Obstructive Sleep Apnea Linked to Gout

“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,” investigators explained. “Given the morbidity associated with sleep problems, we should be vigilant regarding sleep health in our patients with gout.”

Patients with either diagnosed or suspected obstructive sleep apnea (OSA) have a higher likelihood of developing gout, according to a study published in BMC Rheumatology.1 Further, patients with gout more frequently reported insomnia, restless legs syndrome, and worry about their sleep.

“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,” investigators explained. “Given the morbidity associated with sleep problems, we should be vigilant regarding sleep health in our patients with gout.”

In this cross-sectional online survey of 2044 Australian adults, investigators assessed self-reported and doctor diagnosed OSA, as well as patient-reported sleep outcomes, to determine the prevalence of sleep disorders and sleep problems within this population. The survey also included a section on other chronic health conditions, including gout. Age, sex, body mass index, and alcohol consumption were recorded. A possible undiagnosed OSA was determined through self-reported loud snoring and observed apnea.

A total of 1948 (95.3%) participants were included in the analysis, of whom 126 (6.5%) had a diagnosis of gout and 124 (6.4%) had sleep apnea. Patients with gout were more likely to be male than female (11.2% vs 2.0%, respectively) and had higher rates of comorbidities, such as diabetes, obesity, heart disease, and high blood pressure.

Participants with either OSA symptoms or doctor diagnosed OSA were 2.6 and 2.8 times more likely to have a concurrent gout diagnosis. Those with gout were 2.5 times more likely to experience restless leg syndrome and 2 times more likely to have anxiety related to sleep when compared with other respondents (31.9% vs 23.5%, respectively). They were also 1.6 times more likely to discuss these concerns with their physician than patients without gout (38.9% vs 28.5%, respectively).

The percentage of respondents with gout who felt they regularly achieved adequate sleep was not significantly different than those without gout. However, 15% of respondents with gout reported restless leg syndrome, compared with only 6.7% of participants without gout.

The study was strengthened by the large sample size that aligned to Australia’s general population. The cross-sectional design of the study was limiting as investigators were not able to comment on causation. Further, recent data has shown that after adjusting for factors such as renal function, heart failure, and diuretic usage, the link between gout and sleep apnea was no longer associated with male gender. As the information in this study was limited to questions asked in the survey, investigators were not able to adjust for renal function. Lastly, there may be an unknown risk factor for both gout and sleep apnea that was not addressed, which may cause potential bias in the results.

“Our study has highlighted that sleep disorders and gout are common and frequently comorbid in the Australian population. Sleep apnea and gout are both associated with significant cardiovascular morbidity and mortality, but are also treatable,” investigators concluded. “An awareness of the co-existence of both conditions should lead to increased screening and appropriate treatment tailored to patient needs. Further research is required to delineate the nature of the relationship between conditions, and also to establish if treatment of one condition may influence the trajectory of the other condition.”

Reference:

New-Tolley J, Reynolds AC, Appleton SL, et al. Sleep disorders and gout in Australian adults. BMC Rheumatol. 2021;5(1):30. Published 2021 Aug 28. doi:10.1186/s41927-021-00199-y