Obstructive sleep apnoea is associated with reduced semen quality and compartmentalized seminal inflammation: A prospective cohort with non-randomized CPAP follow-up

Obstructive sleep apnoea (OSA) is associated with systemic inflammation and male reproductive dysfunction, but its relationship with semen quality and local seminal inflammation remains unclear.

To investigate the associations of OSA with semen parameters, erectile function, and inflammatory profiles, and to assess longitudinal changes in these markers following continuous positive airway pressure (CPAP) therapy.

This prospective study enrolled 72 reproductive-aged men with OSA and 22 non-OSA controls. Polysomnography was performed at baseline only. During CPAP follow-up, treatment efficacy was ascertained from device-recorded hours of use and residual apnoea-hypopnoea index. Erectile function (IIEF-5), semen quality, and serum/seminal cytokines were assessed.

Compared with controls, OSA patients showed significantly lower total and progressive sperm motility and semen volume, along with elevated seminal IL-1β, IL-6, IL-10, and IL-17A, without corresponding changes in serum cytokines or erectile function. During CPAP follow-up, adherent patients demonstrated early improvements in progressive sperm motility as early as 1 month post-treatment. Sleep architecture disruption and local seminal inflammation were independently associated with reduced semen quality.

OSA is associated with reduced semen quality and localized seminal inflammation, without corresponding systemic or erectile changes. CPAP therapy is accompanied by longitudinal improvements in sperm motility, suggesting that evaluation for sleep-disordered breathing may be considered an exploratory assessment in men presenting with unexplained semen abnormalities.