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Gout And Sleep Apnea

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Gout is a common type of arthritis and accounts for about 5% of all cases of arthritic condition. But what is gout and what are the stages of this condition?...
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Gout present symptoms mainly in the joints. Learn which signs to look for, and when you should seek medical help and diagnosis of gout....
I have found by my own experience and by researching medical literature that sleep apnea causes gout. What surprises me most is that I have found no doctor who knows of this connection.


Last edited by painfree on March 31st, 2005 07:09 AM; edited 1 time in total
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replied November 14th, 2004
Experienced User
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replied March 26th, 2005
Experienced User
Gout And Sleep Apnea
New developments are showing that the monosodium urate crystals that cause gout result from excess uric acid caused by the oxygen deprivation of sleep apnea. Refer to the letter to the editor in the medical journal sleep, feb 05, entitled "gout is an indicator of sleep apnea". Initial screening of gout patients is showing that almost all have sleep apnea. Gout appears to be an early unignorable warning of sleep apnea, whose long term effects can be high blood pressure, coronary artery disease, heart attack, stroke, diabetes, and even sudden death, as happened with former star football player reggie white. Anyone with gout should be tested for sleep apnea. If sleep apnea is present, follow your doctor's advice to get rid of it. It could save your life! It should also cure your gout, as it did for me.




Now that this information is known, I think that the warning of gout is analogous to the warning of a painfully loud fire alarm. The sensible thing to do is to make sure there is no fire, or in this case no sleep apnea. A much more dangerous approach is to ignore the alarm (just live with the gout) or to switch the alarm off without making sure there is no fire (suppressing the gout by mainstream or alternative medicine without testing for sleep apnea). Once you're sure that there is no fire, then it's safe to conclude that the alarm is false and switch off the alarm.
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replied August 13th, 2005
How do you get tested for sleep apnea? I notice that sometimes I think I am dreaming that i'm dying or falling unconsicous, and then I try to wake up and I can't. When I finally wake up I am breathing real hard and it feels like I wasnt dreaming, that I was actually losing consciousness but couldnt' wake up. This happens more often if I try to nap during the day and not so often at night. Also, it seems to happen when I party the night before. Any advice ?

Also, I think I have gout, but I have another post in the forum on that. I also have a family history of diabetes and heart disease, even though I don't have high blood sugar or any other signs of that.
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replied August 14th, 2005
Experienced User
Testing For Sleep Apnea
The definitive way to test for sleep apnea is by monitoring of sleep behavior overnight in a sleep lab, usually prescribed by a doctor. But there are ways of testing yourself first to see if you should prod your doctor for the sleep lab test.

The first things involve sleep habits, so they are usually better tested by your sleeping partner. If you snore, then you very likely have sleep apnea; and if you don’t snore, then you probably don’t have it. If you stop breathing for many seconds at a time and then restart with a loud snort, then you almost certainly have it. Sometimes an apnea episode will cause you to wake up and maybe realize that you have to go to the bathroom, so frequent trips to the bathroom or frequent waking periods may indicate sleep apnea. If you get attacks of gout while you are sleeping, then you almost certainly have it. You can use a pulse oximeter to monitor the percentage of oxygen in your blood while you are sleeping, as I described in my website www.Freewebs.Com/goutcure . Sleep apnea is more likely to occur after drinking alcohol.

The second thing involves your behavior during waking hours. Because your sleep is so restless, you may find that you nod off to sleep almost uncontrollably when you don’t want to. Many traffic accidents have been caused by people with sleep apnea dozing off while driving.

Because sleep apnea is so common, so woefully underdiagnosed, and so potentially dangerous, doctors should routinely screen their patients for it. Very few do. So it us up to each of us to educate ourselves enough to know when to prod our doctors to check us, and remediate the apnea when it is detected. It could be a matter of life or death.
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replied February 28th, 2011
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It is a fraud to claim that "Gout Is an Indicator of Sleep Apnea" and "SLEEP APNEA IS A CAUSAL FACTOR FOR GOUT" [1].

In a Letter To The Editor, entitled "Gout Is an Indicator of Sleep Apnea" [0], the author of the Letter claims: "MEDICAL LITERATURE SHOWS THAT SLEEP APNEA IS A CAUSAL FACTOR FOR GOUT [1],[2]. " -- citing references [1] and [2] as the medical sources that support the claim.

