaus but not in MAILES. No consistent associations across cohorts were detected using traditional polysomnography markers. CONCLUSIONS ORP, a novel EEG-derived metric, measured during wake periods predicts poor sleep quality in two independent cohorts. Consistent with insomnia symptomatology of poor perceived sleep in the absence of excessive daytime sleepiness, ORPwake may provide valuable objective mechanistic insight into physiological hyperarousal.
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Affiliation(s)
- Bastien Lechat
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Appleton
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, MN, Canada
| | - Robert J Adams
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Kristy Hansen
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Branko Zajamsek
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Gary Wittert
- Freemasons Centre for Male Health and Wellness, Adelaide University, Adelaide, SA, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Danny J Eckert
- Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, College of Medicine and Public Health Adelaide, SA, Australia
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7
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Parker JL, Appleton SL, Melaku YA, D'Rozario AL, Wittert GA, Martin SA, Toson B, Catcheside PG, Lechat B, Teare AJ, Adams RJ, Vakulin A. The association between sleep microarchitecture and cognitive function in middle-aged and older men: a community-based cohort study. J Clin Sleep Med 2022; 18:1593-1608. [PMID: 35171095 DOI: 10.5664/jcsm.9934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep microarchitecture parameters determined by quantitative power spectral analysis (PSA) of electroencephalograms (EEGs) have been proposed as potential brain-specific markers of cognitive dysfunction. However, data from community samples remains limited. This study examined cross-sectional associations between sleep microarchitecture and cognitive dysfunction in community-dwelling men. METHODS Florey Adelaide Male Ageing Study participants (n=477) underwent home-based polysomnography (PSG) (2010-2011). All-night EEG recordings were processed using PSA following artefact exclusion. Cognitive testing (2007-2010) included the inspection time task, trail-making tests A (TMT-A) and B (TMT-B), and Fuld object memory evaluation. Complete case cognition, PSG, and covariate data were available in 366 men. Multivariable linear regression models controlling for demographic, biomedical, and behavioral confounders determined cross-sectional associations between sleep microarchitecture and cognitive dysfunction overall and by age-stratified subgroups. RESULTS In the overall sample, worse TMT-A performance was associated with higher NREM theta and REM theta and alpha but lower delta power (all p<0.05). In men ≥65 years, worse TMT-A performance was associated with lower NREM delta but higher NREM and REM theta and alpha power (all p<0.05). Furthermore, in men ≥65 years, worse TMT-B performance was associated with lower REM delta but higher theta and alpha power (all p<0.05). CONCLUSIONS Sleep microarchitecture parameters may represent important brain-specific markers of cognitive dysfunction, particularly in older community-dwelling men. Therefore, this study extends the emerging community-based cohort literature on a potentially important link between sleep microarchitecture and cognitive dysfunction. Utility of sleep microarchitecture for predicting prospective cognitive dysfunction and decline warrants further investigation.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Gary A Wittert
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Alison J Teare
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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8
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Parker JL, Melaku YA, D'Rozario AL, Wittert GA, Martin SA, Catcheside PG, Lechat B, Teare AJ, Adams RJ, Appleton SL, Vakulin A. The association between obstructive sleep apnea and sleep spindles in middle-aged and older men: A community-based cohort study. Sleep 2021; 45:6446158. [PMID: 34850237 DOI: 10.1093/sleep/zsab282] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/01/2021] [Indexed: 01/25/2023] Open
Abstract
STUDY OBJECTIVES Sleep spindles show morphological changes in obstructive sleep apnea (OSA). However, previous small studies have limited generalisability, leaving associations between OSA severity measures and spindle metrics uncertain. This study examined cross-sectional associations between OSA severity measures and spindle metrics among a large population-based sample of men. METHODS Community-dwelling men with no previous OSA diagnosis underwent home-based polysomnography. All-night EEG (F4-M1) recordings were processed for artefacts and spindle events identified using previously validated algorithms. Spindle metrics of interest included frequency (Hz), amplitude (µV 2), overall density (11-16 Hz), slow density (11-13 Hz), and fast density (13-16 Hz) (number/minute). Multivariable linear regression models controlling for demographic, biomedical, and behavioural confounders were used to examine cross-sectional associations between OSA severity measures and spindle metrics. RESULTS In adjusted analyses, higher apnea-hypopnea index (AHI/h, as a continuous variable) and percentage total sleep time with oxygen saturation <90% (TST90) were associated with decreased slow spindle density (AHI, B= -0.003, p=0.032; TST90, B= -0.004, p=0.047) but increased frequency (AHI, B=0.002, p=0.009; TST90, B=0.002, p=0.043). Higher TST90 was also associated with greater spindle amplitude (N2 sleep, B=0.04, p=0.011; N3 sleep, B=0.11, p<0.001). Furthermore, higher arousal index was associated with greater spindle amplitude during N2 sleep (B=0.31, p<0.001) but decreased overall density (B= -1.27, p=0.030) and fast density (B= -4.36, p=0.028) during N3 sleep. CONCLUSIONS Among this large population-based sample of men, OSA severity measures were independently associated with spindle abnormalities. Further population studies are needed to determine associations between spindle metrics and functional outcomes.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Alison J Teare
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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9
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Marriott RJ, Harse J, Murray K, Yeap BB. Systematic review and meta-analyses on associations of endogenous testosterone concentration with health outcomes in community-dwelling men. BMJ Open 2021; 11:e048013. [PMID: 34728442 PMCID: PMC8565564 DOI: 10.1136/bmjopen-2020-048013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The overall study aim is to clarify the relation of endogenous sex hormones with major health outcomes in men. This paper reports a systematic review focusing on published estimates for testosterone associations. SETTING Community-dwelling men. PARTICIPANTS 20 180 adult men participated in the final set of studies identified and selected from a systematic review. Eligible studies included prospective cohort studies with plasma or serum testosterone concentrations measured for adult men using mass spectrometry with at least 5 years of follow-up data and one of the specified outcome measures recorded. Only published or grey literature items written in English were considered. PRIMARY AND SECONDARY OUTCOME MEASURES Planned prospective outcome measures: cardiovascular disease (CVD) events, CVD deaths, all-cause mortality, cancer deaths, cancer diagnoses, cognitive decline, dementia. Meta-analyses were of the most frequently reported outcomes in selected studies: CVD deaths and all-cause mortality. Succinct characterisations of testosterone associations with other outcomes are also presented. RESULTS Screening of 1994 deduplicated items identified 9 suitable studies, with an additional 2 identified by colleagues (11 in total). Summary estimates of mean testosterone concentration and age at recruitment for 20 180 adult men were 15.4±0.7 nmol/L and 64.9±3.3 year. Despite considerable variation in mean testosterone, a metaregression estimated no significant dependence on mean age at recruitment among studies (slope=-0.03, 95% CI -0.11 to 0.06). Meta-analyses demonstrated negligible heterogeneity and no significant effect of a 5 nmol/L increase in testosterone on the risk of all-cause mortality (HR=0.96, 95% CI 0.89 to 1.03) or death from CVD (HR=0.95, 95% CI 0.83 to 1.08). CONCLUSIONS Analyses of published estimates did not demonstrate associations of endogenous testosterone with CVD deaths or with all-cause mortality. Suggested further research includes the planned individual participant data meta-analyses for selected studies, enabling the investigation of non-linear summary effects. PROSPERO REGISTRATION NUMBER PROSPERO: CRD42019139668.
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Affiliation(s)
- Ross James Marriott
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Janis Harse
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Bu Beng Yeap
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
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10
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Ng SK, Martin SA, Adams RJ, O'Loughlin P, Wittert GA. The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study. Am J Mens Health 2021; 14:1557988320959993. [PMID: 33063608 PMCID: PMC7873770 DOI: 10.1177/1557988320959993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.
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Affiliation(s)
- Shu-Kay Ng
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia
| | - Peter O'Loughlin
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia.,Chemical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, SA, Australia
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11
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Salaffi F, Di Carlo M, Carotti M, Farah S, Giovagnoni A. Frailty prevalence according to the Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) definition, and its variables associated, in patients with symptomatic knee osteoarthritis: findings from a cross-sectional study. Aging Clin Exp Res 2021; 33:1519-1527. [PMID: 32734577 PMCID: PMC8203526 DOI: 10.1007/s40520-020-01667-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 12/30/2022]
Abstract
Background Frailty is a frequent condition in patients with knee osteoarthritis (KOA). However, there are different constructs on how to define it. Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) is one of them. Aim To assess the prevalence of frailty, according to the SHARE-FI definition in patients with symptomatic KOA, and to establish its associated factors. Methods Symptomatic KOA patients were evaluated for pain symptoms, quality of life, comorbidities, ongoing drug therapy, and radiological damage. Patients were categorised according to the SHARE-FI definition into frail, pre-frail, and non-frail, and compared to a group of healthy controls associated by age and gender. Results 170 symptomatic KOA patients (76.5% female, mean age 70.1 years) and 186 healthy controls were included. According to SHARE-FI criteria, 35 patients (20.6%) were categorised frail, 50 (29.4%) pre-frail, and 85 (50%) non-frail. The prevalence of frail or pre-frail subjects was statistically significantly higher in patients with symptomatic KOA. Stratifying the patients according to the frailty categories, frail subjects showed significantly higher mean values of pain. The results from logistic regression analysis revealed that polypharmacy (p = 0.003), pain (p = 0.016) and comorbidities (p = 0.035) were the variables independently associated with frailty in symptomatic KOA. Discussion Frailty or pre-frailty, defined by SHARE-FI, is common in symptomatic KOA. The main factors associated with frailty were polypharmacy, pain and comorbidity burden. Conclusions SHARE-FI can represent an useful tool to define frailty in symptomatic KOA.
