Abstract
BackgroundPatients with obstructive sleep apnea (OSA) might be at risk of gout because of pathophysiological mechanisms that can lead to hyperuricemia and eventually gout or because of shared risk factors between both diseases. The objective of the present study was to investigate the risk of gout in patients with OSA.MethodsA population-based case-control study using the UK Clinical Practice Research Datalink GOLD including all patients aged 40 years and older with a first diagnosis of gout between 1987 and 2014. Gout cases were matched by year of birth, sex, and practice to non-gout controls. Conditional logistic regression estimated the risk of gout with an earlier diagnosis of OSA. Analyses were adjusted for lifestyle factors, comorbidities, and recent drug use.ResultsOne hundred eleven thousand five hundred nine cases were matched with 210,241 controls. Patients with OSA were at increased risk of gout (OR 1.86; 95%CI (1.71–2.02). However, this association disappeared (OR 1.05; 95% CI 0.96–1.16) after adjustment for smoking status, body mass index (BMI), alcohol use, a history of heart failure, diabetes mellitus, renal function, and recent use of diuretics and other medications. Among females with OSA and patients with OSA associated with heart failure, renal impairment, or higher BMI, the risk of gout was however still increased when compared to the total control population.ConclusionThis study showed that the observed association between OSA and gout disappeared after adjustment.
Highlights
Gout is the most common inflammatory arthritis [1], affecting up to 1–2% of adults, and leads to disability and reduced quality of life [2]
The relationship could be explained by shared risk factors of gout and obstructive sleep apnea (OSA), such as age, obesity, metabolic syndrome, renal impairment, and heart failure [8]
Two prospective studies in large United Kingdom (UK) primary care databases have demonstrated a 1.5fold increased risk of developing gout among patients with OSA [4, 9] with the overall risk peaking 1 to 2 years after OSA diagnosis [9]. While both papers statistically adjusted their analyses for body mass index (BMI), type 2 diabetes mellitus, ischemic heart disease, hypertension, the use of diuretics of an unspecified class, and alcohol consumption, renal impairment was either ignored or considerably under-recorded [4]
Summary
Gout is the most common inflammatory arthritis [1], affecting up to 1–2% of adults, and leads to disability and reduced quality of life [2]. Two prospective studies in large United Kingdom (UK) primary care databases have demonstrated a 1.5fold increased risk of developing gout among patients with OSA [4, 9] with the overall risk peaking 1 to 2 years after OSA diagnosis [9]. While both papers statistically adjusted their analyses for body mass index (BMI), type 2 diabetes mellitus, ischemic heart disease, hypertension, the use of diuretics of an unspecified class, and alcohol consumption, renal impairment was either ignored or considerably under-recorded [4].
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