Association Between Uric Acid Levels and Obstructive Sleep Apnea Syndrome in a Large Epidemiological Sample

Abstract

IntroductionRecurrent hypoxia, which is associated with obstructive sleep apnea syndrome (OSAS), leads to an increase in the degradation of adenosine triphosphatase into xanthine, which in turn increases uric acid concentrations.ObjectiveThe current study aimed to determine whether an association exists between OSAS and uric acid levels in the peripheral blood from a representative population of Sao Paulo (Brazil).MethodsA population-based survey adopting a probabilistic 3-stage cluster sample of Sao Paulo was used to represent the population according to gender, age, and socioeconomic class. A total of 1,042 volunteers underwent polysomnography recordings for OSAS diagnosis, blood pressure assessment, and biochemical blood analysis, and answered questionnaires.ResultsUric acid levels were correlated with most important risk factors for OSAS, such as AHI, desaturation time and index, minimum oxyhemoglobin saturation (SpO2), blood pressure, cholesterol, BMI, triglycerides and arousal, and with OSAS itself. Also, uric acid was increased in OSAS volunteers even after controlling for all confounders. Hyperuricemic volunteers presented lower mean and minimum SpO2 and increased desaturation index. Importantly, minimum SpO2 was a significant predictor of uric acid levels, which in turn was considered an independent predictor for OSAS in the binary logistic model. However, a ROC curve analysis for establishing cut-off points for uric acid levels as a biomarker of OSAS revealed moderate sensitivity and specificity.ConclusionA strong association was found between uric acid levels and OSAS in a representative sample of the population of Sao Paulo. Although they do not qualify for a biomarker alone, uric acid levels may be involved in OSAS severity and should be considered in sleep apnea management in the future.

Biomarkers associated with obstructive sleep apnea: A scoping review

“…In adult-based studies 70 were classified as B, with 11 studies being classified as C. Only 3 studies were classified as fulfilling A criteria (91, 131, 143). …”

“…Analyzing the level of evidence, only three studies were classified as A(91, 131, 143). Mehra et al (91) evaluated biomarkers in participants of the Cleveland Family Study, a longitudinal genetic epidemiological study in United States.…”

“…Svensson et al (131) selected women from general population in Sweden. Hirotsu et al (143) used subjects from an epidemiologic sleep study namely EPISONO, in Brazil. Considering these three studies, (91, 131, 143) we are able to identify only two potential biomarkers: sIL-6R (91) and uric acid (143).…”

“…Hirotsu et al (143) used subjects from an epidemiologic sleep study namely EPISONO, in Brazil. Considering these three studies, (91, 131, 143) we are able to identify only two potential biomarkers: sIL-6R (91) and uric acid (143). Most studies were classified as level of evidence B, because they used samples from sleep laboratories or patients with suspected OSA rather than community-based approaches.…”

Артеріальна Гіпертензія, Синдром Обструктивного Апное Сну Та Серцево-Судинний Ризик

“…Подібні результати було виявлено в популяцій-ному дослідженні Camila Hirotsu та співавт., що проводилось у Сан-Пауло та включало 1042 учас-ники [19]. Було показано, що хворі із СОАС мали вищі рівні СК (5,7 ± 0,1 мг/дл проти 4,9 ± 0,1 мг/дл; р < 0,0001) порівняно з контролем незалежно від статі, а також після контролю за іншими фактора-ми.…”