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12
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Stevens D, Appleton S, Melaku Y, Martin S, Adams R, Wittert G. Participation in physical activity is associated with reduced nocturnal hypoxaemia in males. ERJ Open Res 2021; 7:00852-2020. [PMID: 34046492 PMCID: PMC8141832 DOI: 10.1183/23120541.00852-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/19/2021] [Indexed: 11/07/2022] Open
Abstract
Moderate to vigorous physical activity (MVPA) interventions reduce the severity of obstructive sleep apnoea (OSA); however, little epidemiological research exists to confirm these findings. 789 participants from the population-based Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent polysomnography. MVPA was assessed using the Active Australia questionnaire, which was completed when participants were first recruited to the MAILES study (2002–2006), and again in 2010. Multinomial logistic regressions established odds ratio between OSA severity categories with MVPA, whilst adjusted linear models determined associations between OSA metrics with MVPA. Cross-sectionally, each hour of MVPA was associated with reduced severity of mean oxygen desaturation (unstandardised β (B)=−0.002, p=0.043) and reduced time below 90% oxygen saturation (B=−0.03, p=0.034). Longitudinally, each hour increase in MVPA was associated with a 4% reduction in the odds of severe OSA and less severe mean oxygen desaturation (B=−0.003, p=0.014), time below 90% oxygen saturation (B=−0.02, p=0.02), and mean duration of apnoeas (B=−0.004, p=0.016). MVPA is associated with reduced hypoxaemia in a cohort of community dwelling males, approximately half of whom had untreated OSA. As nocturnal intermittent hypoxaemia is associated with cardiometabolic disorders, MVPA may offer protection for patients with OSA. This study provides epidemiological evidence that moderate to vigorous physical activity is associated with less severe OSA-induced hypoxaemia. This result suggests that MVPA should be actively implemented in treatment regimens for people with OSA.https://bit.ly/3a9asiZ
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Affiliation(s)
- David Stevens
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Centre for Nutritional and Gastrointestinal Diseases, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Sarah Appleton
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Yohannes Melaku
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Sean Martin
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Robert Adams
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA, Adelaide, Australia
| | - Gary Wittert
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Centre for Male Health and Health and Wellbeing, The University of Adelaide, and the South Australian Health and Medical Research Institute, SA, Australia
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13
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Buchanan CDC, Lust CAC, Burns JL, Hillyer LM, Martin SA, Wittert GA, Ma DWL. Analysis of major fatty acids from matched plasma and serum samples reveals highly comparable absolute and relative levels. Prostaglandins Leukot Essent Fatty Acids 2021; 168:102268. [PMID: 33831721 DOI: 10.1016/j.plefa.2021.102268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/19/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Measuring fatty acid (FA) levels in blood as a risk factor for chronic disease has been studied extensively. Previous research has used either plasma or serum samples to examine these associations. However, whether results from plasma and serum samples can be compared remains unclear, as differences in methodology related to the separation of plasma and serum from whole blood may impact FA levels. This study analyzed the individual FA content of matched plasma and serum samples in both absolute (μg/mL) and relative percent (%) composition. Analyses were performed using archived fasted morning samples from the Florey Adelaide Male Ageing Study (FAMAS). Matched plasma and serum samples were available from 98 male subjects aged 40-85. Total FA were analyzed by gas-liquid chromatography equipped with a flame ionization detector (GLC-FID). Analyses comprised of over 60 FA including major FA such as Palmitic Acid (PA), Palmitoleic acid (POA), Stearic Acid (SA), Oleic Acid (OA), Linoleic Acid (LNA), alpha-linolenic acid (ALA), Eicosapentaenoic acid (EPA), Arachidonic Acid (ARA), and Docosahexaenoic acid (DHA). Differences between groups was determined by t-test. Correlation and Bland-Altman analyses were also performed to examine the relationship between plasma and serum samples. There were no significant differences between major plasma and serum fatty acids expressed in μg/mL and relative % composition. Correlation analysis determined a strong and significantly positive association (r ≥ 0.65, p < 0.05) between major plasma and serum FA in absolute and relative terms. Bland-Altman analysis further supported the strong agreement between plasma and serum values in both absolute and relative terms. These findings demonstrate that studies reporting plasma or serum fatty acid analyzed by GLC-FID can be compared with one another.
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Affiliation(s)
- Connor D C Buchanan
- Department of Kinesiology, University of Guelph-Humber, Toronto, ON, M9W 5L7, Canada
| | - Cody A C Lust
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G2W1, Canada
| | - Jessie L Burns
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G2W1, Canada
| | - Lyn M Hillyer
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G2W1, Canada
| | - Sean A Martin
- Freemasons Centre for Male Health and Wellness, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellness, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - David W L Ma
- Department of Kinesiology, University of Guelph-Humber, Toronto, ON, M9W 5L7, Canada; Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G2W1, Canada.
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14
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Parker JL, Appleton SL, Melaku YA, Stevens D, Wittert GA, Martin S, Adams RJ, Vakulin A. Sleep macroarchitecture but not obstructive sleep apnea is independently associated with cognitive function in only older men of a population-based cohort. J Sleep Res 2021; 30:e13370. [PMID: 33890335 DOI: 10.1111/jsr.13370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
Evidence linking obstructive sleep apnea with cognitive dysfunction predominantly comes from clinical or select community samples. We investigated the independent cross-sectional association of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function in unselected community-dwelling middle-aged and older men. Four hundred and seventy-seven Florey Adelaide Male Ageing Study participants underwent successful home-based polysomnography. They also completed cognitive testing, including the inspection time task, Fuld object memory evaluation, trail-making test A and B, and mini-mental state examination. Multivariable regression models examined independent cross-sectional associations of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function. In univariable analyses, a higher apnea-hypopnea index and percentage of total sleep time with oxygen saturation <90% were associated with worse trail-making test A performance (both p < .05). A higher apnea-hypopnea index was also associated with worse trail-making test B performance and slower inspection time (both p < .05). In adjusted analyses, obstructive sleep apnea and sleep macroarchitecture parameters were not associated with cognitive function (all p > .05). In age-stratified analysis in men ≥65 years, greater stage 1 sleep was independently associated with worse trail-making test A performance, whereas greater stage 3 sleep was independently associated with better trail-making test A performance (both p < .05). Our findings suggest that obstructive sleep apnea is not independently associated with cognitive function. In older, but not younger, men, light sleep was associated with worse attention, whereas deep sleep was associated with better attention. Longitudinal population-based cohort studies are needed to determine if obstructive sleep apnea and disrupted sleep macroarchitecture independently predict prospective cognitive dysfunction and decline.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Yohannes A Melaku
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David Stevens
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sean Martin
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, Adelaide, SA, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,NeuroSleep - NHMRC Centre of Research Excellence, and Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
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Martin S, Zajac I, Vincent A, Adams RJ, Appleton S, Wittert GA. Effect of depression on health service utilisation in men: a prospective cohort study of Australian men aged 35 to 80 years. BMJ Open 2021; 11:e044893. [PMID: 33737438 PMCID: PMC7978072 DOI: 10.1136/bmjopen-2020-044893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men. DESIGN Prospective cohort study. SETTING Community-based. PARTICIPANTS Men aged 35-80 years at recruitment (2002-2005), randomly selected from the northern and western suburbs of Adelaide, Australia, without depression at baseline, who attended follow-up visits (2007-2010) (n=1464). PRIMARY AND SECONDARY OUTCOME MEASURES Depression symptoms were categorised into high burden (total score of ≥13 for the Beck Depression Inventory (BDI) or ≥10 for the Centre for Epidemiologic Studies Depression Scale (CES-D) or low burden (<13 for the BDI or <10 for the CES-D). Diagnosed depression was determined by patient-reported physician diagnosis. Frequent general practitioner (GP) visits were those occurring 5+ times over the preceding year. Use of national medical and prescription services (Medicare Benefit Schedule and Pharmaceutical Benefit Scheme; MBS and PBS) was assessed through data linkage. RESULTS Frequent attendance and depression diagnosis was more common in men with a high than low burden of depression symptoms (45.9% vs 29.3%-18.7% vs 1.9%, p<0.001). Depression diagnoses were also more common in frequent GP attenders compared with low-average attenders (5.1% vs 2.2%, p<0.001). Among men with high burden of symptoms, there was no age-adjusted or multi-adjusted difference for likelihood of depression diagnosis between non-regular and frequent GP attenders. Annualised MBS and PBS expenditure was highest for men with undiagnosed depression. CONCLUSIONS Men with a high burden of depression symptoms have commensurate use of health services when compared with those with a low burden, but only half report a physician diagnosis of depression. Undiagnosed depression led to a higher usage of medical and prescription services.
