The Effect Of Sleep On Male Reproductive System

About 12 percent to 15 percent of couples worldwide suffer from infertility, of which 45 percent to 50 percent are infertility caused by male factors, and about 7 percent of men worldwide are diagnosed with infertility [1-2 ]. The WHO defines infertility as the inability to conceive after at least 12 months of regular sex without contraceptives. At present, infertility has become a major health problem worldwide. Epidemiological studies on male reproductive function are increasingly more and more attention [3-4]. Although infertile couples can conceive through assisted reproductive technology (ART), the assessment of male reproductive function is still important. Semen parameter analysis, reproductive hormone assessment, and history of sexual dysfunction are all common assessments of male reproductive function. item [5].

Sleep is a basic human need, but with the advancement of science and technology and the accelerated pace of life, people's sleep problems have gradually increased, and the public has become more and more aware of the importance of adequate sleep [6]. Shift work, obstructive sleep apnea, and other sleep disorders may contribute to the metabolic syndrome closely related to male sex hormone alterations, with men affected by sleep deprivation exhibiting markedly decreased testosterone levels or hypogonadism [7]. The effect of sleep on male reproductive function is becoming a research hotspot in the field of reproductive medicine. This paper systematically summarizes the effect of sleep on male reproductive function from three aspects: sleep duration, sleep disturbance and circadian rhythm disturbance, providing new insights for the treatment of male infertility. The ideas and new methods may have important theoretical and practical significance for promoting basic research and clinical diagnosis of male reproductive health in my country.

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1. Sleep duration and male reproductive function

Healthy sleep requires adequate time, good quality, proper timing and regularity, and the absence of sleep disturbances or disturbances. Sleep duration is the most commonly investigated health-related measure of sleep. The American Academy of Sleep Medicine (AASM), the Sleep Research Society (SRS), and the National Sleep Foundation (NSF) issued a statement in 2015: Adults should get a regular 7-9 hours of sleep per night to promote optimal health, and every night Sleeping less than seven hours later may be associated with obesity, diabetes, hypertension, heart disease, stroke, depression, infertility, and an increased risk of death [8,9].

1. The effect of sleep duration on male semen parameters

Male fertility depends on the quantity and quality of his sperm, and poor semen quality is associated with reduced fertility, therefore, semen analysis is often used as a tool to assess fertility or find potential causes of infertility [10-11].

The analysis of semen parameters is the cornerstone of laboratory evaluation, which reflects the ability of testicular sperm production, the patency of the ductal system and the secretion activity of the accessory glands. Laboratory Manual 5th edition (sperm volume Greater than or equal to 1.5mL, sperm concentration Greater than or equal to 15×106/mL, total sperm count Greater than or equal to 39×106/mL, sperm forward motility rate Greater than or equal to 32 percent , total sperm motility Greater than or equal to 58 percent )[12- 13].

Liu Peiyi et al[14] conducted a cross-sectional study on the correlation between nighttime sleep duration, sleep onset time, and semen quality in men. The results showed that in people over 40 years old and overweight, nocturnal sleep duration Greater than or equal to 8 h was associated with sperm forward motility rate. associated with lower overall activity rates. Chen et al. [15] aimed at sleep

A series of studies were conducted on the association between sleep behavior and male semen parameters, mainly from the two dimensions of sleep time and sleep duration. Studies have found that reduced sperm counts are associated with sleep behaviors, including too little or too much sleep, midsleep time (the time between the start and end of sleep), and changes in midsleep time (social jet lag) . Men with earlier sleep schedules and later sleep schedules were more prone to sleep deprivation and social jet lag, respectively, both of which were associated with lower sperm counts. Among them, the sleep duration has a significant inverted U-shaped relationship with the semen volume and total sperm count, that is, when the sleep duration is 7.0-7.5 h/d, the semen volume and the total number of sperm reach the highest values, which indicates that short- and long-term sleep will affect both. This results in decreased sperm count and sperm motility, in part due to increased production of anti-sperm antibodies in semen [16]. The research results of Chen et al. [17] also verified this point. Compared with men with a nighttime sleep time of 7.5-8.0 h/d, the total sperm motility and forward motility rate of men with a nighttime sleep time of less than 6.0 h/d were significantly higher. men with a sleep duration of less than 6.0 h/d and greater than 9.0 h/d had lower sperm counts, respectively, compared with men with a total sleep time of 8.0-8.5 h/d, respectively. were 12×106/mL and 3.9×106/mL. The above studies have shown that men should maintain a reasonable amount of sleep every day. Too long (>9 h/d) or too short (<6 h/d)="" sleep="" time="" is="" associated="" with="" impaired="" semen="">

