Obstructive Sleep Apnea and the Risk of Gout

A Population-Based Case-Control Study

Caroline van Durme; Bart Spaetgens; Johanna Driessen; Johannes Nielen; Manuel Sastry; Annelies Boonen; Frank de Vries


Arthritis Res Ther. 2020;22(92) 

In This Article


Table 1 shows the baseline characteristics of the study population. The cohort encompassed 111,509 gout cases and 210,241 controls with a mean age of 62 years (standard deviation SD 13.3), of whom 27% were female. Gout cases had a higher BMI than controls (29 kg/m2 SD 5.3 in cases vs. 26.8 kg/m2 SD 4.8 in controls). On average, gout cases used alcohol more often (73.9% in cases vs. 65.5% in controls) and were more likely to be ex-smokers than controls (34.2% cases vs. 26% controls). With regard to comorbidities, gout cases more often had a history of hypertension, heart failure, or reduced renal function. They were also more frequently recent users of diuretics.

Patients with OSA had an almost doubled risk of gout (crude odds ratio [OR] 1.86; 95% confidence interval [CI] 1.71–2.02, Table 2). However, the effect disappeared after statistical adjustment for alcohol use, a history of diabetes mellitus, renal function, the most recently recorded eGFR measurement, heart failure, smoking status, BMI category, and recent use of statins, beta-blockers, ACE-inhibitors, ARBs, calcium channel blockers, loop diuretics, or thiazide diuretics (adjusted [adj.] OR 1.05; 95% CI 0.96–1.16). Further exploration identified that this shift was almost entirely explained by statistical adjustment for BMI, heart failure, recent use of diuretics, and renal function (Table 3).

Stratification of the fully adjusted models (Table 2) revealed that as compared to patients without OSA, those with OSA and with a high BMI remained at an increased risk of gout (BMI 30–34 kg/m2—adj. OR 1.34; 95% CI 1.13–1.59; BMI ≥ 35 kg/m2—1.56; 95% CI 1.33–1.83). Also, in comparison to patients without OSA, those with OSA and a history of heart failure had an almost doubled risk of gout (adj. OR 1.82; 95% CI 1.21–2.73). Furthermore, recent use of loop diuretics (adj. OR 1.73; 95% CI 1.33–2.26) and use of thiazide diuretics (adj. OR 1.85; 95% CI 1.47–2.33) was also associated with an increased risk of gout. The risk of gout among patients with OSA also further rose with increasing renal impairment (adj. OR 2.22; 95% CI 1.70–2.91 for CKD 3 (eGFR 30–59 ml/min), adj. OR 3.93; 95% CI 1.06–14.56 for CKD 4 (eGFR 15–29 ml/min) (Table 2). With regard to sex, women with OSA remained at an increased risk of gout in contrast to men with OSA (adj. OR 1.64; 95% CI 1.19–2.27).

Compared to patients without OSA, patients with OSA and diabetes mellitus had a statistically significant decreased risk of gout (adj. OR 0.70; 95%CI 0.58–0.85). Patients with OSA and hypercholesterolemia also had a 6% decreased risk, although not statistically significant (adj. OR 0.94; 95%CI 0.82–1.08).