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Affiliation(s)
- Sean Martin
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Zajac
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, South Australia, Australia
| | - Andrew Vincent
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
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Guscoth LB, Appleton SL, Martin SA, Adams RJ, Melaku YA, Wittert GA. The Association of Obstructive Sleep Apnea and Nocturnal Hypoxemia with Lipid Profiles in a Population-Based Study of Community-Dwelling Australian Men. Nat Sci Sleep 2021; 13:1771-1782. [PMID: 34675725 PMCID: PMC8517637 DOI: 10.2147/nss.s327478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/23/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the association of obstructive sleep apnea and nocturnal hypoxemia with serum lipid profiles in unselected community-dwelling men. METHODS Cross-sectional data from participants of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study (n=753) who underwent full in-home polysomnography (Embletta X100) was used. Triglycerides, high- (HDL), low-density lipoprotein (LDL), and total cholesterol were assessed on a fasting morning blood sample. Multivariable linear regression analyses assessed associations between lipids and continuous measures of nocturnal hypoxemia (oxygen desaturation index (3%) (ODI), apnea-hypopnea index (AHI), and rapid eye movement sleep apnea-hypopnea index (REM-AHI)), adjusted for chronic conditions, risk behavior and sociodemographic factors. Sensitivity analyses examined the effect of lipid lowering therapies on reported estimates. Effect modification was examined through stratification by waist circumference groups. RESULTS In 753 participants with mean (SD) age of 60.8 (10.9) years and waist circumference: 99.3 (11.6) cm, the prevalence of OSA (AHI≥10) was 52.6%. Overall, no significant associations between OSA metrics and lipid measures were found. Similarly, sensitivity analysis excluding lipid lowering therapies showed no significant associations. In analysis stratified by waist circumference (<95cm, 95-100cm, >100cm), ODI (3%, unstandardized B: 0.027, 95% CI: 0.015-0.040), AHI (0.023, 0.012-0.033) and AHIREM (0.012, 0.001-0.022) were positively associated with serum triglycerides in participants with a normal waist circumference (<95cm). CONCLUSION Obstructive sleep apnea metrics were positively associated with serum triglyceride levels in men with a normal waist circumference. Healthy weight individuals with OSA require clinical attention to improve cardiometabolic risk profiles.
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Affiliation(s)
- Layla B Guscoth
- Freemasons Centre for Male Health and Well-Being, South Australian Health and Medical Research Institute and Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health, Formerly the Adelaide Institute for Sleep Health) A Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, 5042, Australia
| | - Sean A Martin
- Freemasons Centre for Male Health and Well-Being, South Australian Health and Medical Research Institute and Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health, Formerly the Adelaide Institute for Sleep Health) A Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, 5042, Australia
| | - Yohannes A Melaku
- Flinders Health and Medical Research Institute (Sleep Health, Formerly the Adelaide Institute for Sleep Health) A Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, 5042, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Well-Being, South Australian Health and Medical Research Institute and Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5000, Australia
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Yeap BB, Marriott RJ, Adams RJ, Antonio L, Ballantyne CM, Bhasin S, Cawthon PM, Couper DJ, Dobs AS, Flicker L, Karlsson M, Martin SA, Matsumoto AM, Mellström D, Norman PE, Ohlsson C, Orwoll ES, O'Neill TW, Shores MM, Travison TG, Vanderschueren D, Wittert GA, Wu FCW, Murray K. Androgens In Men Study (AIMS): protocol for meta-analyses of individual participant data investigating associations of androgens with health outcomes in men. BMJ Open 2020; 10:e034777. [PMID: 32398333 PMCID: PMC7239545 DOI: 10.1136/bmjopen-2019-034777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/25/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION This study aims to clarify the role(s) of endogenous sex hormones to influence health outcomes in men, specifically to define the associations of plasma testosterone with incidence of cardiovascular events, cancer, dementia and mortality risk, and to identify factors predicting testosterone concentrations. Data will be accrued from at least three Australian, two European and four North American population-based cohorts involving approximately 20 000 men. METHODS AND ANALYSIS Eligible studies include prospective cohort studies with baseline testosterone concentrations measured using mass spectrometry and 5 years of follow-up data on incident cardiovascular events, mortality, cancer diagnoses or deaths, new-onset dementia or decline in cognitive function recorded. Data for men, who were not taking androgens or drugs suppressing testosterone production, metabolism or action; and had no prior orchidectomy, are eligible. Systematic literature searches were conducted from 14 June 2019 to 31 December 2019, with no date range set for searches. Aggregate level data will be sought where individual participant data (IPD) are not available. One-stage IPD random-effects meta-analyses will be performed, using linear mixed models, generalised linear mixed models and either stratified or frailty-augmented Cox regression models. Heterogeneity in estimates from different studies will be quantified and bias investigated using funnel plots. Effect size estimates will be presented in forest plots and non-negligible heterogeneity and bias investigated using subgroup or meta-regression analyses. ETHICS AND DISSEMINATION Ethics approvals obtained for each of the participating cohorts state that participants have consented to have their data collected and used for research purposes. The Androgens In Men Study has been assessed as exempt from ethics review by the Human Ethics office at the University of Western Australia (file reference number RA/4/20/5014). Each of the component studies had obtained ethics approvals; please refer to respective component studies for details. Research findings will be disseminated to the scientific and broader community via the publication of four research articles, with each involving a separate set of IPD meta-analyses (articles will investigate different, distinct outcomes), at scientific conferences and meetings of relevant professional societies. Collaborating cohort studies will disseminate findings to study participants and local communities. PROSPERO REGISTRATION NUMBER CRD42019139668.
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Affiliation(s)
- Bu Beng Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ross James Marriott
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
| | - Leen Antonio
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | | | | | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - David John Couper
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adrian S Dobs
- School of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leon Flicker
- WA Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Magnus Karlsson
- Department of Clinical Sciences and Orthopedic Surgery, Lund University, Lund, Sweden
| | - Sean A Martin
- Freemasons Foundation Centre for Men's Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dan Mellström
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Paul E Norman
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, Oregon, USA
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester & NIHR Manchester Biomedical Research Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Molly M Shores
- VA Puget Sound Health Care System, Seattle, Washington, USA
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Thomas G Travison
- Harvard Medical School, Boston, Massachusetts, USA
- Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dirk Vanderschueren
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Frederick C W Wu
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
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18
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Stevens D, Appleton S, Vincent AD, Melaku Y, Martin S, Gill T, Hill C, Vakulin A, Adams R, Wittert G. Associations of OSA and Nocturnal Hypoxemia with Strength and Body Composition in Community Dwelling Middle Aged and Older Men. Nat Sci Sleep 2020; 12:959-968. [PMID: 33204199 PMCID: PMC7667192 DOI: 10.2147/nss.s276932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Reduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between OSA indices, HGS, muscle mass, and fat mass. PARTICIPANTS AND METHODS A total of 613 participants (age range 41-88, BMI 28.6 ± 4.3) from the population-based Men Androgen Inflammation Lifestyle Environment and Stress Study underwent in-home overnight polysomnography, assessment of dominant and non-dominant HGS, and dual x-ray absorptiometry to determine whole body muscle mass and fat mass. Linear models determined cross-sectional associations of polysomnographic-derived OSA indices with hand grip strength, muscle mass, and fat mass, whilst adjusting for lifestyle information (income, smoking status, diet, self-reported physical activity), blood sample derived testosterone and systemic inflammation (C-reactive protein), cardiometabolic health (cardiovascular disease, hypertension, type 2 diabetes), and depression. RESULTS In adjusted models, reduced dominant HGS was associated with lower oxygen nadir (unstandardised β [B] = 0.19, 95% confidence interval [CI] 0.08 to 0.29), greater time spent below 90% oxygen saturation (B = -0.08, 95% CI -0.14 to -0.02), and increased apnea duration (B = -0.3, 95% CI -0.23 to -0.02). By contrast, there were no associations between HGS and both AHI and REM AHI. Fat mass was consistently associated with worsening OSA indices, whereas muscle mass demonstrated no associations with any OSA index. CONCLUSION Our findings suggest impairments in HGS may be related to fat infiltration of muscle, hypoxemia-induced reductions in peripheral neural innervation, or even endothelial dysfunction, which is a common outcome of hypoxemia. Longitudinal data are needed to further examine these hypotheses and establish if reduced grip strength in patients with OSA is associated with long-term adverse health outcomes.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Freemason Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Andrew D Vincent
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Centre of Nutrition and Gastrointestinal Diseases, Nutrition Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Yohannes Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sean Martin
- Freemason Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Hill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital and the Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Gary Wittert
- The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Freemason Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Centre of Nutrition and Gastrointestinal Diseases, Nutrition Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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19
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Gyawali P, Martin SA, Heilbronn LK, Vincent AD, Jenkins AJ, Januszewski AS, Adams RJT, O'Loughlin PD, Wittert GA. Higher Serum Sex Hormone-Binding Globulin Levels Are Associated With Incident Cardiovascular Disease in Men. J Clin Endocrinol Metab 2019; 104:6301-6315. [PMID: 31390027 DOI: 10.1210/jc.2019-01317] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/01/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT Sex hormone-binding globulin (SHBG) levels are associated with cardiovascular disease (CVD) risk factors. However, prospective data on the association between SHBG levels and CVD events are sparse, with conflicting results. OBJECTIVES To examine associations between serum SHBG, total testosterone (TT), and incident CVD and CVD-related mortality in middle-aged to elderly men. DESIGN AND METHODS Data on 2563 community-dwelling men (35 to 80 years) were obtained from participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort. The analytic sample included 1492 men without baseline (2002 to 2007) CVD and with fasted morning serum SHBG and TT available at both baseline and follow-up (2007 to 2010) and without medications affecting TT or SHBG. Associations of baseline SHBG and TT, with incident CVD and CVD mortality, were analyzed using logistic regression for incident CVD and Cox proportional hazard regression for CVD mortality, adjusting for established CVD risk factors. RESULTS In multivariable models, elevated baseline SHBG and lower baseline TT were independently associated with incident CVD (SHBG: OR, 1.54; 95% CI, 1.15 to 2.06 per SD increase in SHBG, P = 0.003; TT: OR, 0.71; 95% CI, 0.52 to 0.97 per SD decrease in TT; P = 0.03). A decrease in TT between time points was associated with incident CVD (OR, 0.72; 95% CI, 0.56 to 0.92; P = 0.01). Neither SHBG nor TT was significantly associated with all-age CVD mortality [hazard ratio (HR), 0.69; 95% CI, 0.29 to 1.63; P = 0.40; and HR, 0.60; 95% CI, 0.28 to 1.26; P = 0.18, respectively]. CONCLUSIONS Among all men and men >65 years, elevated SHBG and lower TT were independently associated with both a greater risk of CVD and an increased CVD mortality risk.
