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Sleep and Breathing

, Volume 23, Issue 4, pp 1047–1057 | Cite as

A meta-analysis of the association between gout, serum uric acid level, and obstructive sleep apnea

  • Tingting Shi
  • Min Min
  • Chenyu Sun
  • Ce Cheng
  • Yun Zhang
  • Mingming Liang
  • Feras Kamel Rizeq
  • Yehuan SunEmail author
Sleep Breathing Physiology and Disorders • Review

Abstract

Previous epidemiological investigations have evaluated the association between gout, serum uric acid levels, and obstructive sleep apnea syndrome (OSAS), but with inconsistent results. We conducted this meta-analysis aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout. Relevant studies were identified via electronic databases from inception to December 17, 2018. Study selection was conducted according to predesigned eligibility criteria, and two authors independently extracted data from included studies. The hazard ratio (HR) and weighted mean difference (WMD) and their corresponding 95% confidence interval (CI) were derived using random-effects models. We conducted meta-, heterogeneity, publication bias, sensitivity, and subgroup analyses. Eighteen studies, involving a total of 157,607 individuals (32,395 with OSAS, 125,212 without OSAS) and 12,262 gout cases, were included. Results show that serum uric acid levels are elevated in patients with OSAS (WMD = 52.25, 95% CI 36.16–64.33); OSAS did not reach statistical significance as a predictor of gout (but there was a trend, HR = 1.25, 95% CI 0.91–1.70) and that the association between OSAS and serum uric acid was quite robust. OSAS may be a potential risk factor for hyperuricemia and the development of gout and thus, effective OSAS therapy may present as a valuable preventive measure against gout. Still, it is vital to undertake clinical studies with better designing to corroborate these associations and shed new light on it.

Keywords

Obstructive sleep apnea syndrome OSAS Serum uric acid level Gout 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human and animals participants performed by any of the authors.

