Sleep disorders and gout in Australian adults

Julia New-Tolley,Amy C Reynolds,Tiffany K Gill,Sarah L Appleton,Catherine L Hill,Robert J Adams,Susan Lester

doi:10.1186/s41927-021-00199-y

Abstract

BackgroundThe aims of our study were two-fold. Firstly, to determine if there is an association between gout and OSA in a representative Australian adult population. Secondly, to explore associations between gout and patient reported sleep outcomes.MethodsA cross-sectional national online survey of a representative sample of Australian adults > 18 years assessed self-reported doctor-diagnosed OSA, insomnia and patient reported sleep outcomes. Possible undiagnosed OSA was estimated using self-reported frequent loud snoring and witnessed apnoeas. Participants self-reported physician-diagnosed gout and other health conditions. Multivariable logistic regression analyses were performed for both objectives. Odds ratios with 95% confidence intervals were reported.ResultsThere were 1948 participants of whom 126 (6.5%) had gout and 124 (6.4%) had diagnosed sleep apnoea. After adjusting for age, body mass index (BMI), sex, alcohol intake and the presence of arthritis, those with obstructive sleep apnoea diagnosed on polysomnography were twice as likely to report having gout compared to those without. (OR = 2.6, 95% CI 1.5–4.6). Additionally, participants with symptoms suggestive of sleep apnoea were also twice as likely to have gout compared to those without (OR = 2.8, 95%CI 1.6–5.1). There was also a higher likelihood of restless legs syndrome, insomnia and worry about sleep in patients with gout.ConclusionDiagnosed and suspected OSA are associated with higher likelihood of gout. Participants with gout are also more likely to report suffering from restless legs syndrome, insomnia and worry about their sleep. Given the morbidity associated with sleep problems, we should be vigilant regarding sleep health in our patients with gout.

Highlights

Gout is the most prevalent inflammatory arthropathy with a prevalence of 6.8% in South Australia, and it is the most common form of inflammatory arthritis in men [1]
The association between Obstructive sleep apnoea (OSA) and gout may be explained by intermittent airway obstruction during sleep leading to hypoxia, and resulting in increased serum uric acid via alteration in cellular metabolism [6]
There is likely to be a bidirectional relationship between sleep and gout, as gout flares may be influenced by circadian rhythms, and sleep quality is likely to be influenced by gout flares [7]

Summary

Introduction

Gout is the most prevalent inflammatory arthropathy with a prevalence of 6.8% in South Australia, and it is the most common form of inflammatory arthritis in men [1]. Gout is associated with co-morbidities including the metabolic syndrome and cardiovascular disease [2]. Obstructive sleep apnoea (OSA), which is (2021) 5:30. The association between OSA and gout may be explained by intermittent airway obstruction during sleep leading to hypoxia, and resulting in increased serum uric acid via alteration in cellular metabolism [6]. A study of 724 individuals with gout highlighted that attacks are twice as likely to occur at night [8]. We hypothesized that gout is likely to be associated with sleep disruption, which is known to lead to significant sequelae such as reduced work performance and road safety [3]. To determine if there is an association between gout and OSA in a representative Australian adult population. To explore associations between gout and patient reported sleep outcomes

Objectives

Methods

Results

Conclusion