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Affiliation(s)
- Prabin Gyawali
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sean A Martin
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Leonie K Heilbronn
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Andrew D Vincent
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrzej S Januszewski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Robert J T Adams
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Gary A Wittert
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Appleton SL, Vakulin A, D’Rozario A, Vincent AD, Teare A, Martin SA, Wittert GA, McEvoy RD, Catcheside PG, Adams RJ. Quantitative electroencephalography measures in rapid eye movement and nonrapid eye movement sleep are associated with apnea–hypopnea index and nocturnal hypoxemia in men. Sleep 2019; 42:5475510. [DOI: 10.1093/sleep/zsz092] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
AbstractStudy ObjectivesQuantitative electroencephalography (EEG) measures of sleep may identify vulnerability to obstructive sleep apnea (OSA) sequelae, however, small clinical studies of sleep microarchitecture in OSA show inconsistent alterations. We examined relationships between quantitative EEG measures during rapid eye movement (REM) and non-REM (NREM) sleep and OSA severity among a large population-based sample of men while accounting for insomnia.MethodsAll-night EEG (F4-M1) recordings from full in-home polysomnography (Embletta X100) in 664 men with no prior OSA diagnosis (age ≥ 40) were processed following exclusion of artifacts. Power spectral analysis included non-REM and REM sleep computed absolute EEG power for delta, theta, alpha, sigma, and beta frequency ranges, total power (0.5–32 Hz) and EEG slowing ratio.ResultsApnea–hypopnea index (AHI) ≥10/h was present in 51.2% (severe OSA [AHI ≥ 30/h] 11.6%). In mixed effects regressions, AHI was positively associated with EEG slowing ratio and EEG power across all frequency bands in REM sleep (all p < 0.05); and with beta power during NREM sleep (p = 0.06). Similar associations were observed with oxygen desaturation index (3%). Percentage total sleep time with oxygen saturation <90% was only significantly associated with increased delta, theta, and alpha EEG power in REM sleep. No associations with subjective sleepiness were observed.ConclusionsIn a large sample of community-dwelling men, OSA was significantly associated with increased EEG power and EEG slowing predominantly in REM sleep, independent of insomnia. Further study is required to assess if REM EEG slowing related to nocturnal hypoxemia is more sensitive than standard PSG indices or sleepiness in predicting cognitive decline.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- NeuroSleep—NHMRC Centre of Research Excellence, and Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Angela D’Rozario
- NeuroSleep—NHMRC Centre of Research Excellence, and Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew D Vincent
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alison Teare
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Sean A Martin
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Gary A Wittert
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Robert J Adams
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Wittert G, Atlantis E, Allan C, Bracken K, Conway A, Daniel M, Gebski V, Grossmann M, Hague W, Handelsman DJ, Inder W, Jenkins A, Keech A, McLachlan R, Robledo K, Stuckey B, Yeap BB. Testosterone therapy to prevent type 2 diabetes mellitus in at-risk men (T4DM): Design and implementation of a double-blind randomized controlled trial. Diabetes Obes Metab 2019; 21:772-780. [PMID: 30520208 DOI: 10.1111/dom.13601] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/18/2018] [Accepted: 12/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). AIMS To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. STUDY POPULATION Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). SETTING, DRUG AND PROTOCOL Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. PRIMARY ENDPOINTS: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. SECONDARY ENDPOINTS Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. SAFETY Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. SUB-STUDIES: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.
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Affiliation(s)
- Gary Wittert
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Evan Atlantis
- Freemasons Foundation Centre for Mens Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Carolyn Allan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ann Conway
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australian Capital Territory, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mathis Grossmann
- Dept. of Medicine, The Austin Hospital and University of Melbourne, Victoria, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - David J Handelsman
- Anzac Research Institute and Andrology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Warrick Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Woolloongabba, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Bronwyn Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, and Medical School, University of Western Australia, Perth, Western Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, and Medical School University of Western Australia, Perth, Western Australia
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Myles H, Vincent A, Myles N, Adams R, Chandratilleke M, Liu D, Mercer J, Vakulin A, Wittert G, Galletly C. Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study. Australas Psychiatry 2018; 26:600-603. [PMID: 29737184 DOI: 10.1177/1039856218772241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: Obstructive sleep apnoea (OSA) may be more common in people with schizophrenia compared to the general population, but the relative prevalence is unknown. Here, we determine the relative prevalence of severe OSA in a cohort of men with schizophrenia compared to representative general population controls, and investigate the contribution of age and body mass index (BMI) to differences in prevalence. METHODS: Rates of severe OSA (apnoea-hypopnoea index > 30) were compared between male patients with schizophrenia and controls from a representative general population study of OSA. RESULTS: The prevalence of severe OSA was 25% in the schizophrenia group and 12.3% in the general population group. In subgroups matched by age, the relative risk of severe OSA was 2.9 ( p = 0.05) in the schizophrenia subjects, but when adjusted for age and BMI, the relative risk dropped to 1.7 and became non-significant ( p = 0.17). CONCLUSIONS: OSA is prevalent in men with schizophrenia. Obesity may be an important contributing factor to the increased rate of OSA.
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Affiliation(s)
- Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, and; Country Health (SA) Mental Health; Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Vincent
- School of Medicine, University of Adelaide, Adelaide, SA, and; Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
| | - Nicholas Myles
- School of Medicine, University of Queensland, Herston, QLD, and; Haematology Directorate, SA Pathology, Adelaide, SA, Australia
| | - Robert Adams
- School of Medicine, University of Adelaide, and; The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Madhu Chandratilleke
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Daw Park, SA, Australia
| | - Dennis Liu
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, and; Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jeremy Mercer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Daw Park, SA, Australia
| | - Andrew Vakulin
- NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, and; Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Daw Park, SA, Australia
| | - Gary Wittert
- School of Medicine, University of Adelaide, and; Freemasons Foundation Centre for Men's Health, University of Adelaide, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, and; Ramsay Health Care (SA) Mental Health, Adelaide, SA, and; Northern Adelaide Local Health Network, Adelaide, SA, Australia
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23
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Kaambwa B, Mpundu-Kaambwa C, Adams R, Appleton S, Martin S, Wittert G. Suitability of the Epworth Sleepiness Scale (ESS) for Economic Evaluation: An Assessment of Its Convergent and Discriminant Validity. Behav Sleep Med 2018; 16:448-470. [PMID: 27754703 DOI: 10.1080/15402002.2016.1228647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D]). METHODS Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman's correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests. RESULTS All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities. CONCLUSIONS The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter.
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Affiliation(s)
- Billingsley Kaambwa
- a Health Economics Unit, School of Medicine, Flinders University , Adelaide , Australia
| | | | - Robert Adams
- b The Health Observatory, Discipline of Medicine, University of Adelaide , Adelaide , Australia
| | - Sarah Appleton
- b The Health Observatory, Discipline of Medicine, University of Adelaide , Adelaide , Australia
| | - Sean Martin
- c Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide , Adelaide , Australia
| | - Gary Wittert
- c Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide , Adelaide , Australia
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24
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Gyawali P, Martin SA, Heilbronn LK, Vincent AD, Taylor AW, Adams RJT, O'Loughlin PD, Wittert GA. The role of sex hormone-binding globulin (SHBG), testosterone, and other sex steroids, on the development of type 2 diabetes in a cohort of community-dwelling middle-aged to elderly men. Acta Diabetol 2018; 55:861-872. [PMID: 29845345 DOI: 10.1007/s00592-018-1163-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/18/2018] [Indexed: 12/27/2022]
Abstract
AIMS Contrasting findings exist regarding the association between circulating sex hormone-binding globulin (SHBG) and testosterone levels and type 2 diabetes (T2D) in men. We examined prospective associations of SHBG and sex steroids with incident T2D in a cohort of community-dwelling men. METHODS Participants were from a cohort study of community-dwelling (n = 2563), middle-aged to elderly men (35-80 years) from Adelaide, Australia (the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study). The current study included men who were followed for 5 years and with complete SHBG and sex steroid levels (total testosterone (TT), dihydrotestosterone (DHT) and oestradiol (E2)), but without T2D at baseline (n = 1597). T2D was identified by either self-report, fasting glucose (≥ 7.0 mmol/L), HbA1c (≥ 6.5%/48.0 mmol/mol), and/or prescriptions for diabetes medications. Logistic binomial regression was used to assess associations between SHBG, sex steroids and incident T2D, adjusting for confounders including age, smoking status, physical activity, adiposity, glucose, triglycerides, symptomatic depression, SHBG and sex steroid levels. RESULTS During an average follow-up of 4.95 years, 14.5% (n = 232) of men developed new T2D. Multi-adjusted models revealed an inverse association between baseline SHBG, TT, and DHT levels, and incident T2D (odds ratio (OR) = 0.77, 95% CI [0.62, 0.95], p = 0.02; OR 0.70 [0.57, 0.85], p < 0.001 and OR 0.78 [0.63, 0.96], p = 0.02), respectively. However, SHBG was no longer associated with incident T2D after additional adjustment for TT (OR 0.92 [0.71, 1.17], p = 0.48; TT in incident T2D: OR 0.73 [0.57, 0.92], p = 0.01) and after separate adjustment for DHT (OR 0.83 [0.64, 1.08], p = 0.16; DHT in incident T2D: OR 0.83 [0.65, 1.05], p = 0.13). There was no observed effect of E2 in all models of incident T2D. CONCLUSIONS In men, low TT, but not SHBG and other sex steroids, best predicts the development of T2D after adjustment for confounders.
