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How Sleep Apnea Increases Risk of Gout

Obstructive sleep apnea is a medical condition that is characterized by interrupted breathing during sleep due to an obstruction of the airways. Recent studies have shown that people who have this nocturnal disorder are two times more likely to develop gout than people who don’t. Gout, on the other hand, is a form of arthritis that is caused by an accumulation of uric acid in the joints, and it can be very, very painful.

These two disorders seem completely unrelated, but recent research has shown significant results proving otherwise. In this article, let’s explore the relationship between these two diseases and find out what are the ways to prevent them.

What is obstructive sleep apnea?

Obstructive sleep apnea can be caused by a number of reasons; such as blockage or narrowing of the airways, thickening of tissue or fat in the airways, or an underlying medical condition that causes the neurologic controls for breathing to malfunction.

When a person has sleep apnea, he or she may manifest the following symptoms:

  • Snoring
  • Restless sleep (sometimes mistaken to be insomnia)
  • Repeated interrupted breathing
  • Frequent night urination
  • Daytime fatigue or headache
  • Gasping or grunting during sleep
  • Heartburn
  • Dry mouth
  • A sore throat

People who are at risk for developing sleep apnea are those who have chronic sinusitis, obesity, enlarged tonsils, menopause, Down syndrome, and large neck circumference among other risk factors.

What is gout?

Gout is a form of arthritis that is caused by accumulation and crystallization of uric acid in the joints. This happens when uric acid is not excreted enough, or the body produces too much of it, which causes a buildup in the joints of the body (like in the hands, knees, toes, or wrists). People who have gout suffer from flare-ups that are accompanied by pain, inflammation, redness, and swelling.

The risk of developing gout is increased if a person is obese, consumes alcohol constantly, has a family history of gout, or has renal insufficiency which decreases the kidney’s ability to process uric acid.

What is the relationship between obstructive sleep apnea and gout?

Research shows that people who have obstructive sleep apnea have increased the risk of developing gout in both short-term and long-term. Researchers also found out that sleep apnea and gout share many risk factors; such as obesity and increased alcohol consumption, as well as comorbidities like hypertension and diabetes.

Moreover, it has been found out that people with a normal Body Mass Index (BMI) are most at risk of developing gout compared to other BMI groups, wherein gout likely occurs two to five years after the diagnosis of sleep apnea. This implies that all patients with sleep apnea should be assessed for gout risk, regardless of BMI.

Researchers of this study hypothesized that the relationship between sleep apnea and gout is influenced by intermittent hypoxia (lack of oxygen during episodes of sleep apnea) which increases nucleotide turnover in the body that, in turn, increases the production of endogenous uric acid.

Another possible explanation for the association of sleep apnea with gout is the shared risk factor for both diseases, which is obesity or being overweight. People who are overweight or obese are more likely to develop sleep apnea and gout, possibly being a result of an underlying weight-related condition. However, there is still not enough scientific evidence to show a direct link between sleep apnea and gout.

How to prevent sleep apnea and gout

Since sleep apnea and gout share many common risk factors and comorbidities, correcting modifiable risk factors may decrease the chances of developing either or both of the two diseases. Here are a few tips on how to prevent sleep apnea and gout:

  • If you have a family history of sleep apnea or gout, consult with a doctor to assess your risk of developing the disease
  • Cut down on alcohol consumption; the recommended amount is two drinks per day for men and one drink per day for women
  • Maintain a normal BMI to prevent the development of sleep apnea, gout, and other obesity-related conditions
  • If you have gout, avoid red meats, seafood, and other foods that have a high uric acid content
  • Take care of your kidneys to avoid renal insufficiency; avoid excessive sodium, saturated fat, cholesterol, and processed food in the diet

Conclusion

Despite lack of evidence to show that sleep apnea is directly related to gout, there are reliable studies that strongly suggest the contribution of sleep apnea to the development of gout (due to hypoxia which increases production of uric acid). A more plausible explanation is that the risk factors for sleep apnea are almost the same as that of gout. Thus, a patient who has risk factors for both diseases is most likely to develop both in the long run.

References

Sources and further reading.

 

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