Obstructive Sleep Apnea Linked to Gout Diagnosis

Obstructive sleep apnea (OSA) was associated with an increased likelihood of gout, particularly in female patients, according to a study published in Scientific Reports.¹

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“Although some studies have investigated the relationship between OSA and gout, the relationship has not been assessed completely in recent years in the United States (US),” wrote a group of Chinese investigators. “Neither the home sleep apnea testing nor the in-laboratory polysomnography is largely used, the numbers of OSA patients are likely to be underestimated. Furthermore, the effect of OSA on gout may be overlooked.”

OSA, a condition affecting approximately 25% of adults in the US, includes symptoms of loud, frequent snoring, episodes of apnea, increased daytime sleepiness, and choking or gasping during sleep. When left untreated, the condition can lead to cardiovascular and cerebrovascular disease, and metabolic disorders.² Gout, a common form of arthritis, is also linked to cardiovascular events, as well as hypertension, chronic kidney disease, and obesity.³

Adult participants, aged 20 years or older, enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2008 and 2015 to 2018 were included in the cross-sectional study. The association between OSA symptoms and gout were analyzed using weighted univariable and multivariable logistic regressions. Subgroup and sensitivity analyses were also conducted.

Demographic and health information was collected during in-person interviews. Patients were then asked to participate in physical and laboratory examinations, including the collection of blood and urine samples, conducted in the mobile examination center.

OSA symptoms were determined by how often a person snores, how often they stop breathing, and how often they feel overly tired during daytime hours. The gout diagnosis was self-reported based on the question, “Has a doctor or other health professional ever told you that you have gout?”

Of the 15,947 patients enrolled, the mean age was 47.8 years and approximately half (48.87%) were male. Among this population, 4891(30.67%) had symptoms of OSA and 842 (5.28%) had a gout diagnosis. Patients with gout were predominately male, White, and former smokers. They were also more likely to be obese and older.

According to the multivariable logistic regression analyses, symptoms of OSA were positively associated with gout. In the fully adjusted model, the odds ratio (OR) was 1.315 and the 95% confidence interval (CI) was 1.070 – 1.616.

Within the subgroup analyses, a considerable link between OSA and gender with gout was observed (P = .003). OSA was linked to an increased risk of gout in the female subgroup (OR 1.989; 95% CI 1.480 – 2.673). No significant interactions were reported when stratifying by age, diabetes diagnosis, hypertension, body mass index, and hyperlipidemia. After adjusting for diuretics usage and congestive heart failure, the link between OSA and gout remained stable (OR 1.31, 95% CI 1.07 – 1.62).

Investigators noted by using weighted samples analyses, results could be generalizable to the population of US adults. However, they were only able to diagnose the most OSA symptoms through the sleep questionnaire. Therefore, other symptoms, such as driving accidents and morning headache, could not be collected from the NHANES database. This may have led to an underestimation of OSA diagnosis. Further, misclassification of gout may have occurred due to the self-reported nature of the questionnaire. Lastly, causal conclusions could not be made due to the cross-sectional nature of the study.

“More research is needed to investigate whether treatments targeting OSA, such as continuous positive airway pressure (CPAP), can reduce the incidence of gout,” investigators concluded.

References

1. ^{Gu X, Tang D, Xuan Y, Shen Y, Lu LQ. Association between obstructive sleep apnea symptoms and gout in US population, a cross-sectional study. Sci Rep. 2023;13(1):10192. Published 2023 Jun 23. doi:10.1038/s41598-023-36755-4}
2. ^{Mesarwi, O. A., Loomba, R. & Malhotra, A. Obstructive sleep apnea, hypoxia, and nonalcoholic fatty liver disease. Am. J. Respir. Crit. Care Med. 199, 830–841 (2019).}
3. ^{Singh, J. A., Reddy, S. G. & Kundukulam, J. Risk factors for gout and prevention: A systematic review of the literature. Curr. Opin. Rheumatol. 23, 192–202 (2011).}