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Affiliation(s)
- Prabin Gyawali
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Sean A Martin
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Leonie K Heilbronn
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Andrew D Vincent
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Anne W Taylor
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Population Research and Outcomes Studies, University of Adelaide, Adelaide, SA, Australia
| | - Robert J T Adams
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- The Health Observatory, University of Adelaide, Queen Elizabeth Hospital, Woodville, SA, Australia
| | | | - Gary A Wittert
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
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25
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Gyawali P, Martin SA, Heilbronn LK, Vincent AD, Jenkins AJ, Januszewski AS, Taylor AW, Adams RJT, O’Loughlin PD, Wittert GA. Cross-sectional and longitudinal determinants of serum sex hormone binding globulin (SHBG) in a cohort of community-dwelling men. PLoS One 2018; 13:e0200078. [PMID: 29995902 PMCID: PMC6040731 DOI: 10.1371/journal.pone.0200078] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 06/19/2018] [Indexed: 12/31/2022] Open
Abstract
Despite its widespread clinical use, there is little data available from population-based studies on the determinants of serum sex hormone binding globulin (SHBG). We aimed to examine multifactorial determinants of circulating SHBG levels in community-dwelling men. Study participants comprised randomly selected 35–80 y.o. men (n = 2563) prospectively-followed for 5 years (n = 2038) in the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. After excluding men with illness or medications known to affect SHBG (n = 172), data from 1786 men were available at baseline, and 1476 at follow-up. The relationship between baseline body composition (DXA), serum glucose, insulin, triglycerides, thyroxine (fT4), sex steroids (total testosterone (TT), oestradiol (E2)), and pro-inflammatory cytokines and serum SHBG level at both baseline & follow-up was determined by linear and penalized logistic regression models adjusting for age, lifestyle & demographic, body composition, metabolic, and hormonal factors. Restricted cubic spline analyses was also conducted to capture possible non-linear relationships. At baseline there were positive cross-sectional associations between age (β = 0.409, p<0.001), TT (β = 0.560, p<0.001), fT4 (β = 0.067, p = 0.019) and SHBG, and negative associations between triglycerides (β = -0.112, p<0.001), abdominal fat mass (β = -0.068, p = 0.032) and E2 (β = -0.058, p = 0.050) and SHBG. In longitudinal analysis the positive determinants of SHBG at 4.9 years were age (β = 0.406, p = <0.001), TT (β = 0.461, p = <0.001), and fT4 (β = 0.040, p = 0.034) and negative determinants were triglycerides (β = -0.065, p = 0.027) and abdominal fat mass (β = -0.078, p = 0.032). Taken together these data suggest low SHBG is a marker of abdominal obesity and increased serum triglycerides, conditions which are known to have been associated with low testosterone and low T4.
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Affiliation(s)
- Prabin Gyawali
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men’s Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- * E-mail: (PG); (GW)
| | - Sean A. Martin
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men’s Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Leonie K. Heilbronn
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Andrew D. Vincent
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men’s Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Alicia J. Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrzej S. Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Anne W. Taylor
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Population Research and Outcomes Studies, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J. T. Adams
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- The Health Observatory, University of Adelaide, Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | | | - Gary A. Wittert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men’s Health, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- * E-mail: (PG); (GW)
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26
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Association between multimorbidity and undiagnosed obstructive sleep apnea severity and their impact on quality of life in men over 40 years old. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2018; 3:e10. [PMID: 30263134 PMCID: PMC6152492 DOI: 10.1017/gheg.2018.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023]
Abstract
Background. Multimorbidity is common but little is known about its relationship with obstructive sleep apnea (OSA). Methods. Men Androgen Inflammation Lifestyle Environment and Stress Study participants underwent polysomnography. Chronic diseases (CDs) were determined by biomedical measurement (diabetes, dyslipidaemia, hypertension, obesity), or self-report (depression, asthma, cardiovascular disease, arthritis). Associations between CD count, multimorbidity, apnea-hyponea index (AHI) and OSA severity and quality-of-life (QoL; mental & physical component scores), were determined using multinomial regression analyses, after adjustment for age. Results. Of the 743 men participating in the study, overall 58% had multimorbidity (2+ CDs), and 52% had OSA (11% severe). About 70% of those with multimorbidity had undiagnosed OSA. Multimorbidity was associated with AHI and undiagnosed OSA. Elevated CD count was associated with higher AHI value and increased OSA severity. Conclusion. We demonstrate an independent association between the presence of OSA and multimorbidity in this representative sample of community-based men. This effect was strongest in men with moderate to severe OSA and three or more CDs, and appeared to produce a greater reduction in QoL when both conditions were present together.
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MPUNDU-KAAMBWA C, KAAMBWA B, APPLETON S, MARTIN S, WITTERT G, ADAMS R. International Prostate Symptom Score Should Be Considered a Complement Rather Than a Substitute to Generic Preference-Based Measures for Measuring Lower Urinary Tract Symptoms Within Economic Evaluation. Low Urin Tract Symptoms 2018; 10:45-56. [DOI: 10.1111/luts.12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/30/2016] [Accepted: 04/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Billingsley KAAMBWA
- Flinders Health Economics Group; School of Medicine, Flinders University; Adelaide Australia
| | - Sarah APPLETON
- Freemasons Foundation Centre for Men's Health; School of Medicine, University of Adelaide; Adelaide Australia
| | - Sean MARTIN
- Freemasons Foundation Centre for Men's Health; School of Medicine, University of Adelaide; Adelaide Australia
| | - Gary WITTERT
- Freemasons Foundation Centre for Men's Health; School of Medicine, University of Adelaide; Adelaide Australia
| | - Robert ADAMS
- The Health Observatory, Discipline of Medicine; University of Adelaide; Adelaide Australia
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28
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Nutrient patterns and chronic inflammation in a cohort of community dwelling middle-aged men. Clin Nutr 2017; 36:1040-1047. [DOI: 10.1016/j.clnu.2016.06.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022]
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29
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Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Wittert GA, Martin SA, Catcheside PG, Antic NA, Lack L, Adams RJ. Co-morbid OSA and insomnia increases depression prevalence and severity in men. Respirology 2017; 22:1407-1415. [DOI: 10.1111/resp.13064] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Carol J. Lang
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Sarah L. Appleton
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - R. Doug McEvoy
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Gary A. Wittert
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Sean A. Martin
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Peter G. Catcheside
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Nicholas A. Antic
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Leon Lack
- Adelaide Institute of Sleep Health; Flinders University of South Australia; Adelaide South Australia Australia
| | - Robert J. Adams
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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30
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On ZX, Grant J, Shi Z, Taylor AW, Wittert GA, Tully PJ, Hayley AC, Martin S. The association between gastroesophageal reflux disease with sleep quality, depression, and anxiety in a cohort study of Australian men. J Gastroenterol Hepatol 2017; 32:1170-1177. [PMID: 27862259 DOI: 10.1111/jgh.13650] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/01/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Previous clinical studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) with anxiety and depression; however, few population-based studies have controlled for sleep disorders. The current study aimed to assess the relationship between GERD and anxiety, depression, and sleep disorders in a community-based sample of Australian men. METHODS Participants comprised a subset of 1612 men (mean age: 60.7 years, range: 35-80) who participated in the Men Androgen Inflammation Lifestyle Environment and Stress Study during the years 2001-2012, who had complete GERD measures (Gastresophageal Reflux Disease Questionnaire), and were not taking medications known to impact gastrointestinal function (excluding drugs taken for acid-related disorders). Current depression and anxiety were defined by (i) physician diagnosis, (ii) symptoms of depression (Beck Depression Inventory and Centre for Epidemiological Studies Depression Scale) or anxiety (Generalized Anxiety Disorder-7), and/or current depressive or anxiolytic medication use. Previous depression was indicated by past depressive diagnoses/medication use. Data on sleep quality, daytime sleepiness, and obstructive sleep apnea were collected along with several health, lifestyle, and medical factors, and these were systematically evaluated in both univariate and multivariable analyses. RESULTS Overall, 13.7% (n = 221) men had clinically significant GERD symptoms. In the adjusted models, an association between GERD and anxiety (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.0-6.8) and poor sleep quality (OR 1.8; 95% CI 1.2-2.9) was observed; however, no effect was observed for current depression (OR 1.5; 95% CI 0.8-2.7). After removing poor sleep quality from the model, an independent association between current depression (OR 2.6; 95% CI 1.7-3.8) and current anxiety (OR 3.2; 95% CI 1.8-6.0) and GERD was observed, but not for previous depression (OR 1.4; 95% CI 0.7-2.8). CONCLUSION In this sample of urban-dwelling men, we observed a strong independent association between GERD, anxiety, and current depression, the latter appearing to be partly mediated by poor sleep quality. Patients presenting with GERD should have concurrent mental health assessments in order to identify potential confounders to the successful management of their symptoms.