However, the two references not only do not provide support to the claim, but also do not contain the word "gout" in them! It is beyond one's imagination that the two medical references containing no word "gout" can be stretched out so much to mean: "Gout Is an Indicator of Sleep Apnea" and "SLEEP APNEA IS A CAUSAL FACTOR FOR GOUT". And , inexplicably, the medical journal Sleep published it.

Once these claims had the toe-holds in the Sleep journal, they began to spread, mainly by the same author, to other medical journals, Wikipedia, and internet postings as if the claims are proven and are true. This misled some gouties to be concerned, worried, and even spent time and money to seek the expensive diagnosis and the cure for their non-existing sleep apnea.

There is no pathological nor epidemiological evidence that shows sleep apnea alone causes gout and the cure of sleep apnea is the cure for gout.

The Sleep journal provides a great disservice to the public, especially to the gouties, by publishing such a misleading and fraudulent medical claims in the Letter. Hope the Sleep journal will investigate the merit and the integrity of the Letter and rectify the situation if it is warranted.

References -
[0] Abrams B. "Gout is an indicator of sleep apnea".Sleep. 2005 Feb 1;28(2):275.
[1] Grum CM. "Cells in crisis. Cellular bioenergetics and inadequate oxygenation in the intensive care unit," Chest. 1992 Aug;102(2):329-30. (Editorial, free)
[2] Hasday JD, Grum CM. " Nocturnal increase of urinary uric acid:creatinine ratio. A biochemical correlate of sleep-associated hypoxemia," Am Rev Respir Dis. 1987 Mar;135(3):534-8. (Abstract, free)
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replied March 12th, 2011
Another hoax in "Gout is an indicator of sleep apnea"
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Another hoax in "Gout is an indicator of sleep apnea".

In the above-mentioned Letter to the Editor of the Sleep journal, the author of the Letter also states that "...NO PHYSICIAN WHO KNOWS OF THIS RELATIONSHIP ... the hypoxia resulting from sleep apnea causes .. increase of ... uric acid. The excess of uric acid can lead to the precipitation ... of ... urate crystals into a joint, which causes gout..." [0].

These statements in the Letter misrepresent reference [3], which the Letter cites as a supporting source because:

1) Reference [3] does not state or imply that SA increases the serum uric acid (UA) level, which can lead to gout. In the contrary, the data in [3] show that the serum UA level of SA patients is in the normal range and is lower than that of the non-SA control!

2) Reference [3] does not state or imply SA causes gout.

The following is an abridged table constructed from Table 1 and 3 of reference [3].

------------------------------------------ ------------------------------------------ ------------------------------------------ --
Variables................................. .................Control(n=10)............ ...........SA Patients (n=20)..........
........................................ .............................(No.SA)...... ..........Before CPAP*...........After CPAP
------------------------------------------ ------------------------------------------ ------------------------------------------ --
Serum uric acid, mg/dL..................................... 7 .2..........................6.6......... ...............6.8
Urinary uric acid excretion, mg/dL GFR...........0.32................. ......0.55.......................0.30
Arterial blood pH....................................... ........7.41.........................7.41
------------------------------------------ ------------------------------------.----- ------------------------------------------ ---
* CPAP = continuous positive airway pressure, which is used to normalize SA patients' breathing.

The data mean:

A1) SA patients' serum UA level (6.6 mg/dL) is in the normal range (< 7.0 mg/dL). Also, SA patients have lower serum UA level (6.6 mg/dL) than the non-SA control (7.2 mg/dL). Therefore, SA patients have smaller chance to develop gout than the non-SA control.

A2) The serum UA level increases from 6.6 to 6.8 mg/dL in SA patients when CPAP is used to normalize their breathing during the sleep. In other words, the use of CPAP to treat SA increases the chance of developing gout.

B1) SA patients excrete more UA in the urine than the control, which is good for gout because the higher the UA excretion the lower the serum UA level. (That is how uricosuric agents such as Probenecid work.)

B2) The use of APAP decreases the urinary excretion of UA in SA patients. This is bad for gout because, in this case, the serum UA level is increased.

