阻塞性睡眠呼吸中止症對男性下泌尿道症狀與激素調節之影響：依年齡與嚴重度分層之研究

陳冠宇^1,3、黃玉慧^1,2,3、楊旻鑫^1,3、何承儒^1,3、陳順郎^1,3

¹中山醫學大學附設醫院泌尿科 ²中山醫學大學附設醫院復健醫學部 ³中山醫學大學醫學院

Age- and Severity-Stratified Impact of Obstructive Sleep Apnea on Lower Urinary Tract Symptoms and Hormonal Regulation in Men

Kuan Yu Chen^1,3, Yu Hui Huang^1,2,3, Ming Hsin Yang^1,3, Cheng Ju Ho^1,3, Sung Lang Chen^1,3

¹Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan. ²Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung ³School of Medicine, Chung Shan Medical University Hospital, Taichung,

Purpose:

This study investigated the complex interplay between polysomnographic (PSG) parameters, International Prostate Symptom Score (IPSS) subdomains, and hormonal/electrolyte markers in men with suspected obstructive sleep apnea (OSA). We hypothesized that age and disease severity stratification would reveal phenotype-specific associations that are often obscured in unstratified analyses.

Materials and Methods:

A total of 104 men (mean age 60.8±9.8 years) attended overnight PSG. Participants were stratified by age (<60 vs. ≥60 years) and respiratory disturbance index (RDI) severity. We analyzed correlations between PSG indices, IPSS subdomains (irritative, obstructive, QoL), and markers including antidiuretic hormone (ADH) and plasma renin activity (PRA). A subset of 62 patients completed frequency-volume charts to calculate the nocturnal polyuria index (NPI).

Results:

The prevalence of nocturia was 61.5%. Compared to mild OSA, severe OSA was associated with significantly higher total IPSS (14.5±6.2 vs. 10.5±4.8, p=0.028) and increased nocturia frequency (3.5±1.7 vs. 2.4±1.1, p=0.02). Age-stratified analysis revealed: (1) Younger men (<60 years): Severe RDI demonstrated a very strong correlation with the IPSS obstructive subscore (r_p=0.96, q=0.012) and weak urinary stream (r_p=0.94, q=0.015). (2) Older men (≥60 years): Sleep continuity metrics, specifically sleep efficiency (r_p=0.48) and total sleep time (r_p=0.46), were primarily linked to LUTS-related QoL impairment. Hormonal assessment showed morning ADH levels were significantly suppressed in severe OSA (1.4±0.8 vs. 2.7±1.1 pg/mL, p=0.03), which correlated with nocturnal polyuria (NPI ≥0.33).

Conclusion:

OSA severity and age significantly modulate the urological presentation. In younger men, intermittent hypoxia potentially drives obstructive symptoms through sympathetic overactivity and increased alpha-adrenergic tone in the prostate. In older men, sleep fragmentation is the dominant factor impacting QoL. The suppression of ADH in severe cases underscores nocturnal polyuria as a primary mechanistic pathway. These findings advocate for integrated PSG-IPSS screening to facilitate personalized adjunct therapies, such as alpha-blockers for younger obstructive-dominant patients or biomarker-guided desmopressin for those with ADH deficiency.