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Affiliation(s)
- Zhi Xiang On
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Grant
- Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zumin Shi
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Population Research and Outcome Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amie C Hayley
- IMPACT SRC, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Sean Martin
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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31
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Li JJ, Appleton SL, Gill TK, Vakulin A, Wittert GA, Antic NA, Taylor AW, Adams RJ, Hill CL. Association of Musculoskeletal Joint Pain With Obstructive Sleep Apnea, Daytime Sleepiness, and Poor Sleep Quality in Men. Arthritis Care Res (Hoboken) 2017; 69:742-747. [DOI: 10.1002/acr.22994] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/22/2016] [Accepted: 07/12/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Joule J. Li
- University of Adelaide, Queen Elizabeth Hospital, Woodville, South Australia, Australia, and the Freemasons Foundation Centre for Men's Health, University of Adelaide; Adelaide South Australia Australia
| | - Sarah L. Appleton
- University of Adelaide, Queen Elizabeth Hospital; Woodville South Australia Australia
| | - Tiffany K. Gill
- School of Medicine, University of Adelaide; Adelaide South Australia Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia, and the National Health and Medical Research Council, Centres of Research Excellence, CIRUS and NeuroSleep Clinic, University of Sydney; Sydney New South Wales Australia
| | - Gary A. Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide; Adelaide South Australia Australia
| | - Nick A. Antic
- Adelaide Institute for Sleep Health, Flinders University; Bedford Park South Australia Australia
| | - Anne W. Taylor
- University of Adelaide; Adelaide South Australia Australia
| | - Robert J. Adams
- University of Adelaide, Queen Elizabeth Hospital; Woodville South Australia Australia
| | - Catherine L. Hill
- University of Adelaide, Queen Elizabeth Hospital; Woodville South Australia Australia
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Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Vincent AD, Wittert GA, Martin SA, Grant JF, Taylor AW, Antic N, Catcheside PG, Adams RJ. Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study. J Clin Sleep Med 2017; 13:575-582. [PMID: 28095971 DOI: 10.5664/jcsm.6546] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/27/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether undiagnosed obstructive sleep apnea (OSA) and/or excessive daytime sleepiness are associated with symptomatic depression in Australian men. METHODS Participants were randomly selected, urban community dwelling men aged 40 to 88 years without a prior diagnosis of OSA. Clinically significant depressive symptoms were assessed using the Beck Depression Inventory-1A or Centre for Epidemiological Studies Depression Scale (2007-2010). A random sample of men (n = 788) undertook full at-home unattended polysomnography (Embletta X100, Broomfield, Colorado, United States) and completed the Epworth Sleepiness Scale questionnaire (2010-2012). RESULTS Undiagnosed severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/h) was associated with depressive symptoms (adjusted odds ratio = 1.98; 95% confidence interval [CI] 1.05-3.73; P = .036). However, a significant interaction was observed between obstructive sleep apnea and excessive daytime sleepiness (P = .03) such that individuals with OSA and excessive daytime sleepiness (Epworth Sleepiness Scale score of 10 or higher) exhibited the strongest associations with depression (mild-moderate apnea: adjusted odd ratio = 3.86; 95% CI 1.87-7.95; severe apnea: adjusted odd ratio = 4.82; 95% CI 1.42-16.35) when compared to individuals without apnea. CONCLUSIONS Depressive symptoms in men were associated with undiagnosed OSA in the community. It is important that clinicians and primary care practitioners consider screening for depression in men with severe OSA and for OSA in men with depression. Screening for depression should also be considered in men with excessive daytime sleepiness regardless of OSA severity.
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Affiliation(s)
- Carol J Lang
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Andrew D Vincent
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet F Grant
- Population Research and Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research and Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicholas Antic
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute of Sleep Health, Flinders University of South Australia, c/o Repatriation General Hospital, Daw Park, South Australia, Australia.,School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
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Camargo AB, Manucha W. Potential protective role of nitric oxide and Hsp70 linked to functional foods in the atherosclerosis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.artere.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Camargo AB, Manucha W. Potencial rol protector del óxido nítrico y Hsp70 asociado a alimentos funcionales en la aterosclerosis. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:36-45. [DOI: 10.1016/j.arteri.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 12/16/2022]
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35
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Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology 2016; 97:219-226. [DOI: 10.1016/j.urology.2016.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
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Currier D, Pirkis J, Carlin J, Degenhardt L, Dharmage SC, Giles-Corti B, Gordon I, Gurrin L, Hocking J, Kavanagh A, Keogh LA, Koelmeyer R, LaMontagne AD, Schlichthorst M, Patton G, Sanci L, Spittal MJ, Studdert DM, Williams J, English DR. The Australian longitudinal study on male health-methods. BMC Public Health 2016; 16:1030. [PMID: 28185550 PMCID: PMC5103246 DOI: 10.1186/s12889-016-3698-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development. METHODS Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use. RESULTS A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %. CONCLUSION Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.
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Affiliation(s)
- Dianne Currier
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - John Carlin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, 2031, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Billie Giles-Corti
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Ian Gordon
- Statistical Consulting Centre, School of Mathematics and Statistics, The University of Melbourne, Melbourne, 3010, Australia
| | - Lyle Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Anne Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Rachel Koelmeyer
- School of Clinical Sciences, Monash University, Clayton, 3168, Australia
| | - Anthony D LaMontagne
- School of Health & Social Development, Deakin University, Burwood, 3125, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - George Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, 3010, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, 3010, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - David M Studdert
- Centre for Health Policy/PCOR, Stanford University School of Medicine, Stanford, 94305, USA.,Stanford Law School, Stanford, 94305, USA
| | - Joanne Williams
- School of Health & Social Development, Deakin University, Burwood, 3125, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
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Tremellen K. Gut Endotoxin Leading to a Decline IN Gonadal function (GELDING) - a novel theory for the development of late onset hypogonadism in obese men. Basic Clin Androl 2016; 26:7. [PMID: 27340554 PMCID: PMC4918028 DOI: 10.1186/s12610-016-0034-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/24/2016] [Indexed: 12/25/2022] Open
Abstract
Obesity is an increasing public health problem, with two-thirds of the adult population in many Western countries now being either overweight or obese. Male obesity is associated with late onset hypogonadism, a condition characterised by decreased serum testosterone, sperm quality plus diminished fertility and quality of life. In this paper we propose a novel theory underlying the development of obesity related hypogonadism- the GELDING theory (Gut Endotoxin Leading to a Decline IN Gonadal function). Several observational studies have previously reported an association between obesity related hypogonadism (low testosterone) and systemic inflammation. However, for the first time we postulate that the trans-mucosal passage of bacterial lipopolysaccharide (LPS) from the gut lumen into the circulation is a key inflammatory trigger underlying male hypogonadism. Obesity and a high fat/high calorie diet are both reported to result in changes to gut bacteria and intestinal wall permeability, leading to the passage of bacterial endotoxin (lipopolysaccharide- LPS) from within the gut lumen into the circulation (metabolic endotoxaemia), where it initiates systemic inflammation. Endotoxin is known to reduce testosterone production by the testis, both by direct inhibition of Leydig cell steroidogenic pathways and indirectly by reducing pituitary LH drive, thereby also leading to a decline in sperm production. In this paper we also highlight the novel evolutionary benefits of the GELDING theory. Testosterone is known to be a powerful immune-suppressive, decreasing a man's ability to fight infection. Therefore we postulate that the male reproductive axis has evolved the capacity to lower testosterone production during times of infection and resulting endotoxin exposure, decreasing the immunosuppressive influence of testosterone, in turn enhancing the ability to fight infection. While this response is adaptive in times of sepsis, it becomes maladaptive in the setting of "non-infectious" obesity related metabolic endotoxaemia.
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Affiliation(s)
- Kelton Tremellen
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia, Australia
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Adams RJ, Appleton SL, Vakulin A, Lang C, Martin SA, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Wittert GA. Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men. Respirology 2016; 21:1314-21. [DOI: 10.1111/resp.12829] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J. Adams
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
| | - Sarah L. Appleton
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School; University of Sydney; Sydney New South Wales Australia
| | - Carol Lang
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
| | - Sean A. Martin
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Anne W. Taylor
- Population Research & Outcomes Studies, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Nick A. Antic
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Peter G. Catcheside
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences; Flinders University; Bedford Park South Australia Australia
- Department of Medicine; Flinders University; Bedford Park, Adelaide South Australia Australia
| | - Gary A. Wittert
- The Health Observatory, Discipline of Medicine; University of Adelaide; Woodville South Australia Australia
- Freemasons Centre for Men's Health, Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
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Li JJ, Wittert GA, Vincent A, Atlantis E, Shi Z, Appleton SL, Hill CL, Jenkins AJ, Januszewski AS, Adams RJ. Muscle grip strength predicts incident type 2 diabetes: Population-based cohort study. Metabolism 2016; 65:883-92. [PMID: 27173467 DOI: 10.1016/j.metabol.2016.03.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/03/2016] [Accepted: 03/22/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the longitudinal relationship of muscle mass and strength with incident type 2 diabetes, and previously unstudied mediating effects of testosterone and inflammation. METHODS Community-dwelling male participants (aged ≥35years) of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent biomedical assessment in 2002-2006 and 2007-2010, including hand grip strength (dynamometer), testosterone and inflammatory markers. Body composition (dual-energy X-ray absorptiometry) was assessed at baseline only. Incident type 2 diabetes was defined as a self-reported doctor diagnosis, diabetes medication use, fasting plasma glucose ≥7.0mmol/L, or glycated haemoglobin ≥6.5% (48mmol/mol) at follow-up, that was not present at baseline. RESULTS Of n=1632 men, incident type 2 diabetes occurred in 146 (8.9%). Muscle mass was not associated with incident type 2 diabetes. Grip strength was inversely associated with incident type 2 diabetes [unadjusted odds ratio (OR) per 5kg: 0.87, 95% confidence interval (CI): 0.80-0.95; adjusted OR, 95% CI: 0.87, 0.78-0.97]. Arm muscle quality (grip strength divided by arm lean mass) was similarly associated with incident type 2 diabetes. Testosterone, IL-6 and TNF-α did not significantly mediate the associations. The population attributable fraction of type 2 diabetes from low grip strength was 27% (13-40%), assuming intervention could increase strength by 25%. CONCLUSIONS Reduced muscle strength, but not reduced muscle mass, is a risk factor for incident type 2 diabetes in men. This is not mediated by testosterone or inflammation. Intervention could prevent a substantial proportion of disease.
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Affiliation(s)
- Joule J Li
- The Health Observatory, School of Medicine, University of Adelaide; Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide.
