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Re: This may be due to increased testosterone.

Dear Editor

Regarding the article by Wing et al.[1] It is my hypothesis that the percentage of individuals of higher testosterone is increasing worldwide, more in some places than others. I suggest this is the cause of the "secular trend." Among a number of characteristics that may result from this increase in numbers of individuals of higher testosterone, I suggest increasing obesity is one. An obesity epidemic is occurring within children. (See "Obesity Epidemic in Children..." at http://www.anthropogeny.com/research.html)

Wing,et al, report that "sleep disordered breathing," "predominantly obstructive," occurs with greater frequency within obese children. I suggest this may also be due testosterone. Cistulli, et al, reported that in a 13-year-old boy that "Our data strongly suggest that the mechanism by which testosterone administration may induce or exacerbate OSA is through an influence on neuromuscular control of upper airway patency during sleep."[2]

I suggest the findings of Wing, et al, may represent the combined effects of testosterone on "sleep disordered breathing" and obesity in the children of their study.

References

1. YK Wing, SH Hui, WM Pak, CK Ho, A Cheung, AM Li, and TF Fok. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child 2003; 88: 1043-1047

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Re: Author's reply

Dear Editor

Thank you for the useful and thought provoking comment made by JM Howard.[1]

There is no doubt that the control mechanism for childhood obstructive sleep apnoea (OSA) is multifactorial. Obesity as a cause is not simply a mechanical imbalance of the equilibrium and there is increasing evidence to suggest neuromuscular and hormonal factors coming into play. Sex hormone involvement in OSA is better studied in the adult population with oestrogen being suggested as a protective hormone for the condition. The evidence for testosterone however, is still conflicting; Gambineri et al.[2] found a negative correlation between polysomnographic parameters and testosterone levels in a study involving obese OSA men with controls matched for age and anthropometric measures. Luboshitzky et al.[3] suggested that sleep fragmentation and hypoxia actually caused central suppression of testosterone. The jury is still out and we await for further evidence linking testosterone with OSA.

References

(1) Howard JM. This may be due to increased testosterone [electronic response to YK Wing, SH Hui, WM Pak, CK Ho, A Cheung, AM Li, TF Fok; A controlled study of sleep related disordered breathing in obese children] archdischild.com 2004 http://adc.bmjjournals.com/cgi/eletters/archdischild;88/12/1043#596

(2) Gambrineri A, Pelusi C, Pasquali R. Testosterone levels in obese male patients with obstructive sleep apnea syndrome: relation to oxygen desaturation, body weight, fat distribution and the metabolic parameters. J Endocrinol Invest 2003;26(6):493-8.