Association of nocturnal hypoxemia and benign prostatic hyperplasia in patients with obstructive sleep apnea

Background
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder marked by chronic intermittent hypoxia. Chronic intermittent hypoxia has been shown to trigger systemic inflammatory responses, which may result in cellular damage and contribute to the development of benign prostatic hyperplasia (BPH). Our study aimed to explore the potential association between sleep-related hypoxemia and the development of BPH.


Patients and methods
The cross-sectional study included 91 men recruited between May 2023 and April 2024 at our Sleep Center. All participants underwent a full-night polysomnography following history taking, physical examination, and completion of sleep-related questionnaires. Evaluation for BPH was performed using the International Prostate Symptom Score and abdominal ultrasound. Our patients were stratified into two groups (nonsevere and severe OSA) using apnea–hypopnea index (AHI). Then, they were stratified into BPH and the non-BPH groups for further analysis.


Results

Ninety-one patients with OSA were involved in our study (seven mild, 18 moderate, and 66 severe) with a mean age of 53.07 ± 11.85 years. The majority of them were nonsmokers (65.9%). Hypertension was the most common comorbidity, affecting 51.6% of patients. Neck circumference and BMI were significantly higher among severe OSA patients than nonsevere OSA (
P
=0.001). Friedman tongue position score showed a significant difference between the two groups with a
P
value of 0.004. The severe OSA group demonstrated notably higher Epworth Sleepiness Scale and STOP-BANG scores. Also, the severe OSA group exhibited markedly higher AHI, oxygen desaturation index, T90%, T80%, and AHT%, along with significantly lower average and lowest oxygen saturation in comparison to the nonsevere group (all
P
=0.001). The BPH prevalence in our two studied groups was 54.5% in the severe OSA group compared with 20% in the nonsevere group. BPH patients showed significantly higher AHI, oxygen desaturation index, and AHT% compared with non-BPH patients, along with a markedly elevated T90% (
P
=0.005). Both lowest and average oxygen saturation values were significantly reduced in BPH patients (
P
=0.001).



Conclusions
Our study highlights a strong correlation between OSA-induced nocturnal hypoxemia and the development of BPH.