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide
| | - Andrew Vincent
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide
| | - Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University
| | - Zumin Shi
- Population Research and Outcome Studies, School of Medicine, University of Adelaide
| | - Sarah L Appleton
- The Health Observatory, School of Medicine, University of Adelaide; Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide
| | - Catherine L Hill
- The Health Observatory, School of Medicine, University of Adelaide
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney
| | | | - Robert J Adams
- The Health Observatory, School of Medicine, University of Adelaide
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Atlantis E, Fahey P, Martin S, O'Loughlin P, Taylor AW, Adams RJ, Shi Z, Wittert G. Predictive value of serum testosterone for type 2 diabetes risk assessment in men. BMC Endocr Disord 2016; 16:26. [PMID: 27230668 PMCID: PMC4882776 DOI: 10.1186/s12902-016-0109-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/17/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Effective prevention of type 2 diabetes (T2D) requires early identification of high-risk individuals who might benefit from intervention. We sought to determine whether low serum testosterone, a novel risk factor for T2D in men, adds clinically meaningful information beyond current T2D risk models. METHODS The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study population consists of 2563 community-dwelling men aged 35-80 years in Adelaide, Australia. Of the MAILES participants, 2038 (80.0 %) provided information at baseline (2002-2006) and follow-up (2007-2010). After excluding participants with diabetes (n = 317), underweight (n = 5), and unknown BMI status (n = 11) at baseline; and unknown diabetes status (n = 50) at follow-up; 1655 participants were followed for 5 years. T2D at baseline and follow-up was defined by self-reported diabetes, or fasting plasma glucose (FPG) ≥7.0 mmol/L (126.1 mg/dL), or glycated haemoglobin (HbA1c) ≥6.5 %, or diabetes medications. Risk models were tested using logistic regression models. Sensitivity, specificity, positive predictive values (PPV) were used to identify the optimal cut-off point for low serum testosterone for incident T2D and the area under the receiver operating characteristic (AROC) curve was used to summarise the predictive power of the model. 15.5 % of men had at least one missing predictor variable; addressed through multiple imputation. RESULTS The incidence rate of T2D was 8.9 % (147/1655) over a median follow-up of 4.95 years (interquartile range: 4.35-5.00). Serum testosterone level predicted incident T2D (relative risk 0.96 [95 % CI: 0.92,1.00], P = 0.032) independent of current risk models including the AUSDRISK, but did not improve corresponding AROC statistics. A cut-off point of <16 nmol/L for low serum testosterone, which classified about 43 % of men, returned equal sensitivity (61.3 % [95 % CI: 52.6,69.4]) and specificity (58.3 % [95 % CI: 55.6,60.9) for predicting T2D risk, with a PPV of 12.9 % (95 % CI: 10.4,15.8). CONCLUSIONS Low serum testosterone predicts an increased risk of developing T2D in men over 5 years independent of current T2D risk models applicable for use in routine clinical practice. Screening for low serum testosterone in addition to risk factors from current T2D risk assessment models or tools, including the AUSDRISK, would identify a large subgroup of distinct men who might benefit from targeted preventive interventions.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Paul Fahey
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | - Sean Martin
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Loughlin
- Chemical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Adams
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Zumin Shi
- Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia, Australia
| | - Gary Wittert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men. Nutrients 2016; 8:207. [PMID: 27070639 PMCID: PMC4848676 DOI: 10.3390/nu8040207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/08/2023] Open
Abstract
Background: macronutrient intake has been found to affect sleep parameters including obstructive sleep apnoea (OSA) in experimental studies, but there is uncertainty at the population level in adults. Methods: cross-sectional analysis was conducted of participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort (n = 784, age 35–80 years). Dietary intake was measured by a validated food frequency questionnaire. Self-reported poor sleep quality and daytime sleepiness were measured by questionnaires. Overnight in-home polysomnography (PSG) was conducted among participants with without previously diagnosed OSA. Results: after adjusting for demographic, lifestyle factors, and chronic diseases, the highest quartile of fat intake was positively associated with excessive daytime sleepiness (relative risk ratio (RRR) = 1.78, 95% CI 1.10, 2.89) and apnoea-hypopnoea index (AHI) ≥20, (RRR = 2.98, 95% CI 1.20–7.38). Body mass index mediated the association between fat intake and AHI (30%), but not daytime sleepiness. There were no associations between other intake of macronutrient and sleep outcomes. Conclusion: high fat is associated with daytime sleepiness and AHI. Sleep outcomes are generally not assessed in studies investigating the effects of varying macronutrient diets on weight loss. The current result highlights the potential public health significance of doing so.
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Appleton SL, Vakulin A, Wittert GA, Martin SA, Grant JF, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Adams RJ. The association of obstructive sleep apnea (OSA) and nocturnal hypoxemia with the development of abnormal HbA1c in a population cohort of men without diabetes. Diabetes Res Clin Pract 2016; 114:151-9. [PMID: 26810273 DOI: 10.1016/j.diabres.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
Abstract
AIM To examine the relationship between indices of undiagnosed OSA and the development of abnormal glycaemic control in community-dwelling men free of diabetes. METHODS The Men, Androgens, Inflammation, Lifestyle, Environment, and Stress (MAILES) Study is a population-based cohort study in Adelaide, South Australia. Clinic visits at baseline (2002-06) and follow-up (2007-10) identified abnormal glycaemic metabolism [HbA1c 6.0 to <6.5% (42 to <48mmol/mol)] in men without diabetes. At follow-up (2010-11), n=837 underwent assessment of OSA by full in-home unattended polysomnography (Embletta X100). RESULTS Development of abnormal glycaemic metabolism over 4-6 years (n=103 "incident" cases, 17.0%) showed adjusted associations [odds ratio (95% CI)] with the 1st [1.7 (0.8-3.8)], 2nd [2.4 (1.1-4.9)], and 3rd [2.3 (1.1-4.8)] quartiles of mean oxygen saturation (SaO2) compared to the highest quartile. Prevalent abnormal glycaemic metabolism (n=140, 20.8%) was independently associated with the third and fourth quartiles of percentage of sleep time with oxygen saturation <90% and lowest quartile of mean SaO2. Linear regression analysis showed a significant reduction in HbA1c [unstandardized B, 95% CI: -0.02 (-0.04, -0.002), p=0.034] per percentage point increase in mean SaO2. OSA as measured by the apnea-hypopnea index showed no adjusted relationship with abnormal glycaemic metabolism. CONCLUSIONS Development of abnormal glycaemic metabolism was associated with nocturnal hypoxemia. Improved management of OSA and glycaemic control may occur if patients presenting with one abnormality are assessed for the other.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia; Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet F Grant
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - R Douglas McEvoy
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Nick A Antic
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
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Appleton SL, Vakulin A, Martin SA, Lang CJ, Wittert GA, Taylor AW, McEvoy RD, Antic NA, Catcheside PG, Adams RJ. Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep. Chest 2016; 150:495-505. [PMID: 27001264 DOI: 10.1016/j.chest.2016.03.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/12/2016] [Accepted: 03/01/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Evidence linking OSA with hypertension in population studies is conflicting. We examined longitudinal and cross-sectional associations of previously unrecognized OSA, including OSA occurring in rapid eye movement (REM) sleep, with hypertension. METHODS The Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) study is a longitudinal study of community-dwelling men in Adelaide, South Australia. Biomedical assessments at baseline (2002-2006) and follow-up (2007-2010) identified hypertension (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg, or medication) and risk factors. In 2010 to 2011, 837 men without a prior diagnosis of OSA underwent full in-home unattended polysomnography of whom 739 recorded ≥ 30 min of REM sleep. Hypertension at follow-up (concomitant with OSA status) was defined as prevalent hypertension. Recent-onset hypertension was defined as hypertension at biomedical follow-up (56 months mean follow-up [range, 48-74]) in men free of hypertension at baseline. RESULTS Severe REM OSA (apnea hypopnea index ≥30/h) showed independent adjusted associations with prevalent (OR, 2.40, 95% CI, 1.42-4.06), and recent-onset hypertension (2.24 [1.04-4.81]). Significant associations with non-REM AHI were not seen. In men with AHI < 10, REM OSA (apnea hypopnea index) ≥ 20/h was significantly associated with prevalent hypertension (2.67 [1.33-5.38]) and the relationship with recent-onset hypertension was positive but not statistically significant (2.32 [0.79-6.84]). Similar results were seen when analyses were confined to men with non-REM AHI < 10. CONCLUSIONS In men not considered to have OSA (AHI < 10), hypertension was associated with OSA during REM sleep. REM OSA may need consideration as an important clinical entity requiring treatment but further systematic assessment and evidence is needed.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia; The NHMRC Centres of Research Excellence, CIRUS and NEUROSLEEP, Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, NSW, Australia
| | - Sean A Martin
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Carol J Lang
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Anne W Taylor
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia
| | - Nick A Antic
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Sleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia
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Handelsman DJ, Yeap B, Flicker L, Martin S, Wittert GA, Ly LP. Age-specific population centiles for androgen status in men. Eur J Endocrinol 2015; 173:809-17. [PMID: 26385186 DOI: 10.1530/eje-15-0380] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/18/2015] [Indexed: 01/14/2023]
Abstract
AIM The age-specific population profiles in men of circulating testosterone and its two bioactive metabolites dihydrotestosterone (DHT) and estradiol (E2) across the adult lifespan and its determinants are not well described. OBJECTIVE Our objective was to deduce smoothed age-specific centiles of circulating testosterone, DHT, and E2 in men using pooled data from population-based studies in three Australian cities from liquid chromatography-mass spectrometry steroid measurements in a single laboratory. DESIGN, SETTING, AND PARTICIPANTS We pooled data of 10 904 serum samples (serum testosterone, DHT, E2, age, height, and weight) from observational population-based studies in three major cities across Australia. MAIN OUTCOME MEASURES Age-specific smoothed centiles for serum testosterone, DHT, and E2 in men aged 35-100 years were deduced by large sample data analysis methods. RESULTS We found that serum testosterone, DHT, and E2 decline gradually from ages 35 onwards with a more marked decline after 80 years of age. Higher weight, BMI, and body surface area as well as shorter stature are associated with reduced serum testosterone, DHT, and E2. CONCLUSIONS Among Australian men, there is a gradual progressive population-wide decline in androgen status during male aging until the age of 80 years after which there is a more marked decline. Obesity and short stature are associated with reduced androgen status. Research into the age-related decline in androgen status should focus on the progressive accumulation of age-related comorbidities to better inform optimal clinical trial design.
