Sleep Disturbances in AGA — Donovan Hair Clinic

Using a case control design, authors set out to determine if sleep abnormalities were more common in males with mild, moderate and severe AGA compared to controls. Study participants completed a standardized questionnaire that contained self-evaluated sleep measures, including Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and STOP-BANG questionnaire. The Pittsburgh Sleep Quality Index is 19-item self-rated questionnaire and is used to determine sleep quality. It has 7 components including subjective sleep quality, sleep latency, sleep duration, habitual sleep effciency, sleep disturbances, sleep-promoting medication, and daytime dysfunction. The total PSQI score (called the ‘global score’) ranges from 0 to 21. Poor sleep quality is indicated when the score is greater than 5. The Epworth Sleepiness Scale measures average daytime sleepiness. The total ESS score ranges from 0 to 24 and a score of 11 or more indcicates excessive daytime sleepiness. The STOP-BANG score is used to evaluate sleep apnea risk. Patients with a STOP-BANG score score of 0 to 2 are considered to be low risk for moderate to severe obstructive sleep apnea. Those with a STOP-Bang score of 5 to 8 are considered to be at high risk for moderate to severe OSA.


There were 446 male participants in the study including 223 (50%) males in the AGA group, and 223 (50%) were in the control group. The mean age of the AGA group was comparable to the controls (54.9±13.9 vs. 53.6±10.5 years; p=0.238).

The rate of high blood pressure was significantly higher in the AGA group than in controls (32% vs. 19%; p=0.002). There were no differences between groups in body mass index, smoking, alcohol consumption or diabetes. THere were no differences in the Pittsburgh Sleep Quality Index between groups or the Epworth sleepiness scores between groups. However, STOP BANG scores of 5 or more (high risk) were significantly higher in the AGA group (21% vs. 14%; p=0.044).

Multivariable logistic regression analysis revealed males with AGA were more likely to have high blood pressure (odds ratio [OR] =1.90, 95% confidence interval [CI]=1.16–3.11, p=0.011) and STOP-BANG score≥5 (OR=2.05, 95%CI=1.15–3.66, p=0.015).

The authors evaluated whether there were differences according to severity of AGA. Of 223 patients with AGA, 124 (56%) were mild, 56 (25%) were moderate, and 43 (19%) were severe. When further evaluating data according to severity of AGA, males with severe AGA were more likely to have three sleep abnormalities. These were: total sleep time≤6 h (OR=2.16, 95%CI=1.02–4.57, p=0.044), Pittsburgh Sleep Quality Index >5 (OR=3.72, 95%CI=1.42–9.72, p=0.008), and STOP-BANG score≥5 (OR=3.01, 95%CI=1.11–8.13, p=0.030).


The conclusion of these studies were that males with AGA were more likely to have sleep disturbances especially the risk for obstructive sleep apnea. This was based on the significant association with a STOP-BANG score≥5. Males with AGA were also more likely to have high blood pressure. Patients with severe AGA patients appear to be at greater risk for having poor sleep quality and coexisting OSA.

The reasons for these links is not clear. It is generally proposed that poor sleep and sleep apnea drive metabolic and inflammatory issues that generally affect health and promote follicular microinflammation. However, the links are not clear.


Somprasong Liamsombut et al. Sleep quality in men with androgenetic alopecia.Sleep and Breathing. 2022 Apr 25.

Baik I, Lee S, Thomas RJ, Shin C (2019) Obstructive sleep apnea, low transferrin saturation levels, and male-pattern baldness. Int J Dermatol 58:67–74. 11.

Yi Y, Qiu J, Jia J et al (2020) Severity of androgenetic alopecia associated with poor sleeping habits and carnivorous eating and junk food consumption-a web-based investigation of male pattern hair loss in China. D

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