2. The effect of sleep duration on male reproductive hormones

Reproductive hormone assessment is another important tool in male infertility treatment. From a quantitative point of view, the most important reproductive hormone is testosterone. Most of the testosterone released by men every day is released during sleep. It is essential for the development and maintenance of male sexual characteristics, male sexual behavior and reproductive function. reproductive hormones [18]. The assessment of reproductive hormones is considered by many clinicians to be part of the routine examination of every male infertility patient, and the recommended basic hormone assessment should include analysis of serum follicle-stimulating hormone (FSH) and total testosterone (T) [19].

Decreased total sleep time is often thought to be associated with low male hormone levels. A study of 531 healthy Singaporean men found that men who slept less than 6 hours had significantly lower testosterone levels [20]. In previous studies, regarding the relationship between sleep deprivation and decreased serum testosterone, researchers believed that sleep would have a direct impact on gonadotropin-releasing hormone (GnRH) synthesis and release [21]. However, few scholars have studied the relationship between excessive sleep and male reproductive hormones. Ruge et al. [22] explored the relationship between total sleep duration and serum total testosterone, bioactive testosterone, and free testosterone (tT, bT and fT), sex hormone binding balls. The relationship between protein (SHBG) and dehydroepiandrosterone sulfate (DHEAS) levels, the study found that excessive sleep (>9 h/d) was associated with lower sleep duration compared with 7-9 h sleep duration per day. Free testosterone levels were significantly correlated, and mean levels of fT, bT, and tT in serum were lower, independent of SHBG or DHEAS levels. Sleep also helps maintain circulating androgen levels in older adults. By measuring total sleep time and morning testosterone levels, Penev verified that nighttime sleep duration was an important and independent predictor of morning total testosterone and free testosterone levels in healthy elderly men [23]. The above studies show that too much (>9 h/d) or too little (<6>

Sleep affects the secretion of male reproductive hormones.

3. The effect of sleep duration on male sexual function

Sexual dysfunction frequently occurs in men of reproductive age, and it has been reported that sexual dysfunction may be a cause of infertility in 0.4 percent to 4.6 percent of infertile men [24]. Common types of sexual dysfunction leading to male infertility include erectile dysfunction (ED), ejaculation

Dysfunction, premature ejaculation, etc. One in six infertile men suffers from erectile dysfunction [25]

. Erectile dysfunction is defined as the inability to achieve or maintain an erection for sexual intercourse [26]. Erectile dysfunction has several risk factors such as cardiovascular disease, diabetes, old age, high abdominal fat mass

and depression, etc. [27]. Sexual dysfunction and the psychological effects of male infertility can be substantial barriers to successful fertility and should be screened for during clinical evaluation. Smith et al [28]

The relationship between sleep duration and sexual function was investigated in a cohort of older UK men and women. The findings showed that in women, there was no significant correlation between sleep duration and sexual function. In men, however, there was a significant association between prolonged sleep and increased odds of erectile dysfunction compared with optimal sleep duration. Previous studies have reported increased risk of cardiovascular disease, symptomatic diabetes, and mortality in people with prolonged sleep [29], which have been shown to be associated with ED [30], an underlying condition that may lead to Reasons for the association between prolonged sleep and sexual dysfunction in men. In conclusion, older adults with sleep problems should be screened for sexual dysfunction and vice versa.

