Shared pathways, targets and biomarkers of sleep apnea and gout

Abstract

In the period from 2011 to 2020, 4 large-scale population-based studies were conducted to identify gout in patients with obstructive sleep apnea (OSA), as well as one study to detect the frequency of sleep apnea in patients with gout.All recently published studies confirm connection between the development of OSA and an increase in the level of uric acid in blood serum, both against the background of clinically significant gout arthritis and without it. However, only one big population-based study during 2010 — 2020 assessed the development of OSA against the background of gout. According to this study, incidence of OSA was 14.3 per 1.000 person-years in patients with gout, compared with 3.9 per 1.000 person-years without gout, with HR = 2.07 (95 % CI 2.00 — 2.15 %), which is significantly higher than the incidence of gout in patients with OSA, even taking into account hypertension and hyperlipidemia.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. Older age and restricted mobility put patients with gout at a significant risk during OSA episodes. In cases where the treatment of both diseases is conducted independently, the volume of drug therapy and the likelihood of developing negative side effects increase. In this regard, it is necessary to monitor patients with gout who develop sleep apnea differently to gout only patients, as well as to prescribe adequate treatment for both diseases.In our review, we aimed to show the most recent information on the mechanisms of gout-OSA development, shared pathways, targets and biomarkers, emphasizing the likely ways that cause the progression of OSA in patients with gout. In addition, analysis of the latest publications to date showed nonuniformity in study subjects, allowing to identify different subtypes of gout-OSA patients: combined with metabolic syndrome (most common), combined with renal dysfunction without obesity, and others (dietary violations, genetic diseases, acidosis).