Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Should we screen for sleep apnoea in men with idiopathic infertility?

Nature Reviews Urology (2025)Cite this article

Subjects

Despite major advances in reproductive medicine, the causes of male infertility remain undefined in a substantial proportion of patients. Here, we respond to the recent Review by Tessa Lord (Pathophysiological effects of hypoxia on testis function and spermatogenesis. Nat. Rev. Urol. 22, 470–488; 2025)1, in which the pathophysiological effects of hypoxia on testicular function and spermatogenesis are explored. This work highlights the biological complexity of testicular oxygen homeostasis and its clinical relevance.

Building upon these findings, we wish to underscore the clinical importance of one of the factors discussed, namely sleep apnoea, which is a modifiable source of testicular hypoxia that remains under-recognized2. In particular, we focus on obstructive sleep apnoea (OSA), which has been an important area of research for our group. In today’s increasingly sedentary, chronically sleep-deprived and metabolically compromised society, the prevalence of OSA is rising3. Modern populations sleep less than ever before, with shortened sleep duration now being linked to weight gain, insulin resistance and systemic inflammation, among other conditions4. Evidence from an ongoing population-based study by the São Paulo Epidemiologic Sleep Study (EPISONO) shows that almost 33% of adult men have some degree of OSA3, suggesting a silent epidemic with potential reproductive consequences.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Lord, T. Pathophysiological effects of hypoxia on testis function and spermatogenesis. Nat. Rev. Urol. 22, 470–488 (2025).

    Article  PubMed  Google Scholar 

  2. Li, Z. et al. Effects of environmental and pathological hypoxia on male fertility. Front. Cell Dev. Biol. 9, 725933 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tufik, S., Santos-Silva, R., Taddei, J. A. & Bittencourt, L. R. A. Obstructive sleep apnea syndrome in the São Paulo Epidemiologic Sleep Study. Sleep Med. 11, 441–446 (2010).

    Article  PubMed  Google Scholar 

  4. Patel, S. R. & Hu, F. B. Short sleep duration and weight gain: a systematic review. Obesity 16, 643–653 (2008).

    Article  PubMed  Google Scholar 

  5. Lv, R. et al. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct. Target. Ther. 25, 218 (2023).

    Article  Google Scholar 

  6. Torres, M. et al. Male fertility is reduced by chronic intermittent hypoxia mimicking sleep apnea in mice. Sleep 37, 1757–1765 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Andersen, M. L., Gozal, D., Pires, G. N. & Tufik, S. Exploring the interactions between obstructive sleep apnea, erectile dysfunction and gut microbiota: a narrative review. Sex. Med. Rev. 12, 76–86 (2023).

    Article  PubMed  Google Scholar 

  8. Skoracka, K., Eder, P., Łykowska-Szuber, L., Dobrowolska, A. & Krela-Kaźmierczak, I. Diet and nutritional factors in male (in)fertility—underestimated factors. J. Clin. Med. 9, 1440 (2020).

    Article  Google Scholar 

  9. Wang, X. et al. Hypoxia reduces testosterone synthesis in mouse Leydig cells by inhibiting NRF1-activated StAR expression. Oncotarget 8, 16401–16413 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Travicic, D. Z., Miljkovic, D., Andric, S. A. & Kostic, T. S. Circadian disruption impairs Leydig cell maturation and reproductive development in male rats. Reprod. Biol. Endocrinol. 23, 104 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cojocaru, C., Cojocaru, E., Pohaci-Antonesei, L.-S., Pohaci-Antonesei, C.-A. & Dumitrache-Rujinski, S. Sleep apnea syndrome associated with gonadal hormone imbalance (review). Biomed. Rep. 19, 101 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Cavalhas-Almeida, C. et al. Sleep and male (in)fertility: a comprehensive overview. Sleep Med. Rev. 81, 102080 (2025).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the Associação Fundo de Incentivo à Pesquisa (AFIP) for institutional support. S.T. and M.L.A. are recipients of fellowships from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). M.L.A. is also supported by a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, grant no. 2020/13467-8).

Author information

Authors and Affiliations

  1. Associação Fundo de Incentivo à Pesquisa (AFIP), Sleep Institute, São Paulo, Brazil

    Tathiana A. Alvarenga, Sergio Tufik & Monica Levy Andersen

  2. Departamento de Cirurgia, Disciplina de Urologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

    Matheus Brandão Vasco

  3. Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

    Bianca Camilo Schimenes, Sergio Tufik & Monica Levy Andersen

Authors
  1. Tathiana A. Alvarenga
    View author publications

    Search author on:PubMed Google Scholar

  2. Matheus Brandão Vasco
    View author publications

    Search author on:PubMed Google Scholar

  3. Bianca Camilo Schimenes
    View author publications

    Search author on:PubMed Google Scholar

  4. Sergio Tufik
    View author publications

    Search author on:PubMed Google Scholar

  5. Monica Levy Andersen
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Monica Levy Andersen.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alvarenga, T.A., Vasco, M.B., Schimenes, B.C. et al. Should we screen for sleep apnoea in men with idiopathic infertility?. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01093-9

Download citation

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41585-025-01093-9

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing