Sleep Apnea in Men
Obstructive sleep apnea is repeated collapse of the airway during sleep, causing breathing pauses. It is markedly more common in men, per the 2017 AASM diagnostic guideline.
Symptoms
Loud snoring, witnessed breathing pauses, gasping awakenings, unrefreshing sleep, and daytime sleepiness -- often noticed by a partner before the patient themselves.
Causes and risk
Obesity and a larger neck circumference (over 17 inches in men) are the leading risk factors, per a 2021 AHA scientific statement. Testosterone therapy is a less-appreciated risk factor -- it can increase tongue and airway muscle mass and worsen OSA severity, worth mentioning if you are on or considering TRT.
How it is evaluated
A home sleep apnea test is appropriate for men with a high pre-test likelihood and no complicating conditions; in-lab polysomnography follows a negative home test that doesn't match the clinical picture, per the AASM 2017 guideline.
Treatment
CPAP is first-line and most effective when used consistently. Weight loss meaningfully reduces severity, and oral appliances or positional therapy help select men who can't tolerate CPAP. No OSA therapy has demonstrated a mortality benefit in randomized trials per the current evidence, so treatment is aimed at symptoms and cardiovascular risk reduction, not a survival claim.
When to seek care
OSA itself is not an emergency, but severe daytime sleepiness affecting safe driving, or chest pain, needs prompt attention.