References

  1. 1.
    Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, Nuki G (2008) Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis 67(7):960–966.  https://doi.org/10.1136/ard.2007.076232 CrossRefPubMedGoogle Scholar
  2. 2.
    Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Schumacher HR Jr, Saag KG (2005) Gout epidemiology: results from the UK general practice research database, 1990-1999. Ann Rheum Dis 64(2):267–272.  https://doi.org/10.1136/ard.2004.024091 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Zhu Y, Pandya BJ, Choi HK (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 63(10):3136–3141.  https://doi.org/10.1002/art.30520 CrossRefPubMedGoogle Scholar
  4. 4.
    Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M (2015) Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis 74(4):661–667.  https://doi.org/10.1136/annrheumdis-2013-204463 CrossRefPubMedGoogle Scholar
  5. 5.
    Klemp P, Stansfield SA, Castle B, Robertson MC (1997) Gout is on the increase in New Zealand. Ann Rheum Dis 56(1):22–26.  https://doi.org/10.1136/ard.56.1.22 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cassim B, Mody GM, Deenadayalu VK, Hammond MG (1994) Gout in black South Africans: a clinical and genetic study. Ann Rheum Ddis 53(11):759–762.  https://doi.org/10.1136/ard.53.11.759 CrossRefGoogle Scholar
  7. 7.
    Zeng Q, Wang Q, Chen R, Xiao Z, Huang S, Xu J (2003) Primary gout in Shantou: a clinical and epidemiological study. Chinese Medical J 116(6):66–69Google Scholar
  8. 8.
    Roddy E, Choi HK (2014) Epidemiology of gout. Rheum Dis Clin N Am 40(2):155–175.  https://doi.org/10.1016/j.rdc.2014.01.001 CrossRefGoogle Scholar
  9. 9.
    McAdams-DeMarco MA, Maynard JW, Baer AN, Coresh J (2012) Hypertension and the risk of incident gout in a population-based study: the atherosclerosis risk in communities cohort. J Clin Hypertens 14(10):675–679.  https://doi.org/10.1111/j.1751-7176.2012.00674.x CrossRefGoogle Scholar
  10. 10.
    Maynard JW, McAdams-DeMarco MA, Baer AN, Köttgen A, Folsom AR, Coresh J, Gelber AC (2012) Incident gout in women and association with obesity in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Med 125(7):717.e9717.  https://doi.org/10.1016/j.amjmed.2011.11.018 CrossRefGoogle Scholar
  11. 11.
    Choi HK, Ford ES, Li C, Curhan G (2007) Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 57(1):109–115.  https://doi.org/10.1002/art.22466 CrossRefPubMedGoogle Scholar
  12. 12.
    Zhu Y, Pandya BJ, Choi HK (2012) Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007-2008. Am J Med 125(7):679–687.e1.  https://doi.org/10.1016/j.amjmed.2011.09.033 CrossRefPubMedGoogle Scholar
  13. 13.
    Richette P, Clerson P, Bouee S et al (2015) Identification of patients with gout: elaboration of a questionnaire for epidemiological studies. Ann Rheum Dis 74(9):1684–1690.  https://doi.org/10.1136/annrheumdis-2013-204976 CrossRefPubMedGoogle Scholar
  14. 14.
    Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH, Research MRFIT (2008) Group: long-term cardiovascular mortality among middle-aged men with gout. Arch Intern Med 168(10):1104–1110.  https://doi.org/10.1001/archinte.168.10.1104 CrossRefPubMedGoogle Scholar
  15. 15.
    Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, Lin CM, Chen HW, Yu KH (2010) Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology 49(1):141–146.  https://doi.org/10.1093/rheumatology/kep364 CrossRefPubMedGoogle Scholar
  16. 16.
    Listed NA (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):662–689CrossRefGoogle Scholar
  17. 17.
    Lindberg E, Gislason T (2000) Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 4(5):411–433.  https://doi.org/10.1053/smrv.2000.0118 CrossRefPubMedGoogle Scholar
  18. 18.
    Sasanabe R, Banno K, Otake K et al (2006) Metabolic syndrome in Japanese patients with obstructive sleep apnea syndrome. Hypertens Res 29(5):315–322.  https://doi.org/10.1291/hypres.29.315 CrossRefPubMedGoogle Scholar
  19. 19.
    Parish JM, Adam T, Facchiano L (2007) Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med 3(5):467–472PubMedPubMedCentralGoogle Scholar
  20. 20.
    Kono M, Tatsumi K, Saibara T, Nakamura A, Tanabe N, Takiguchi Y, Kuriyama T (2007) Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest 131:1387–1392.  https://doi.org/10.1378/chest.06-1807 CrossRefPubMedGoogle Scholar
  21. 21.
    Chou YT, Chuang LP, Li HY et al (2010) Hyperlipidaemia in patients with sleep-related breathing disorders: prevalence & risk factors. Indian J Med Res 131(5):121–125.  https://doi.org/10.1378/chest.06-1807 CrossRefPubMedGoogle Scholar
  22. 22.
