Finasteride and Obstructive Sleep Apnea: Is there a link?

Does finasteride contribute to sleep apnea?

Finasteride is FDA approved for the treatment of androgenetic alopecia. Although sleep disturbance has rarely been reported as a side effect of finasteride, the associated between finasteride and obstructive sleep apnea has not been investigatad.

A recent study suggest finasteride users may be at slightly increased risk of sleep apnea and poor sleep

In research publication in the journal Skinmed, researchers set out to evaluate whether finasteride use could potentially be associated with sleep apnea. The research group attempted to answer this question by carefully examining data in the the US Food and Drugs Administration Adverse Event Reporting System (FAERS) database. They wanted to see if finasteride use was associated with a potential safety signal of OSA compared to a baseline potential safety signal for all other drugs in the US Food and Drugs Administration Adverse Event Reporting System (FAERS) database. Cases of finasteride-associated sleep apnea were compared to a reference potential safety signal of sleep apnea associated with all other drugs in the database.

Is there an association between finasteride use and sleep apnea and insomnia?

The researchers found that there was a link between finasteride and insomnia. Their data confirmed previous reports of a greater than expected reporting of insomnia with finasteride use (ROR = 1.93 [95% CI 1.77-2.09, z = 15.958, P < 0.0001]). In addition, a significant disproportionality (ROR = 5.65 [95% CI 4.83-6.62, z = 21.56, P < 0.0001]) in reporting of sleep apnea among finasteride users was also noted.

The potential safety signal for sleep apnea among finasteride users remained significantly higher than controls in both male patients using finasteride use for hair loss and male patients using finasteride for prostate enlargement.

Conclusion

This was an interesting study. Patients in hair practices who use finasteride may need to be better seen for sleep disturbances. Patients using finasteride who have risk factors for sleep apnea may benefit from proper evaluation for sleep apnea. Furthermore, high risk patients for sleep apnea or those with current sleep may present a relative contraindication to finasteride use. More studies are needed in order to determine how best to manage and prevent sleep disturbances in finasteride users.

Reference

Gupta M et al. Finasteride Use Is Associated with Higher Odds of Obstructive Sleep Apnea: Results from the US Food and Drug Administration Adverse Events Reporting System. Skinmed 2020 May 1;18(3):146-150.