4. Effects of sleep deprivation on male reproductive function

Sleep deprivation (SD) occurs when a severe lack of sleep duration results in decreased performance, less alertness, and worsened health. is a detrimental aspect of modern life

Stress, which may adversely affect the health of the organism, affects the normal function of vital organs such as the brain, heart, liver, kidneys, and sexual organs such as the testes and epididymis [31-32].

Sexually experienced rats were placed in sleep deprivation for 96 h or sleep restriction (SR) for 21 d, and another group without any intervention was set up as a control. Their sexual behavior, hormone levels, sperm parameters, stress, and nitric oxide (NO)-related gene expression were mainly assessed. Compared with the control group, the sexual behavior of SD group rats was significantly reduced, while the SR group had no obvious sexual behavior. At the same time, the level of testosterone in the SD group was significantly lower than that in the control group, and the sperm motility in both SD and SR groups was lower than that in the control group [33]. In this study, increased NO production was observed in the SD and SR groups, suggesting that these animals exhibited infertility, decreased sperm motility, and increased expression of NO genes in the testis associated with apoptosis, affecting sperm through the testicular NO pathway. Function. A recent study [34] investigated the effect of long-term deep slow-wave sleep deprivation on the male rat gonadal axis and sperm deformity rate and testicular malformation rate.

In this study, 30 healthy male rats were divided into a sleep phase deprivation group (SD1 group), a sleep phase and length deprivation group (SD2 group), and a control group. Compared with the control group, the sperm motility rate and epididymal caudate sperm count were significantly decreased in SD2 group, and the sperm aberration rate in SD1 and SD2 groups was significantly increased. The experimental results show that long-term deep slow wave sleep deprivation can damage the testicular structure, reduce sperm motility, and increase the risk of sperm aberration.

Choi et al [35] also showed that sleep deprivation in animals can lead to abnormal testicular structure and decreased sperm quality (especially sperm motility). The study divided the rats into 3 groups: sleep deprivation for 4 days (SD4), sleep deprivation for 7 days (SD7) and the control group, and compared the sperm quality (sperm motility parameters), hormone levels (corticosterone and testosterone) of the three groups of rats. ) and testicular histopathological changes. Compared with the control group, sperm motility was significantly decreased in SD7 group, partial seminiferous tubule atrophy and/or sperm cell retention occurred in SD4 and SD7 groups, and corticosterone level was significantly increased, while testosterone level was significantly decreased, while SD7 group Corticosterone concentrations increased approximately 3-fold, while testosterone concentrations decreased approximately 1/4. Studies [36-37] have shown that the increase in corticosteroid levels caused by stressful stimulation may inhibit the hypothalamic-pituitary-gonadal (HPG) axis, resulting in decreased testosterone secretion. ) is related to the activation of the axis, thus leading to an increase in corticosteroids. Testosterone has important androgenic effects in the body, including the promotion of spermatogenesis and the development of spermatogenic tissue, in the presence of sleep deprivation, corticosterone levels are elevated due to stress, decreased Leydig cell testosterone production, and induction of Leydig cells apoptosis. These studies have shown that lack of sleep is not conducive to male sexual behavior, and affect the male reproductive system. Hormonal abnormalities in the hypothalamic-pituitary-gonadal axis are recognized as the cause of male reproductive function, and sleep deprivation has been shown to reduce the secretory activity of the male pituitary-gonadal axis. To understand the mechanism of action, Schmid et al. [38] Studies have shown that total sleep deprivation and 4.5 h of sleep deprivation significantly reduce morning testosterone levels in men. Androgen levels in young subjects drop significantly during complete sleep deprivation and rapidly recover once sleep is restored [39]. The risk of infertility increases when exposed to environmental stressors including sleep deprivation, mainly in the male population [40]. Interruption or deprivation of sleep can significantly alter sperm motility, morphology, and quantity, seriously affecting male fertility [41].

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