Patients with OSA Linked to Greater Gout Risk

Pushti Khandwala, MD

Credit: Jefferson Health

Patients with obstructive sleep apnea (OSA) are associated with having a greater gout risk, according to a new study.¹ Compared to patients without OSA, patients with OSA have 2.65 times greater odds of having gout.

“In our study, it was seen that the population with OSA was elderly, predominantly males, and had a higher prevalence of heart failure, [chronic kidney disease], and use of diuretics,” wrote investigators, led by Pushti Khandwala, MD, from the Einstein Medical Center Philadelphia. “Gout is associated with many of the same comorbidities, which are prevalent in OSA.”

It has been theorized OSA has an association with gout due to the fact sleep apnea-induced hypoxemia can lead to increased purine concentrations which can ultimately increase uric acid levels. The uric acid levels can form urate crystals, and gout occurs when urate crystals accumulate in the joint.

Other studies have explored the link between OSA and gout, such as a 2021 study that found people with diagnosed or suspected OSA had a greater likelihood of developing gout, likely due to the bidirectional relationship between sleep and gout.

Since OSA has shared risk factors with gout, investigators conducted a retrospective, non-interventional cohort study, to evaluate the relationship between OSA and gout in patients with a body mass index (BMI) > 30. They leveraged data from the global research network, TrinetX, which encompasses data from 130 major healthcare systems worldwide via electronic medical records. The team used propensity score matching to match sex, race, chronic kidney disease (CKD), heart failure, and the use of diuretics.

The sample was broken into 2 groups: with OSA and without OSA. Of the 3,541,566 patients in the sample, 23% had OSA, 7.19% had OSA with gout, and 2.84% with gout without OSA (P < .0001). The odds of gout were 2.65 times greater in patients with OSA than in patients without OSA (hazard ratio [HR], 2.393; 95% CI, 2.367 – 2.419; P < .0001).

“This contrasts with the study by Durme et al. in 2020, which showed that the association between gout and OSA had disappeared after adequate statistical adjustment for BMI, renal function, heart failure, and recent use of diuretics,” investigators wrote. “Regardless, the drop in odds ratio does shine a light that OSA and gout have many confounding or associated comorbidities.”

After propensity score matching, gout prevalence was greater in the OSA (6.93%) than without OSA (4.63%). Additionally, patients with OSA had 1.533 greater odds of having gout (95% CI, 1.512 – 1.554; P < .0001) with a gout risk of 1.404 (95% CI, 1.386 – 1.423).

Patients were older in the OSA group than the non-OSA group (59.8±14.3 years vs. 54±17.2 years, P <.0001). Half (50%) of patients with OSA were female and 65% were females in the group without OSA. The cohort had a majority of Caucasians, followed by African Americans (P < .0001). Furthermore, unknown races and Asians had a greater prevalence in the non-OSA group than in the OSA group. For the comorbidities of heart failure, CKD, and diuretic use was more prevalent in the OSA group.

Investigators highlighted 2 limitations, including how the retrospective observational study design cannot determine accurate causality and potential administrative errors in coding.

“Though prospective studies are required for determining causality, medical practitioners should be vigilant about OSA being a risk factor in the development of gout,” investigators concluded. “There is also a need for studies evaluating the role of OSA treatment in primary prevention of gout or secondary prevention of gout flares.”

^References

1. ^{Khandwala P, Desai D, Sen M. Obstructive Sleep Apnea: A Contributing Factor in Gout. Cureus. 2024;16(1):e52115. Published 2024 Jan 11. doi:10.7759/cureus.52115}
2. ^{Gout. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897#:~:text=Gout%20occurs%20when%20urate%20crystals,found%20naturally%20in%20your%20body. Accessed February 21, 2024.}
3. ^{Pine, L. Obstructive Sleep Apnea Linked to Gout. HCPLive. September 10, 2021. https://www.hcplive.com/view/obstructive-sleep-apnea-linked-to-gout. Accessed February 21, 2024.}