    West SD, Nicoll DJ, Stradling JR (2006) Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 61(11):945–950.  https://doi.org/10.1136/thx.2005.057745 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Shahar E, Whitney CW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163(1):19–25.  https://doi.org/10.1164/ajrccm.163.1.2001008 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Choi HK, Atkinson K, Karlson EW, Curhan G (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 165(7):742–748.  https://doi.org/10.1001/archinte.165.7.742 CrossRefPubMedGoogle Scholar
  25. 25.
    Ruiz Garcia A, Sanchez Armengol A et al (2006) Blood uric acid levels in patients with sleep-disordered breathing. Arch Bronconeumol 42(10):492–500.  https://doi.org/10.1016/S1579-2129(06)60575-2 CrossRefPubMedGoogle Scholar
  26. 26.
    Plywaczewski R, Bednarek M, Jonczak L, Gorecka D, Sliwiniski P (2005) Hyperuricaemia in males with obstructive sleep apnoea (OSA). Pneumonol Alergol Pol 73(3):254–259PubMedGoogle Scholar
  27. 27.
    Plywaczewski R, Bednarek M, Jonczak L, Gorecka D, Sliwinski P (2006) Hyperuricaemia in females with obstructive sleep apnoea. Pneumonol Alergol Pol 74(4):159–165PubMedGoogle Scholar
  28. 28.
    Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA (2010) Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res 62(2):170–180.  https://doi.org/10.1002/acr.20065 CrossRefGoogle Scholar
  29. 29.
    Krishnan E, Pandya BJ, Chung L, Dabbous O (2011) Hyperuricemia and the risk for subclinical coronary atherosclerosis--data from a prospective observational cohort study. Arthritis Res Ther 13(2):R66.  https://doi.org/10.1186/ar3322 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Choi HK, Niu J, Neogi T, Chen CA, Chaisson C, Hunter D, Zhang Y (2015) Nocturnal risk of gout attacks. Arthritis Rheumatol 67(2):555–562.  https://doi.org/10.1002/art.38917 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mirrakhimov AE, Mirrakhimov EM (2013) Obstructive sleep apnoea, gout and cardiovascular risk: a worth studying association. Med Hypotheses 81(4):749.  https://doi.org/10.1016/j.mehy.2013.07.042 CrossRefPubMedGoogle Scholar
  32. 32.
    Abrams B (2012) High prevalence of gout with sleep apnea. Med Hypotheses 78(2):349.  https://doi.org/10.1016/j.mehy.2011.10.029 CrossRefPubMedGoogle Scholar
  33. 33.
    Abrams B (2009) Sleep apnea as a cause of gout flares. Medscape J Med 11:3PubMedPubMedCentralGoogle Scholar
  34. 34.
    Simkin PA (2009) The pathogenesis of podagra. Medscape J Med 11(1):3Google Scholar
  35. 35.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012.  https://doi.org/10.1016/j.jclinepi.2009.06.005 CrossRefPubMedGoogle Scholar
  36. 36.
    Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748.  https://doi.org/10.1093/jnci/22.4.719 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    He W, Li Q, Yang M, Jiao J, Ma X, Zhou Y, Song A, Heymsfield SB, Zhang S, Zhu S (2015) Lower BMI cutoffs to define overweight and obesity in China. Obesity 23(3):684–691.  https://doi.org/10.1002/oby.20995 CrossRefPubMedGoogle Scholar
  38. 38.
    Li P, Yan L, Su L, Li Q (2009) Changes of uric acid and blood lipids in patients with obstructive sleep apnea hypopnea syndrome complicated with coronary heart disease. Shandong Medical Journal 49(29):33–34.  https://doi.org/10.3969/j.issn.1002-266X.2009.29.014 CrossRefGoogle Scholar
  39. 39.
    Xu H, Cao F, Wei GR et al (2010) Association between the condition and plasma uric acid levels and carotid atherosclerosis in patients with obstructive sleep apnea hypopnea syndrome. Journal of Clinical Neurology 23(06):411–413Google Scholar
  40. 40.
    Liu MQ, Bi JY, Wan JM (2013) Changes of blood uric acid before and after operation in children with obstructive sleep apnea hypopnea syndrome. Medical Journal of Wuhan University 34(05):733–736.  https://doi.org/10.14188/j.1671-8852.2013.05.041 CrossRefGoogle Scholar
  41. 41.
    Deng QF (2011) Changes of blood uric acid and lipids in children with obstructive sleep apnea hyperpnoea. Chinese General Practice 14(34):3943–3945.  https://doi.org/10.3969/j.issn.1007-9572.2011.34.019 CrossRefGoogle Scholar
  42. 42.
    Deng KP, Zhang LJ, Yang C (2007) Changes of indirect bilirubin and uric acid levels in patients with obstructive sleep apnea hypopnea syndrome. Chinese Journal of Microcirculation 17(02):35–36.  https://doi.org/10.3969/j.issn.1005-1740.2007.02.014 CrossRefGoogle Scholar
  43. 43.
    Ding SF, Wang L, Liu Y, Liu HY, Xie F (2009) The relationship between obstructive sleep apnea-hypopnea syndrome and blood uric acid levels. Journal of Cardiovascular and Pulmonary Diseases 28(06):400–403.  https://doi.org/10.3969/j.issn.1007-5062.2009.06.008 CrossRefGoogle Scholar
  44. 44.
    Wu J, Liu YH (2008) Clinical study on serum uric acid and bilirubin levels in patients with obstructive sleep apnea hypopnea syndrome. Acta Universitatis Medicinalis Anhui 43(06):706–708.  https://doi.org/10.3969/j.issn.1000-1492.2008.06.030 CrossRefGoogle Scholar
