Stress Hormone Dysregulation in Overweight Male Adults with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) may influence the hypothalamic-pituitary-adrenal (HPA) axis and result in subsequent physiological dysregulation. Given the inconsistent findings of the current literature and the lack of investigations on stress hormones, this study explored the potential impact of OSA on stress markers of adrenocroticotrophic hormone (ACTH), cortisol, and dehydroepiandrosterone (DHEA)/DHEA-S in male overweight OSA patients.

This prospective, single-blind, cross-sectional study enrolled male overweight (body mass index >25 kg/m2) OSA patients. The patients were grouped into mild/moderate and severe OSA groups based on the apnea/hypopnea index to investigate the differences in stress hormones. The inter-relationships among ACTH, cortisol, and DHEA in both groups were further analyzed in detail with Pearson's correlations to determine the potential impact of OSA severity.

Overall, 144 subjects were recruited. DHEA in saliva and serum DHEA-S were found significantly lower in the severe OSA group compared to the mild/moderate OSA group. Pearson's correlations demonstrated that in both groups, ACTH and cortisol concentrations (morning and night) showed significant positive correlations. Significant relationships between night ACTH and DHEA-S in saliva (r = 0.368, p = 0.023) and blood (r = 0.361, p = 0.017) were also found in mild/moderate OSA group, but neither was noted in the severe group.

Severe OSA may impact the HPA axis by reducing concentrations of DHEA and DHEA-S without affecting cortisol and ACTH concentrations in male overweight OSA patients. This could possibly imply the dysregulation of DHEA/DHEA-S production in a much severe sleep disturbance situation.