Gout and the Risk of Incident Obstructive Sleep Apnea in Adults 65 Years or Older: An Observational Study

Associations between Sleep-Disordered Breathing and Serum Uric Acid and Their Sex Differences: The Nagahama Study

Sleep-disordered breathing (SDB) is often accompanied by noncommunicable diseases (NCDs), including gout. However, the association between serum uric acid (sUA) levels and NCDs is complicated in patients with SDB. We aimed to clarify this issue utilizing large-scale epidemiological data. This community-based study included 9850 inhabitants. SDB and its severity were assessed by a 3% oxygen desaturation index (3% ODI) corrected for sleep duration using wrist actigraphy. The associations between sUA and moderate to severe SDB (MS-SDB) and sUA and NCDs in patients with MS-SDB were analyzed. A total of 7895 subjects were eligible. In females, the prevalence of MS-SDB increased according to an elevation in sUA levels even after adjusting for confounders, and sUA ≥ 5 mg/dL was the threshold. These were not found in males. There was a positive interaction between sUA ≥ 5 mg/dL and female sex for MS-SDB. In females with MS-SDB, the prevalence of diabetes mellitus (DM) increased according to an elevation in sUA levels, and those with sUA ≥ 5 mg/dL showed a higher prevalence of DM than their counterparts. There is a clear correlation between sUA levels and the severity of SDB, and elevated sUA poses a risk for DM in females with MS-SDB.

Association between obstructive sleep apnea symptoms and gout in US population, a cross-sectional study

The results of association between Obstructive Sleep Apnea (OSA) and gout are not consistent. Participants aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) 2007-2008 and 2015-2018 were included. Weighted univariable and multivariable logistic regressions were used to evaluate the association between OSA symptoms and gout. The subgroup and sensitivity analyses were also performed. Among the 15,947 participants in this study, the mean age was 47.8 years old, 48.87% of whom were male, 4891 had OSA symptoms, and 842 had gout. In multivariable logistic regression analyses, OSA symptoms were positively associated with gout in all models. The odds ratio (OR) was 1.315 and 95% confidence interval (CI) was 1.070-1.616 in fully adjusted model 4. In the subgroup analyses, we found a considerable interaction between OSA symptoms and gender with gout (P for interaction = 0.003). In the sensitivity analyses, the association between OSA symptoms and gout remained stable after adjustment for congestive heart failure and diuretics using. OSA symptoms were associated with an increased likelihood of gout. This association could especially be found in female participants.

Relationship Between Hyperuricemia-Waist Phenotype and Obstructive Sleep Apnea in Type 2 Diabetes Mellitus

Objective

This study aimed to propose the hyperuricemia-waist (HUAW) phenotype and investigate the relationship between the HUAW phenotype and obstructive sleep apnea (OSA) in type 2 diabetes mellitus (T2DM).

Methods

We enrolled 255 patients with T2DM (165 male and 90 female) from the First Hospital of Qinhuangdao. The sleep test was performed, and serum uric acid (UA) levels and waist circumference (WC) were calculated. The HUAW phenotype was defined as serum UA concentrations ≥420 μmol/L and WC ≥90 cm (male) and ≥85 cm (female). The participants were categorized into four phenotype groups based on the mentioned cutoffs: normal WC and normal UA concentrations (group A); normal WC and elevated UA concentrations (group B); enlarged WC and normal UA concentrations (group C); and enlarged WC and elevated UA concentrations (group D). Among these participants, 17.6% were characterized by the HUAW phenotype, 80.0% had OSA, and 47.0% had moderate-to-severe OSA. The prevalence of OSA was 43.4%, 71.4%, 89.7%, and 97.8% in groups A, B, C, and D, respectively. The prevalence of moderate-to-severe OSA was 7.5%, 28.6%, 56.9%, and 72.7% in groups A, B, C, and D, respectively. After adjusting for age, sex, duration of diabetes, glycosylated hemoglobin A1c, smoking, and drinking, the HUAW phenotype was found to be significantly associated with OSA and moderate-to-severe OSA.

