Gout and Sleep Apnea — What’s the Link?

If you or someone you know suffers from gout, a type of inflammatory arthritis, you know how painful the condition can be — especially during acute attacks when joints become red and swollen. Gout is a condition that occurs when uric acid levels in our blood become too high. But did you know elevated uric acid levels can contribute to other serious health conditions and diseases? You may have heard that kidney stones are linked to high uric acid levels — but did you know that research has found links between obstructive sleep apnea and gout?

What Causes Elevated Uric Acid Levels?

First, it can be helpful to understand how uric acid levels in our blood can become too high. Our body produces uric acid when it breaks down organic compounds called purines. Purines are “building blocks” essential for cellular energy production and DNA and RNA synthesis. When cells in our body die, their purines must be broken down. We also get purines from the foods we eat, which our body must break down as well.

When all our bodily systems are functioning properly, our livers break down the purines and release a waste product — uric acid — into our blood.
Our kidneys filter the uric acid from our blood and then it is excreted through our urine.
If our bodies produce too much uric acid or our kidneys can’t remove it fast enough, we develop a condition called hyperuricemia.
Hyperuricemia can cause needle-shaped uric acid crystals to form in the linings of our joints, which is the painful condition gout.
Crystals can also form in our kidneys, which are called uric acid kidney stones.

Untreated, the crystals can cause permanent bone and tissue damage in our joints. Large, swollen growths under the skin called tophi can form around the joints or on the upper curve of the ear. The kidney stones can be undetected until they move into the ureters, tubes that connect the kidneys to the bladder, or into the bladder itself — which can be very painful. Check out ourpost about uric acid here.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a disorder that affects millions of people around the world, many of whom don’t know they have it.

OSA occurs when our tongue and throat muscles relax during sleep and our soft palate collapses, blocking our airway.
The blockage disrupts our breathing, so our lungs aren’t receiving oxygen — which then leads to oxygen deprivation in our brain and throughout our body, a condition called hypoxia.
After 10 to 20 seconds, our brain signals our body to wake up, and weresume breathing again.
The apnea episodes can happen anywhere from 5 to 30 or more times per hour.

Often, OSA sufferers don’t realize they are being awakened during the night — but their sleep is so disrupted, it leads to a whole host of other problems such as excessive daytime sleepiness, difficulty concentrating, high blood pressure, depression, and irritability. People with untreated OSA have a much higher rate of car accidents and work-related accidents due to their almost debilitating fatigue.

What Are Obstructive Sleep Apnea Symptoms?

The most common symptom of OSA is loud snoring followed by periods of quiet, then awakening with a gasp or a choking sound. Often sleep partners are the first to notice this OSA symptom since the snorts and gasps awaken them. Other OSA symptoms include waking with a dry mouth or sore throat, morning headaches, excessive daytime sleepiness, falling asleep during the day while sitting up, frequent need to urinate at night, sexual dysfunction, decreased libido and nighttime sweating.

What Are the Risk Factors for Obstructive Sleep Apnea?

Many of the risk factors for OSA are related to an unhealthy diet and a sedentary lifestyle, but some are related to age, genetics, race, gender, and ethnicity. OSA can occur in children, but OSA generally affects people over the age of 40. Learn more about OSA here.

OSA lifestyle risk factors include:

Obesity (approximately two-thirds of OSA sufferers are overweight or obese)
Smoking
Consuming alcohol

Other OSA risk factors include:

Family history of OSA
Anatomical factors such as a smaller jaw, large tonsils, large neck circumference, and narrow airway
Being male, although post-menopausal women have an almost equal risk
Race (Blacks, Hispanics and Native Americans have a higher risk)

What’s the Link Between Uric Acid and Sleep Apnea?

Researchers in the U.K. did a comprehensive study of OSA patients and their rate of experiencing a gout episode. They studied 15,879 patients with OSA and 63,296 without OSA and followed them for an average of about six years. Researchers found that 4.9 percent of the OSA patients developed gout, compared with only 2.9 percent of the non-OSA patients — meaning that the OSA patients were almost 50 percent more likely to develop gout.

According to the researchers, one obvious correlation is that both OSA and gout affect overweight people far more than thin people. But they also surmised thathypoxia (low blood oxygen levels) could be a factor. Hypoxia leads to tissue damage and cell breakdown — and as we noted above, cell breakdown produces uric acid. Gout attacks are far more common at night and early morning.

During OSA-induced hypoxia, tissues in the body are damaged and cells die, so OSA sufferers’ bodies are producing uric acid at night.
Uric acid crystals are more likely to form when our body temperature is lower — and our body temperature is lower at night.
Another contributing factor is dehydration — we become dehydrated overnight as we sleep.
Chronic dehydration is a significant gout risk factor — our body can’t flush out the excess uric acid without adequate fluid intake.

These factors lead to elevated uric acid levels, so people who suffer from untreated OSA are twice as likely to develop gout. The good news is you can lower your gout risk by reducing your uric acid levels. Dietary changes and natural supplements can help. Learn more abouthow to lower your gout risk naturally!

If you (or your sleep partner) suffers from OSA, you should see a doctor. OSA increases the risk of several serious health conditions beyond gout — OSA increases your risk of developing certain cancers, kidney disease, cognitive and behavioral disorders, heart disease, high blood pressure, Type 2 diabetes and more. In addition to making dietary and lifestyle changes, OSA treatment usually involves using a continuous positive airway pressure device (CPAP) during sleep. CPAP is a mask that fits over the nose and/or mouth and gently blows air into the airway to prevent it from collapsing.

Sources:

https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea-ahi-numbers

https://www.nhlbi.nih.gov/health-topics/sleep-apnea

https://www.nytimes.com/2018/09/11/well/live/sleep-apnea-may-increase-risk-of-gout.html

https://www.webmd.com/sleep-disorders/sleep-apnea/news/20180830/sleep-apnea-might-raise-odds-for-painful-gout

https://www.health.harvard.edu/blog/gout-sleep-apnea-may-raise-your-risk-201511178633

https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090