Gout & Sleep Apnea: A Strong Connection, But Often Ignored

Every time I see a patient in my practice that has gout, almost invariably, they have signs and symptoms of untreated obstructive sleep apnea. Gout is an arthritic condition that’s caused by uric acid buildup. Allopurinol is the medication of choice, which works by reducing levels of uric acid in the body. Gout is also associated with the metabolic syndrome (obesity, hypertension, high cholesterol, and insulin resistance).

A recent study showed that gout rates in the US are climbing. About 6% of US men and 2% of women have this painful and often debilitating condition.

Despite strong evidence that sleep apnea is a major contributor to gout, little has been done to screen for sleep problems upon initial diagnosis. Chronic hypoxia promotes excess uric acid production in the bloodstream, which the kidneys try to eliminate, leading to higher concentrations in urine. This can also lead to kidney stones.

I’ve had numerous patients that report to me that their gout has improved significantly since starting sleep apnea treatment, whether through conservative lifestyle changes or more definitive options such as CPAP and surgery.

There are a number of very common medical conditions where sleep-breathing problems should be screened for (obstructive sleep apnea or upper airway resistance syndrome). Add gout to this long and growing list.

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4 thoughts on “Gout & Sleep Apnea: A Strong Connection, But Often Ignored

  1. Most gout attacks are initiated while the gout sufferer is asleep. That points to sleep apnea as a major causal factor. There are three effects from the hypoxia of sleep apnea that have been published in medical journals, any one of which can lead to an overnight gout flare. Effect #1 is the reduction of oxygen to the cells that starts a catabolic process which culminates irreversibly in their generation of excess uric acid fed into the blood. Effect #2 is the reduction in serum pH, so that the blood can hold less uric acid in solution. Effect #3 is the long term decrease in kidney function, which slows the extraction of uric acid from the blood. When the serum uric acid becomes too concentrated, the urate crystals which cause gout precipitate.

    After the apnea ceases, effect #1 normalizes almost immediately and effect #2 more gradually. If serum uric acid were to be measured at any time other than when the apnea is ongoing, its peak value will be missed. There should be no wondering why so many gout patients test normal for serum uric acid, because it is measured during their waking hours.

    Gout is an early warning of sleep apnea, whereas the more serious life-threatening consequences of sleep apnea generally develop over a long time. Gout patients should be tested for sleep apnea and treated for it when indicated. That will usually allow their sleep apnea to be resolved before it leads irreversibly to more serious consequences.

  2. I am finding that my gout is gotten wourse, i have gout all the time 7 / 24 hours

    I am on 300mgs and about 5 weeks now and things are not better at all should i see my doctor again or just stop taken allopurinol.

    I am tried all the time and just fell I was ran over by a mack truck.

    Thank you

    LLoyd

  3. I have a sleep apnea for 18 years now. After my menoposal 10 year ago. I have my hypertension 1 and my sleep apnea more severe. I can even hear it while sleeping and wake for it.. I have my dry mouth. I have my INDAPAMIDE for my hypertension. and I notice that every morning I have phlegm going out from my mouth. later I I feel the pain and have athirities..when my uric acid level is high I have to blow acidic enzymes and my stomac.h is full of acid. my doctor give me , omeprezol, allopurinol and celecoxib. I Take the medicine for three months and I stop. Now it come back my uric acid level. do I need to continue again the above medicine I mention, and for how many months or takes ayear to clear my uric acid.
    thank you
    julie