Easy blood oxygen accumulation distribution area index (EBOADAI) integrating apneic events and hypoxemic burden: association with testosterone deficiency and sexual health in adult males

The link between obstructive sleep apnea (OSA) and serum testosterone levels is still unclear. This cross-sectional study analyzed data from the 2015–2016 NHANES cycle and an independent polysomnography (PSG) cohort (validation cohort). We examined associations between OSA severity and risks of testosterone deficiency. Additionally, we quantified the capacity of BOADAI and apnea-hypopnea index to assess testosterone deficiency in OSA patients. The study included 2,359 participants from the NHANES cohort and 172 from the standardized PSG cohort. A negative correlation was identified between OSA and serum testosterone levels. After multivariable adjustment, OSA patients exhibited a 31% increased risk of testosterone deficiency (odds ratio [OR] = 1.31, 95% confidence interval [CI]: (1.02, 1.70), p = 0.03). This risk escalated to 67% in severe OSA (OR = 1.67, 95% CI: (1.04–2.68), p = 0.03) versus controls. The BOADAI showed stronger inverse correlation with testosterone(r = −0.37) and remained independently associated with testosterone deficiency (OR = 2.37, 95% CI:(1.12–5.32), p = 0.01). This study provided evidence of a negative association between OSA and serum testosterone levels. The BOADAI, measurable at home via a finger-clip oximeter, provides an effective and more convenient monitoring alternative for monitoring testosterone levels in OSA management.