Does testosterone influence the association between sleep and frailty in men: results from the European Male Aging Study.

Seema D Sharma, Michael J Cook, Leen Antonio, Evelien Gielen, Gyorgy Bartfai, Felipe F Casanueva, Ilpo T Huhtaniemi, Mario Maggi, Margus Punab, Giulia Rastrelli, Jolanta Slowikowska-Hilczer, Jos Tournoy, Dirk Vanderschueren, Frederick C Wu, Terence W O'Neill

Journal: BMC geriatrics 2023;23(1):813

PMID: 38057724

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Abstract

BACKGROUND

Previous studies have suggested an association between sleep disturbance and frailty. The mechanism is unknown, although it has been suggested that hormonal factors may play a role.

METHODS

The aim was to determine the association between sleep duration, sleep quality and frailty, and to determine whether testosterone influenced this association. Males aged 40-79 years were recruited from eight European centres to the European Male Aging Study (EMAS). Subjects completed an interviewer-assisted questionnaire including questions regarding sleep quality and duration. Sleep quality was scored 0-20 and categorised as 0-4, 5-9, 10-14, and 15-20, with higher scores indicating poorer quality. A 39-component frailty index (FI) was constructed. Total testosterone levels were measured. The association between sleep duration, sleep quality and the FI was assessed using negative binomial regression, with adjustment for putative confounders including testosterone level.

RESULTS

Two thousand three hundred ninety-three participants contributed data to the analysis. The mean age was 63.3 years and mean sleep duration was 7.01 h. The mean frailty index was 0.15. Mean testosterone levels declined with decreasing sleep quality. After adjustment, compared to those with a sleep score of 0-4, the FI was 57% (95% CI 38%, 78%) higher among those with a sleep score of 15-20. After adjustment compared to those with normal sleep duration (6-9 h), those with a short (< 6 h) and long (≥ 9 h) sleep duration had a 16% (95% CI 6%, 28%) and 11% (95% CI 0%, 23%) higher FI, respectively. Adjustment for testosterone did not influence the strength of either association.

CONCLUSION

Frailty is associated with impaired sleep quality and sleep duration. The association cannot, however, be explained by variation in testosterone levels.

Address: Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, University of Manchester, The Stopford Building, Oxford Road, Manchester, M13 9PT, UK. [email protected].; Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, University of Manchester, The Stopford Building, Oxford Road, Manchester, M13 9PT, UK.; Department of Clinical and Experimental Medicine, KU Leuven, Laboratory of Clinical and Experimental Endocrinology, Louvain, Belgium.; Department of Endocrinology, University Hospitals Leuven, Louvain, Belgium.; Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Louvain, Belgium.; Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary.; Department of Medicine, CIBER de Fisiopatología Obesidad y Nutricion, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), Instituto Salud Carlos III, CB06/03, Santiago de Compostela, Spain.; Institute of Reproductive and Developmental, Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London, UK.; Andrology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.; Andrology Clinic, Tartu University Hospital, Tartu, Estonia.; Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.; Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.; Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland.; Department of Geriatrics, University Hospitals Leuven, Louvain, Belgium.; Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium.; Department of Endocrinology, Manchester University NHS Foundation Trust, Manchester, UK.; NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.

DOI: 10.1186/s12877-023-04450-8

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MeSH Terms: Aged, Humans, Male, Frailty, Frail Elderly, Testosterone, Aging, Sleep