Impact of long-term gonadotropin replacement treatment on sleep in men with idiopathic hypogonadotropic hypogonadism.

ABSTRACT

INTRODUCTION: Concern has been expressed in recently published literature that gonadotropin replacement therapy (GnRT) in hypogonadism may alter sleep architecture and induce, or worsen, obstructive sleep apnea (OSA). AIM: To investigate the sleep stages and sleep-breathing parameters in young men with idiopathic hypogonadotropic hypogonadism (IHH)-a treatable form of male infertility and sexual dysfunction-before and 12 months following GnRT. METHODS: Sixteen male patients with IHH (mean age 27.5 ± 10.5 years, range 17-48 years) and 16 individually age-matched healthy men were included in the study. Human chorionic gonadotropin (HCG) was administered 1,500 U intramuscularly three times/week for 6 months, and then 75 U twice/week, recombinant follicle stimulating hormone (FSH) was added to HCG for the following 6 months. Polysomnography (PSG) recordings were performed at baseline in all and following the GnRT in the patient group. MAIN OUTCOME MEASURES: Sleep stages and sleep-breathing parameters on PSG. RESULTS: Patients with IHH had a higher percentage of slow-wave-sleep (SWS) (22.3 ± 6.3%) compared to that in the healthy controls (14.5 ± 9.5%; P = 0.009). Four patients and one control subject had OSA (Apnea-Hypopnea Index [AHI] > 5(-h) ) at baseline (not significant). Following the GnRT in the patient group, there was a slight decrease in SWS (18.6 ± 6.4%; P = 0.05) without any significant changes regarding the sleep-breathing parameters in the whole patient group. However, of the four patients with OSA at baseline, the GnRT was associated with worsening of the AHI in three of them. CONCLUSIONS: IHH in men is associated with a higher percentage of SWS. One-year GnRT slightly decreases SWS and does not induce OSA. However, in patients with OSA at baseline long-term GnRT should be exercised with caution.