Association Of Obstructive Sleep Apnea With The Risk Of Male Infertility In Taiwan

Importance Obstructive sleep apnea (OSA) has been proposed as a risk factor in infertility. However, to date, the association between OSA and male infertility has not been examined in a population-based study. Objective To investigate the risk factor of OSA in male infertility and the outcome of OSA treatment for the risk of male infertility. Design, Setting, and Participants This case-control population-based study collected data from the Longitudinal Health Insurance Database, a subset of the National Health Insurance Research Database in Taiwan. Male patients with a diagnosis of infertility and at least 3 outpatient visits or 1 hospitalization between January 1, 2000, and December 31, 2013, were included and matched by age, sex, and date of infertility diagnosis with individuals without an infertility diagnosis. Data analysis was performed from October 22, 2018, to April 22, 2019. Exposures Patients with male infertility and randomly selected patients without male infertility were matched using a 1:4 propensity score matching ratio. Main Outcomes and Measures A primary outcome was the risk factor of OSA (diagnosed through polysomnography). A secondary outcome was the association of the risk of male infertility with OSA exposure time interval (short term, middle term, and long term) and OSA management (ie, none, continuous positive airway pressure, uvulopalatopharyngoplasty, or both). Results A total of 4607 male patients with infertility (mean [SD] age, 34.18 [5.44] years) and 18 428 control patients (mean [SD] age, 34.28 [5.81] years) were included. In the multivariate conditional logistic regression analysis, OSA was an independent risk factor associated with infertility (adjusted odds ratio [OR], 1.24; 95% CI, 1.10-1.64; P = .003). The absolute risk was 0.204 (95% CI, 0.092-0.391). For patients with OSA in the group without treatment, the adjusted OR was 1.80 (95% CI, 1.56-2.07; P < .001) for infertility compared with patients without OSA. Conclusions and Relevance Results of this study support the hypothesis that OSA increases the risk of infertility in male patients, and the risk is associated with the OSA exposure time. Furthermore, no OSA management or treatment is associated with a higher infertility risk.This case-control study examines the demographic variables, comorbidities, exposure to obstructive sleep apnea, and obstructive sleep apnea therapies in adult men with or without an infertility diagnosis.Question What is the association between obstructive sleep apnea and male infertility? Findings In this large case-control study of 4607 men with infertility and 18 428 control patients, obstructive sleep apnea was associated with a 1.24-fold higher risk of developing infertility. Meaning Findings from this study suggest that sleep disturbance, including obstructive sleep apnea, has an association with metabolic and neurocognitive functions and that obstructive sleep apnea increases the risk of infertility in men.