Sleep apnea, heart health and testosterone: unravelling the triad of well-being

Sleep disorders, cardiovascular diseases (CVDs), and hormonal imbalances, particularly with respect to testosterone levels, are closely interconnected and significantly impact public health. This review examines the complex interactions between these 3 factors. Poor sleep quality and conditions like obstructive sleep apnea (OSA) are prevalent among individuals with CVDs and contribute to cardiovascular pathology through several mechanisms, including sympathetic activation, oxidative stress, and systemic inflammation. Testosterone plays a critical role in metabolic regulation, muscle and bone health, and mood. Low testosterone levels are associated with increased CVD risk factors like insulin resistance and arterial stiffness. Substantial evidence suggests that sleep disorders may impair testosterone levels, partially improved after specific treatments (for instance: positive airway pressure for OSA). On the other hand, appropriate indications for testosterone replacement therapy (TRT) can alleviate hypogonadism symptoms and cardiometabolic dysfunction, but may increase the risk of OSA, requiring careful management. This narrative review highlights the importance of a holistic approach in managing sleep disorders, CVDs, and hormonal imbalances and emphasises the need for further research to improve patient outcomes.