Conclusion

The present study proposed the HUAW phenotype and demonstrated that in T2DM, the HUAW phenotype was associated with OSA, especially with moderate-to-severe OSA. Unlike T2DM without the HUAW phenotype, T2DM with the HUAW phenotype showed a significantly higher prevalence of OSA, especially moderate-to-severe OSA. Thus, early sleep studies should be routinely examined in individuals with T2DM who display the HUAW phenotype.

Assessing the causal associations of obstructive sleep apnea with serum uric acid levels and gout: a bidirectional two-sample Mendelian randomization study

OBJECTIVE

Multiple observational studies have reported the close associations of obstructive sleep apnea (OSA) with serum uric acid (SUA) levels and gout. However, the causal nature and direction remains unclear.

METHODS

A bidirectional two-sample Mendelian randomization (MR) study was performed, based on publicly available genome-wide association studies (GWAS) summary statistics, to investigate whether OSA is causally related to SUA levels, gout and vice versa. The inverse-variance weighted (IVW) was used as the primary analysis approach, supplemented with four sensitive analysis methods applied to assess the robustness of the results. Moreover, multivariable MR (MVMR) was utilized to evaluate the independent causal effect of OSA on SUA and gout after adjusting for body mass index (BMI), hypertension, type 2 diabetes (T2D), coronary artery disease (CAD), and chronic kidney disease (CKD).

RESULTS

Genetically predicted OSA liability was significantly associated with increased levels of SUA (IVW method: β = 0.19, 95% CI = 0.11 - 0.26, P = 7.24 × 10^-7) and risk of gout [IVW method: odds ratio (OR) = 1.75 95% CI = 1.13 - 2.69, P = 0.01] in univariable MR. The MVMR results suggested that OSA retained its significant association with increased SUA levels, whereas the significant association between OSA and gout was attenuated to null after adjusting for BMI and T2D. No causal effect of OSA on SUA levels and gout was found in the reverse direction.

CONCLUSIONS

Our findings suggest that OSA was causally associated with increased levels of SUA, but was not independently associated with gout risk.

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout

Objective

To develop a Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout, with the goal of increasing public understanding and awareness, and ensure consistent and understandable messages about gout.

Methods

A G-CAN working group that included patients, physicians and nongovernmental organisation (NGO) representatives was formed to develop a common language definition of gout for use with the public, media, healthcare providers and stakeholders. A literature search and interviews with patients, healthcare workers and stakeholders informed development of the definition. Following consultation with G-CAN members and partners, the definition was endorsed by the G-CAN board.

Results

The G-CAN common language definition of gout describes the epidemiology, pathophysiology, symptoms and impact, risk factors, comorbidities, management and healthcare and workforce considerations. Detailed information is provided to support the content of the definition. After the publication of the English-language version, the definition will be available for translation into other languages by G-CAN members.

Conclusion

G-CAN has developed a concise and easily understandable statement describing gout in language that can be used in conversations with the lay public, media, NGOs, funders, healthcare providers and other stakeholders.

Sleep disorders and gout in Australian adults

BACKGROUND

The 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.

METHODS

A 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.

RESULTS

There 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.

CONCLUSION

Diagnosed 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.