  45. 45.
    Zhang XY, Ye XW, Feng RX, Rao SS (2008) The study between serum uric acid and early morning blood pressure of obstructive sleep apnea syndrome patients. Chinese Journal of Practical Internal Medicine 28(S1):94–95Google Scholar
  46. 46.
    Yi XB (2010) Obstructive sleep apnea-syndrome in patients with serum uric acid and lipid levels of correlation. China Modern Medicine 17(04):11–13.  https://doi.org/10.3969/j.issn.1674-4721.2010.04.007 CrossRefGoogle Scholar
  47. 47.
    Huang ZY, Liu DB, Wan GP, Zhong JW, Tan ZY, Wei W, Xu JJ, Shao JB, Qiu SY (2011) Correlation between serum uric acid levels and obstructive sleep apnea/hypopnea syndrome in children. Chinese Journal of Pediatrics 49(3):218–220.  https://doi.org/10.3760/cma.j.issn.0578-1310.2011.03.014 CrossRefPubMedGoogle Scholar
  48. 48.
    Zhang LF (2015) Association between obstructive sleep apnea hypopnea syndrome and uric acid in male [D]. Fujian University of Medicine CNKI:CDMD:2.1015.991504Google Scholar
  49. 49.
    Sunnetcioglu A, Gunbatar H, Yıldız H (2018) Red cell distribution width and uric acid in patients with obstructive sleep apnea. Clin Respir J 12(3):1046–1052.  https://doi.org/10.1111/crj.12626 CrossRefPubMedGoogle Scholar
  50. 50.
    Hira HS, Shukla A, Kaur A, Kapoor S (2012) Serum uric acid and lactate levels among patients with obstructive sleep apnea syndrome: which is a better marker of hypoxemia? Ann Saudi Med 32(1):37–42.  https://doi.org/10.5144/0256-4947.2012.37 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Blagojevic-Bucknall M, Mallen C, Muller S, Hayward R, West S, Choi H, Roddy E (2018) The risk of gout among patients with sleep apnea: a matched cohort study. Arthritis Rheumatol 71(1):154–160.  https://doi.org/10.1002/art.40662 CrossRefPubMedGoogle Scholar
  52. 52.
    Zhang Y, Peloquin CE, Dubreuil M, Roddy E, Lu N, Neogi T, Choi HK (2015) Sleep apnea and the risk of incident gout: a population-based, body mass index-matched cohort study. Arthritis Rheumatol 67(12):3298–3302.  https://doi.org/10.1002/art.39330 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Yi-Fong Su Y, Hong JY, Perng DW (2014) Obstructive sleep apnea and risk of gout-a nationwide population-based study. Thorac Med 29(5):272–279Google Scholar
  54. 54.
    Roddy E, Muller S, Hayward R, Mallen CD (2013) The association of gout with sleep disorders: a cross-sectional study in primary care. BMC Musculoskeletal Dis 14(119).  https://doi.org/10.1186/1471-2474-14-119
  55. 55.
    Gersch C, Palii SP, Kim KM, Angerhofer A, Johnson RJ, Henderson GN (2008) Inactivation of nitric oxide by uric acid. Nucleosides Nucleotides Nucleic Acids 27(8):967–978.  https://doi.org/10.1080/15257770802257952 CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Ho WJ, Tsai WP, Yu KH, Tsay PK, Wang CL, Hsu TS, Kuo CT (2010) Association between endothelial dysfunction and hyperuricaemia. Rheumatology 49(10):1929–1934.  https://doi.org/10.1093/rheumatology/keq184 CrossRefPubMedGoogle Scholar
  57. 57.
    Yamauchi M, Kimura H (2008) Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complications. Antioxid Redox Signal 10(4):755–768.  https://doi.org/10.1089/ars.2007.1946 CrossRefPubMedGoogle Scholar
  58. 58.
    Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D, Colombo PC, Basner RC, Factor P, LeJemtel TH (2008) Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117(17):2270–2278.  https://doi.org/10.1161/CIRCULATIONAHA.107.741512 CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Prabhakar NR, Kumar GK (2010) Mechanisms of sympathetic activation and blood pressure elevation by intermittent hypoxia. Respir Physiol Neurobiol 174(1–2):156–161.  https://doi.org/10.1016/j.resp.2010.08.021 CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Pant S, Deshmukh A, Gurumurthy GS, Pothineni NV, Watts TE, Romeo F, Mehta JL (2014) Inflammation and atherosclerosis--revisited. J Cardiovasc Pharmacol Ther 19(2):170–178.  https://doi.org/10.1177/1074248413504994 CrossRefPubMedGoogle Scholar
  61. 61.
    Sahebjani H (1998) Changes in urinary uric acid excretion in obstructive sleep apnea before and after therapy with nasal continuous positive airway pressure. Chest 113(6):1604–1608.  https://doi.org/10.1378/chest.113.6.1604 CrossRefPubMedGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Health Statistics, School of Public HealthAnhui Medical UniversityHefeiChina
  2. 2.The First Affiliated Hospital of Anhui Medical UniversityHefeiChina
  3. 3.Arizona College of Osteopathic MedicineMidwestern UniversityGlendaleUSA
  4. 4.Avalon University School of MedicineWillemstadCuraçao
  5. 5.Center for Evidence-Based PracticeAnhui Medical UniversityHefeiChina

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