Gout, hyperuricaemia, sleep apnoea-hypopnoea syndrome and vascular risk

Moreira, Miguel Cantalejo; Cabello, Raúl María Veiga; Díaz, Vanesa García; Casero, Miguel Ángel Racionero; Gaviria, A. Zapatero

doi:10.1093/rheumatology/kes418

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…Most of these studies access a health database to form a risk ratio of the number of gout patients who have been diagnosed with OSA relative to those with no OSA diagnosis, ranging from 1.75:1 up to 3.7:1. They do not take into account the fact that a very large percentage of people with OSA have never been diagnosed with it [16], so they would have been misplaced in the no OSA diagnosis category instead of the diagnosed OSA category. If these studies had taken that into account, the estimated risk ratios of OSA with gout could have been much higher.…”

Section: Epidemiology and Clinical Studiesmentioning

confidence: 99%

Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea

Abrams

2023

Explor Musculoskeletal Dis

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Hyperuricemia is known to be a necessary and causal condition for gout, but much more prevalent than gout. Medicine has standardized treatments for gout, but has no such determination for asymptomatic hyperuricemia. Nevertheless, people with hyperuricemia, gouty or not, too often continue to be at risk for shortened lifespans from life-threatening comorbidities, all of which are known to be consequences of obstructive sleep apnea (OSA), which is shown herein to cause most hyperuricemia. This review also presents the wide variety of OSA consequences, many of which are irreversible and life-threatening, as the rationale for treating all hyperuricemia (gouty and asymptomatic) by diagnostic testing and effective treatment for OSA as soon as hyperuricemia is detected. It advocates frequent ultrasonic screening for aggregated urate crystals. Multiple epidemiological studies have found OSA to be significantly more prevalent in those people with gout diagnosed with OSA than it is in those never diagnosed with it. A clinical study shows an even higher prevalence of OSA in people with gout. The pathophysiology of hypoxia from OSA explains how it would lead to both the overproduction and the underexcretion of uric acid, leading to hyperuricemia and the precipitation of monosodium urate crystals which cause a gout flare. Resolving OSA has been shown to prevent or even reverse life-threatening diseases that are recognized comorbidities of hyperuricemia and gout, and can prevent further gout flares. In order to extend the length and quality of life of people with gout or hyperuricemia, when either first manifests a patient sleep study is recommended, followed by effective OSA treatment as warranted.

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Section: Epidemiology and Clinical Studiesmentioning

confidence: 99%

Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea

Abrams

2023

Explor Musculoskeletal Dis

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“…Epidemiological studies have suggested an association between gout and OSA. 4,5 Urate levels may be influenced by cell apoptosis secondary to apnoea-induced episodes of hypoxia. 6 Furthermore, increased adenosine triphosphate degradation in recurrent hypoxia may increase uric acid levels.…”

Section: Introductionmentioning

confidence: 99%

Serum urate and obstructive sleep apnoea in severe obesity

et al. 2015

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Obstructive sleep apnoea (OSA) may increase the risk of hyperuricaemia and predispose to gout. The evidence for the effects of OSA on serum urate in severe obesity is limited. This study investigated whether OSA was associated with serum urate in severe obesity and whether continuous positive airway pressure (CPAP) treatment was associated with a fall in urate. Severely obese subjects without known OSA or gout were recruited. Baseline assessments included urate, metabolic parameters, spirometry and overnight polysomnography. OSA patients were initially naive to treatment and were offered CPAP. At follow-up, change in urate was compared between CPAP-treated and non-CPAP-treated subjects. A high urate was defined as greater than the median. Logistic regression was performed to identify associations between (1) OSA and high urate at baseline and (2) use of CPAP and change in urate at follow-up. In total, 92 subjects were recruited (61 (66%) OSA and 31 (34%) non-OSA). Median urate was 345 mol/L. OSA was associated with high urate in females at baseline after adjusting for confounders (adjusted odds ratio OR adj ¼ 10.2; 95% CI: 1.1, 93.5). At follow-up (14 months), 58 subjects (28 on CPAP and 30 not on CPAP) were reassessed. CPAP was significantly associated with a fall to a low urate category at follow-up ( ¼ 0.017). Regression revealed a trend for a fall in urate category in the CPAP-treated group (OR adj ¼ 9.3; 95% CI: 0.8, 97). Serum urate is associated with OSA in severely obese females and CPAP may reduce levels in patients with OSA. There may be a need to consider and assess for OSA in obese patients with hyperuricaemia and recurrent attacks of gout.

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Obstructive sleep apnoea, gout and cardiovascular risk: A worth studying association

Mirrakhimov

2013

Medical Hypotheses

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Gout, hyperuricaemia, sleep apnoea-hypopnoea syndrome and vascular risk

Abstract: Patients with gout and hyperuricaemia and suspicion of SAHS had polysomnographically confirmed SAHS in 88.9% of cases. These patients had more severe forms of SAHS and a greater prevalence of documented atherothrombotic disease compared with a control group with OA.

Cited by 6 publications

References 14 publications

Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea

Premature mortality with gout and hyperuricemia may be reduced by early resolution of comorbid obstructive sleep apnea

Serum urate and obstructive sleep apnoea in severe obesity

Obstructive sleep apnoea, gout and cardiovascular risk: A worth studying association

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