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Sleep apnea patients at increased risk of gout

Sleep apnea patients at increased risk of gout

United Kingdom: Obstructive sleep apnea (OSA) patients are at higher risk of developing gout beyond the first year following the diagnosis compared with patients without OSA, finds a new study published in the journal Arthritis & Rheumatology.

Obstructive sleep apnea,OSA is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. This type of apnea occurs when the throat muscles intermittently relax and block the airway during sleep. A noticeable sign of obstructive sleep apnea is snoring.

Milica Blagojevic-Bucknall, Keele University in the United Kingdom, and colleagues conducted this retrospective cohort study to investigate whether people with OSA are more likely to develop gout, in the short and long-term, compared to those without OSA.

For the purpose, the research team used data from the U.K. Clinical Practice Research Datalink to identify 15,879 patients aged ≥18 years who received a diagnosis of OSA between 1990 and 2010, as well as 63,296 controls without OSA, matched on age, sex, and practice.

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Key Findings:

  • During a median follow-up of 5.8 years, 4.9 percent of patients with OSA and 2.6 percent of patients without OSA developed gout, yielding incidence rates of 7.83 and 4.03 per 1,000 person-years, respectively.
  • The adjusted hazard ratio was 1.42. The risk for developing gout among OSA patients was highest one to two years after the index date (hazard ratio, 1.64) compared with those without OSA, and this finding persisted among those who were overweight and obese.
  • The highest significant hazard ratio (2.02) for those with a normal body mass index was seen at two to five years after the index date.

Also Read: Gout patients unable to achieve uric acid targets at increased death risk

It’s thought that intermittent oxygen deficiency due to OSA leads to overproduction of uric acid, which causes gout. “Sleep apnea is commonly treated with continuous positive airways pressure–or CPAP–therapy. Since CPAP treatment corrects low oxygen levels it might also be expected to reduce uric acid levels, which could possibly reduce the risk of developing gout or treat existing gout; however, further research is needed to investigate the effect of treatment with CPAP in people with gout,” said Dr. Blagojevic-Bucknall.

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Source: With inputs from Arthritis & Rheumatology

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  1. This is the fourth epidemiologic study showing significantly increased likelihood of gout among individuals who had been diagnosed with sleep apnea relative to those who had never been diagnosed with sleep apnea. Pulmonology journal literature starting in the 1980s describes why that would occur. The chronic intermittent hypoxemia of sleep apnea leads to intermittent increase in uric acid in the cells that is fed into the blood, concurrent intermittent reduced solubility of uric acid in the blood, and long term degradation of kidney function which slows removal of uric acid from the blood. These are perfect storm conditions for precipitation of the monosodium urate crystals which cause a gout attack when they form in a joint.

    When gout attacks first occur, it is usually early in the multiyear development of the life-threatening consequences of sleep apnea. In other words, gout is an early warning of the presence of sleep apnea.
    Gout sufferers are best advised to heed the warning and get tested for sleep apnea before one of its life-threatening consequences develops, and then follow the recommended treatment for sleep apnea. Not only will the length and quality of their lives be extended, but their gout attacks will probably cease as well.