Introduction: Secondary polycythemia is a well-known complication of obstructive sleep apnea (OSA), a disorder that increases in incidence with age. Similarly, increased recognition of low testosterone and its associated symptoms in aging men has led to increased administration of testosterone replacement therapy (TRT), which has also been associated with secondary polycythemia. We hypothesized that given the common association of aging with OSA and testosterone deficiency, a significant percentage of men with OSA would carry concurrent diagnoses of testosterone deficiency and secondary polycythemia. The objective of this study was to investigate the epidemiology of men with OSA, secondary polycythemia, and testosterone deficiency in men using a large electronic health record network.
Methods: We performed a real-time search for adult men (18+) with a diagnosis of obstructive sleep apnea (ICD-10-CM G47.33) in the TriNetX network, which provides health record data for more than 75 million patients from 48 healthcare organizations. This cohort was used to separately identify men with testosterone deficiency, as defined by those with a diagnosis of testicular dysfunction or hypofunction (ICD-10-CM E29, E29.1), and secondary polycythemia (ICD-10-CM D75.1). Lastly, we queried the network for men with all three diagnoses: OSA, testosterone deficiency, and secondary polycythemia. All men with diagnosis of polycythemia vera or familial erythrocytosis were removed from the analysis to account for men with concurrent primary polycythemia.
Results: A total of 1,166,640 men with a diagnosis of OSA were identified in the network. Mean age of men with OSA was 61 [46 – 76]. Among men with OSA, 6.0% of men had testosterone deficiency (TT < 300ng/dL), and 1.3% of men had associated polycythemia (Hct > 52%). Interestingly, only 3,562 (0.3%) of men in the network had all three diagnoses of obstructive sleep apnea, testosterone deficiency, and secondary polycythemia. Strengths of this study include use of a large and heterogenous study population and adjustment for other causes of polycythemia. Limitations include lack of data on chronology of diagnoses, inconsistent data recording, and missing data.
Conclusions: In a large, cross-sectional, multicenter electronic health record study, we found that 6.0% of men with OSA will have testosterone deficiency. Reassuringly, only 0.3% of men carry all diagnoses of obstructive sleep apnea, testosterone deficiency, and secondary polycythemia. Nevertheless, men with OSA who receive TRT warrant close follow-up for potentially dangerous increases in hematocrit when considering treatment for testosterone deficiency.
Source of Funding: This work was supported by National Institutes of Health Grant R01 DK130991 and the Clinician Scientist Development Grant from the American Cancer Society to Ranjith Ramasamy.