SLEEP APNEA IN GOUT PATIENTS: UNDERLYING MECHANISMS AND SHARED PATIENT SUBTYPES

Acute and chronic inflammation in gout causes permanent tissue damage, leads to restricted mobility and significantly reduces the quality of life. Obstructive sleep apnea (OSA) is a breath disordered sleep disease, which is a risk factor for respiratory, cardiovascular and cerebrovascular complications, nephropathy and other diseases. The aim of this paper was to explore the underlying mechanisms and shared pathways, targets and biomarkers of sleep apnea and gout. aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout. Materials and methods. We conducted this literature analysis on relevant studies, which were identified via electronic databases from inception to May 30, 2020. Study selection was conducted according to predesigned criteria, and two authors independently extracted data from included studies. Results. In the period from 2010 to 2020, 4 large-scale population-based studies were conducted to prove that OSA can affect the level of uric acid, resulting in increased incidence of gout in OSA patients. Only one big population-based study during 2010-2020 assessed the development of OSA against the background of gout. 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. Conclusions. Relationship between OSA, gout, and pro-inflammatory/metabolic disorders is therefore complex; with some recent studies indicate different mechanisms may play a role in the development of OSA-gout combination. The inconsistency in results may indicate the presence of several patient profiles or subtypes with gout-OSA comorbidity: combined with metabolic syndrome (most common), combined with renal dysfunction without obesity, and others (dietary violations, genetic diseases, acidosis). This paper reviews the research progress on the relationship between the epidemiological characteristics of OSA and the incidence of gout, with the insight into pathogenetic mechanisms of comorbidity.

Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors

Gout is the most common inflammatory arthritis and occurs when hyperuricaemia, sustained elevation of serum urate levels resulting in supersaturation of body tissues with urate, leads to the formation and deposition of monosodium urate crystals in and around the joints. Recent reports of the prevalence and incidence of gout vary widely according to the population studied and methods employed but range from a prevalence of <1% to 6.8% and an incidence of 0.58-2.89 per 1,000 person-years. Gout is more prevalent in men than in women, with increasing age, and in some ethnic groups. Despite rising prevalence and incidence, suboptimal management of gout continues in many countries. Typically, only a third to half of patients with gout receive urate-lowering therapy, which is a definitive, curative treatment, and fewer than a half of patients adhere to treatment. Many gout risk factors exist, including obesity, dietary factors and comorbid conditions. As well as a firmly established increased risk of cardiovascular disease and chronic kidney disease in those with gout, novel associations of gout with other comorbidities have been reported, including erectile dysfunction, atrial fibrillation, obstructive sleep apnoea, osteoporosis and venous thromboembolism. Discrete patterns of comorbidity clustering in individuals with gout have been described. Increasing prevalence and incidence of obesity and comorbidities are likely to contribute substantially to the rising burden of gout.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.

Self-reported sleep quality and sleep disorders in people with physician-diagnosed gout: an Internet cross-sectional survey

Background

Limited information exists regarding sleep disorders in gout. Our objective was to assess the burden of sleep disorders in people with gout.

Methods

A brief anonymized Internet survey of people with physician-diagnosed gout who visited a gout education website assessed the frequency of sleep problems, sleep quality over the past 24 h (0 = best possible sleep, 10 = worst possible sleep), daytime sleepiness on a typical day (0 = none and 10 = most sleepy during the day), sleep quantity (number of hours of sleep), and the frequency of snoring or gasping, and snorting or stopping breathing during the sleep, using validated questionnaires, including the NHANES 2016 sleep questionnaire. We used Chi-square test to compare the categorical and t test the continuous variables.

Results

Of the 454 website visitors who clicked the survey, 320 survey respondents reported physician-diagnosed gout. Mean age was 57 years (standard deviation [SD], 13.4), 72% were male, 77% were White, and mean gout duration was 7.6 (SD, 11). Of the respondents, 23% reported doctor-diagnosed sleep disorder (sleep apnea, 17%; sleep study ordered, diagnosis pending, 4%; other sleep disorder 2%). A mean 6.7 h of sleep per night was reported (SD, 1.3). Eighty-six percent reported snoring during sleep and 45% reported having snorted, gasped, or stopped breathing while asleep. Two thirds of the patients reported feeling sleepy during the day, at least 3–4 times a month or more. Sleep quality was 5.5 (SD, 2.6), and daytime sleepiness was 3.5 (SD, 2.6) on a 0–10 scale (higher = worse).

Conclusions

People with physician-diagnosed gout reported frequent sleep disorders and daytime sleepiness in an Internet survey. More in-depth studies are needed to better understand the association of gout with sleep disorders.