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Affiliation(s)
| | - B Yeap
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
| | - L Flicker
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
| | - S Martin
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
| | - G A Wittert
- AndrologyANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, AustraliaSchool of Medicine and PharmacologyUniversity of Western Australia, Perth, Western Australia, AustraliaDepartment of Endocrinology and DiabetesFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Centre for Health and AgingCentre for Medical Research, University of Western Australia, Perth, Western Australia, AustraliaDiscipline of MedicineUniversity of Adelaide, Adelaide, South Australia, Australia
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Walsh TP, Gill TK, Evans AM, Yaxley A, Shanahan EM, Hill CL. Association of Fat Mass and Adipokines With Foot Pain in a Community Cohort. Arthritis Care Res (Hoboken) 2015; 68:526-33. [PMID: 26315271 DOI: 10.1002/acr.22719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/03/2015] [Accepted: 08/18/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine, first, if fat mass index (FMI) or fat-free mass index (FFMI) and serum adipokines tumor necrosis factor (TNF) and interleukin-6 (IL-6) are associated with prevalent (stage 2) foot pain, and, second, if they are predictive of future (stage 3) foot pain. METHODS A subset of participants ages ≥50 years (n = 1,462) from the North West Adelaide Health Study were used for this study. Participants from this community cohort were asked in stage 2 (2004-2006) and stage 3 (2008-2010) if they had foot pain, aching, or stiffness. In stage 2, serum adipokines and anthropometry were measured, while body composition was analyzed with dual x-ray absorptiometry. These variables, along with comorbidities and social history, were used in logistic regression analyses to determine if FMI, FFMI, and serum adipokines were associated with foot pain. RESULTS Prevalent foot pain was present in 20.2% of participants, and future foot pain in 36.4%. Following multivariate modeling, the odds of having pain at stage 2 increased by 8% for each FMI unit (odds ratio [OR] 1.08, 95% confidence interval [95% CI] 1.04-1.12), while the odds of having pain at stage 3 increased by 6% for each FMI unit at stage 2 (OR 1.06, 95% CI 1.02-1.11). TNF level, IL-6 level, and FFMI were not associated with pain. CONCLUSION Increased FMI, but not body mass index, FFMI, or TNF or IL-6 level, was associated with both prevalent and future foot pain. These results suggest that body fat may be more important than body weight with respect to foot pain. The role played by other adipokines requires further investigation.
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Affiliation(s)
- Tom P Walsh
- Flinders University, Bedford Park, South Australia, Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Tiffany K Gill
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Alison Yaxley
- Flinders University, Bedford Park, South Australia, Australia
| | - E Michael Shanahan
- Flinders University, Bedford Park, South Australia, Australia, and Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Catherine L Hill
- University of Adelaide, Adelaide, South Australia, Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Appleton SL, Vakulin A, McEvoy RD, Wittert GA, Martin SA, Grant JF, Taylor AW, Antic NA, Catcheside PG, Adams RJ. Nocturnal Hypoxemia and Severe Obstructive Sleep Apnea are Associated with Incident Type 2 Diabetes in a Population Cohort of Men. J Clin Sleep Med 2015; 11:609-14. [PMID: 25766697 DOI: 10.5664/jcsm.4768] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Studies examining the longitudinal association of untreated obstructive sleep apnea (OSA) with diabetes in population samples are limited. This study therefore examined the relationship between previously undiagnosed OSA with incident type 2 diabetes in community-dwelling men aged ≥ 40 y. METHODS The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study is a longitudinal population-based cohort in Adelaide, South Australia. Clinic assessments at baseline and follow-up identified diabetes (self-reported doctor diagnosed, fasting plasma glucose ≥ 7.0 mmol/L, glycated hemoglobin ≥ 6.5% or diabetes medication use) and included anthropometry. At cohort follow-up (2010-2012), n = 837 underwent full in-home unattended polysomnography (PSG, Embletta X100, Broomfield, CO). RESULTS Of 736 men free of diabetes at baseline, incident diabetes occurred in 66 (9.0%) over a mean follow-up time of 56 mo (standard deviation = 5, range: 48-74 mo). Incident diabetes was associated with current oxygen desaturation index (3%) ≥ 16 events/h (odds ratio [OR]: 1.85 [1.06-3.21]), and severe OSA [OR: 2.6 (1.1-6.1)], in adjusted models including age, percentage total body fat, and weight gain (> 5 cm waist circumference). An age-adjusted association of incident diabetes with percentage of total sleep time with oxygen saturation < 90% did not persist after adjustment for percentage of body fat. No modification of these relationships by excessive daytime sleepiness was observed. CONCLUSIONS Severe undiagnosed OSA and nocturnal hypoxemia were independently associated with the development of diabetes. A reduction in the burden of undiagnosed OSA and undiagnosed diabetes is likely to occur if patients presenting with one disorder are assessed for the other.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet F Grant
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nick A Antic
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
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Appleton SL, Vakulin A, McEvoy RD, Vincent A, Martin SA, Grant JF, Taylor AW, Antic NA, Catcheside PG, Wittert GA, Adams RJ. Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort. Sleep Breath 2015; 19:1309-16. [DOI: 10.1007/s11325-015-1171-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/15/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
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Bai PY, Wittert GA, Taylor AW, Martin SA, Milne RW, Shi Z. The association of socio-demographic status, lifestyle factors and dietary patterns with total urinary phthalates in Australian men. PLoS One 2015; 10:e0122140. [PMID: 25875472 PMCID: PMC4398403 DOI: 10.1371/journal.pone.0122140] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/11/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate the associations between socio-demographic status, lifestyle factors, dietary patterns and urinary total phthalate concentration in a cohort of South Australian men. METHOD We randomly selected 1527 males aged 39 to 84 from wave two of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. Total phthalate concentration was examined in fasting morning urine samples. Socio-demographic and lifestyle factors were assessed by questionnaire. Food intake was assessed by food frequency questionnaire (FFQ). Dietary patterns were constructed using factor analysis. RESULTS Total phthalates were detected in 99.6% of the urine samples. The overall geometric mean (95% CI) of total phthalate concentration was 112.4 (107.5-117.5) ng/mL. The least square geometric means (LSGMs) of total phthalate concentration were significantly higher among people who were obese (127.8 ng/mL), consuming less than two serves fruit per day (125.7 ng/mL) and drinking more than one can (375mL) of carbonated soft drink per day (131.9 ng/mL). Two dietary patterns were identified: a prudent dietary pattern and a western dietary pattern. Both the western dietary pattern (p = 0.002) and multiple lifestyle risk factors including smoking, obesity, insufficient physical activity and the highest quartile of the western dietary pattern (p<0.001), were positively associated with total phthalate levels. There was no significant relationship between total phthalate concentration and socio-demographic status. CONCLUSION Phthalate exposure is ubiquitous and positively associated with lifestyle risk factors in urban dwelling Australian men.
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Affiliation(s)
- Peter Y. Bai
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- * E-mail:
| | - Gary A. Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W. Taylor
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A. Martin
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert W. Milne
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zumin Shi
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Tully PJ, Baumeister H, Bengel J, Jenkins A, Januszewski A, Martin S, Wittert GA. The longitudinal association between inflammation and incident depressive symptoms in men: the effects of hs-CRP are independent of abdominal obesity and metabolic disturbances. Physiol Behav 2014; 139:328-35. [PMID: 25460540 DOI: 10.1016/j.physbeh.2014.11.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND This cohort study evaluates whether the association between low-grade inflammation and incident depressive symptoms is independent of abdominal obesity and metabolic disturbances. METHODS A cohort of 1167 non-depressed men aged 35 to 80 years were followed up over 5 years to assess incident depressive symptoms measured by the Centre for Epidemiology Scale-Depression or Beck Depression Inventory-I. Venous tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) were quantified at baseline and 5years. Logistic regression determined whether hsCRP, IL-6 and TNF-α were associated with incident depressive symptoms independent of abdominal obesity and metabolic factors. Ancillary analysis utilizing depression z scores stratified participants by waist circumference ≥ 102 cm and ≥2 metabolic disturbances. RESULTS Incident depressive symptoms occurred in 95 men at 5 years (8.14% of total). Clinically relevant depressive symptoms were associated with baseline hsCRP (adjusted OR=1.04; 95% CI 1.00-1.07, p=.03) and annualized ΔhsCRP (adjusted OR=1.04; 95% CI 1.01-1.08, p=.02). Ancillary analysis showed that the association between annualized ΔhsCRP and depression z score was only significant in men with waist circumference<102 cm (β=.19, p<.001) and ≤1 metabolic disturbance (β=.18, p<.001). None of the measured cytokines were significantly associated with depression. CONCLUSIONS hsCRP and annualized ΔhsCRP were positively associated with depressive symptoms in a cohort of men. Further investigation into the role of abdominal obesity and metabolic disturbances in the inflammation-depression hypothesis is warranted.
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Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany; Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Alicia Jenkins
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | | | - Sean Martin
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
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On Treating Athletes with Banned Substances: The Relationship Between Mild Traumatic Brain Injury, Hypopituitarism, and Hormone Replacement Therapy. NEUROETHICS-NETH 2014. [DOI: 10.1007/s12152-014-9215-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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