Obstructive Sleep Apnea May Increase Gout Risk
Clinicians should consider the possibility of gout in patients with sleep apnea regardless of obesity.
Patients with obstructive sleep apnea are at a higher risk of developing gout during the first 2 years after diagnosis, according to a study published in Arthritis & Rheumatology.
Researchers performed a retrospective, matched cohort study identifying the association between obstructive sleep apnea and the development of gout. The United Kingdom Clinical Practice Research Datalink was used to identify patients with obstructive sleep apnea (n=15,879) and matched controls (n=63,296). Patients were followed from initial diagnosis, or matched index date for controls, until a diagnosis of gout or the end of the study. The average follow-up time was 5.8 years, the average age was 52.2 years, and 76% of the study population was male.
Patients with obstructive sleep apnea had more comorbidities and were more likely to be obese, be taking diuretics, and use alcohol. Overall, 4.9% of those with obstructive sleep apnea and 2.6% of the matched controls developed gout. Between the first and second year after diagnosis of obstructive sleep apnea, patients had the highest risk for gout development with a hazard ratio (HR) of 1.64 (95% CI, 1.30-2.06).
Body mass index (BMI) and sleep apnea had a statistically significant interaction (P <.001). Risk for gout among patients with obstructive sleep apnea compared with controls was highest in the normal BMI category (HR, 1.76; 95% CI, 1.22-2.53). Patients with obstructive sleep apnea in the normal BMI category were twice as likely to develop gout between 2 and 5 years than those without obstructive sleep apnea (HR, 2.02; 95% CI, 1.13-3.62). Patients with obstructive sleep apnea in the overweight and obese BMI categories were at highest risk for gout between 1 and 2 years (HR, 1.73; 95% CI, 1.02-2.96; HR, 1.70; 95% CI, 1.18-2.43, respectively).
Future studies need to analyze the relationship between gout and neck and waist circumference, and whether correction of hypoxia could reduce the risk for gout by reducing uric acid production.
In conclusion, patients with obstructive sleep apnea are at a higher risk of developing gout early after diagnosis, and the peak risk times vary based on BMI. Researchers noted that "clinicians should consider the possibility of gout in patients with sleep apnea regardless of obesity."
This study was supported by the National Institute for Health.
Blagojevic-Bucknall M, Mallen C, Muller S, et al. The risk of gout among patients with sleep apnea: a matched cohort study. [published online Aug. 30, 2018]. Arthritis Rheumatol. doi: 10.1002/art.40662.