Obstructive Sleep Apnea Linked With Higher Gout Risk

Jennifer Garcia

August 30, 2018

People with obstructive sleep apnea (OSA) may have a higher risk of developing gout, according to a study published online August 30 in Arthritis and Rheumatology.

As part of a retrospective cohort study, researchers in the United Kingdom evaluated primary care data from adult patients (age ≥ 18 years) diagnosed with OSA between 1990 and 2010 (n = 15,879). For the comparison group, the researchers matched each patient with OSA with up to four individuals without OSA (n = 63,296) on the basis of age, sex, and general practice. They then evaluated the risk for incident gout in both groups at different time points and across various body mass index (BMI) categories.

During the 5.8-year follow-up period, 4.9% of individuals with OSA developed gout compared with 2.6% in the non-OSA group. This resulted in incidence rates per 1000 person-years of 7.83 (95% confidence interval [CI], 7.29 - 8.40) and 4.03 (95% CI, 3.84 - 4.23), respectively.

Overall, after adjusting for covariates such as diabetes, hypertension, and ischemic heart disease, the study authors documented a statistically significant hazard ratio (HR) of 1.42 (95% CI, 1.29 - 1.56) and noted that this increased risk persisted across all BMI categories.

Despite previous research linking a higher risk for gout in the first year after a diagnosis of OSA, the authors of the current study found the highest risk for gout 1 to 2 years after OSA diagnosis regardless of BMI. Specifically, among patients with OSA in the normal BMI category (BMI < 25), the highest risk for incident gout was 2 to 5 years after OSA diagnosis and was more than twice the risk when compared with that in people without OSA (HR, 2.02; 95% CI, 1.13 - 3.62).

The authors propose that a reason for this link may be the intermittent oxygen deficiency experienced by patients with OSA, leading to overproduction of uric acid, which causes gout. Although treatments such as continuous positive airway pressure (CPAP) may correct low oxygen levels and reduce the risk for gout in patients with OSA, the authors acknowledge that "further adequately-powered randomized controlled trials are required to investigate the potential therapeutic urate-lowering effect of CPAP."

On the basis of these study findings, the researchers note that the risk for gout among patients with OSA "is independent of BMI and clinicians should consider the possibility of gout in patients with sleep apnea regardless of obesity." Further, they say that the risk for gout "persists beyond the first year after OSA diagnosis," suggesting the need for greater vigilance in this patient population.

The National Institute for Health Research provided funding for this study. The authors have disclosed no relevant financial relationships.

Arthritis Rheumatol.  Published online August 30, 2018. Abstract

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