Sleep Apnea Triggers Gout Flares

Patients with sleep apnea have an increased risk of developing gout and nighttime flare-ups.

This may be because oxygen deprivation associated with sleep apnea can exacerbate nucleotide turnover, which generates purines that are metabolized to uric acid, and uric acid deposits in joints and tissues cause gout.

A recent study sought to more clearly capture this relationship between sleep apnea and gout.

Researchers used data from nearly 10,000 patients with newly diagnosed sleep apnea and compared them with about 40,000 patients with similar body and age profiles but no sleep apnea.

Over the course of a year, there were 76 cases of gout in the sleep apnea group, and 197 in the larger control group—indicating that gout was nearly twice as common in those with sleep apnea.

Broken down further, the data revealed that the increased risk of incident gout from sleep apnea was maintained across several sub-groups, including age, sex, and obesity status.

Since sleep apnea is notoriously difficult to detect, the study authors noted that their “effect estimates may have been under-estimated because individuals in the comparison cohort with a mean [body mass index (BMI)] of 32.2 may have had undiagnosed sleep apnea, thus contributing to the risk of gout.”

They concluded that further investigation is needed in order to determine how to optimize treatment for sleep apnea-associated hypoxia as a strategy for managing gout more effectively.

“As the hypoxia-associated hyperuricemia among sleep apnea patients is treatable, clarifying the role of sleep apnea on the risk of incident gout could lead to a useful strategy to prevent gout flares,” the authors wrote.

In the meantime, pharmacists can advise patients to pursue behavioral changes and try to maintain a healthy weight, as obesity is a serious risk factor for both sleep apnea and gout.

The current study appeared in the October 2015 issue of Arthritis and Rheumatology.