Sleep Apnea in Gout Patients: Underlying Mechanisms and Shared Patient Subtypes

Abstract

Acute and chronic inflammation in gout causes permanent tissue damage, leads to restricted mobility and significantly reduces the quality of life. Obstructive sleep apnea (OSA) is a breath disordered sleep disease, which is a risk factor for respiratory, cardiovascular and cerebrovascular complications, nephropathy and other diseases. The aim of this paper was to explore the underlying mechanisms and shared pathways, targets and biomarkers of sleep apnea and gout. aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout. Materials and methods. We conducted this literature analysis on relevant studies, which were identified via electronic databases from inception to May 30, 2020. Study selection was conducted according to predesigned criteria, and two authors independently extracted data from included studies. Results. In the period from 2010 to 2020, 4 large-scale population-based studies were conducted to prove that OSA can affect the level of uric acid, resulting in increased incidence of gout in OSA patients. Only one big population-based study during 2010-2020 assessed the development of OSA against the background of gout. The data from these studies showed an undoubted relationship between the two diseases, but to date it is not completely known how much it is due to common risk factors and how interlinked the development mechanisms are. Conclusions. Relationship between OSA, gout, and pro-inflammatory/metabolic disorders is therefore complex; with some recent studies indicate different mechanisms may play a role in the development of OSA-gout combination. The inconsistency in results may indicate the presence of several patient profiles or subtypes with gout-OSA comorbidity: combined with metabolic syndrome (most common), combined with renal dysfunction without obesity, and others (dietary violations, genetic diseases, acidosis). This paper reviews the research progress on the relationship between the epidemiological characteristics of OSA and the incidence of gout, with the insight into pathogenetic mechanisms of comorbidity.