C) The control and the SA patients have the same arterial blood pH (7.41).

In short, reference [3] indicates SA patients have normal serum UA level therefore, theoretically, they should not develop gout. Also, the SA patients' serum UA level is lower than that of the non-SA control, therefore, SA patients are less likely than non-SA people to develop gout.

It is inconceivable that the author of the Letter to the Sleep journal reverses, by 180 degrees, what the data in reference [3] indicate, to claim: "... SLEEP APNEA IS A CAUSAL FACTOR FOR GOUT ... NO PHYSICIAN WHO KNOWS OF THIS RELATIONSHIP..."! And, the Sleep journal published the Letter!

References: -

[0] Gout is an indicator of sleep apnea. Abrams B., Sleep. 2005 Feb 1;28(2):275.
[3] Changes in urinary uric acid excretion in obstructive sleep apnea before and after therapy with nasal continuous positive airway pressure. Sahebjani H., Chest. 1998 Jun;113(6):1604-8. (Article, free)
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replied March 15th, 2011
Experienced User
Reference [3] in Noapnea's above post clearly states that the hypoxia from sleep apnea leads to excess cellular generation of uric acid from the disintegration of cellular adenosine triphosphate, and the article demonstrates that excess uric acid is expelled afterward in the urine. Blood that was drawn for serum uric acid measurement in that study was taken in the morning after patients had awakened. Noapnea mistakenly assumes that the serum uric acid measured after awakening is representative of any temporary rise in serum uric acid during REM sleep hours earlier when the apnea was at its peak.

References [1] and [2] describe two effects of inadequate oxygenation from sleep apnea or other means -- excess cellular generation of uric acid in the blood, and acidosis (reduced serum pH). This increased blood acidity means that the blood can retain less uric acid in solution. Thus, with more uric acid fed into the blood when the blood has reduced ability to keep it dissolved, there is increased likelihood that the uric acid will precipitate in the crystalline form which causes gout. Both elevated serum uric acid and low serum pH are widely recognized as conditions which can lead to a gout attack, and they both occur as a result of sleep apnea.

None of the references [1], [2], or [3] connects gout with sleep apnea, or even mentions gout. The contribution made to medical literature by reference [0] is to use their results to make that connection so that medical practitioners would be apprised of it. The author of reference [0] put two and two together to get four. Apparently, Noapnea tries to put two and two together and gets zero. The editors of the medical journal Sleep saw the insight in reference [0] as worthy of publication in their journal, but Noapnea sees it as a hoax.

I hope that Noapnea's denial does not stand in the way of thoughtful health-conscious gout sufferers from pursuing the possibility that their gout may be an indicator of underlying sleep apnea, which can lead to life-shortening and quality diminishing consequences if left untreated.
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replied March 16th, 2011
so has anyone ever been cured of sleep apnea via surgery or otherwise. I think now that this is the root of my gout issues. I have horrible sleep apnea and my girlfriend confirms that at times she is scared and wants to wake me up because of how labored my breathing can get. especially during high allergy season.
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replied March 16th, 2011
Experienced User
Slatt34 -

There are several ways of treating sleep apnea, each of which is known to be effective in some people with sleep apnea. Here are the ones that I am aware of.

(1) Position therapy, which means ensuring that you never sleep on your back because in that position gravity can pull the back of your tongue down into your throat to close off the airway. There are a number of different props available which help prevent the sleeper from turning over onto his or her back during sleep. This therapy is generally most effective for people who are not overweight and whose sleep apnea is not severe.

(2) Devices to keep the tongue moved forward during sleep, including dental appliances that look like an athlete's mouth guard. Such devices are usually fit by a dentist who specializes in sleep dentistry.

(3) Surgery to shorten the uvula, or move the hyoid bone, or to extend the lower jaw, or even tracheostomy. Tracheostomy is the most drastic of these, but also the most generally effective. These surgeries are usually performed by an otolaryngologist.

(4) Use of a pressurized mask during sleep whose slightly elevated pressure helps keep the airway from closing up even when the throat muscles relax during sleep. These are the most commonly prescribed treatments, and are usually very effective if they are always used during sleep. Unfortunately, many people find them too cumbersome to use, so they don't comply regularly. These devices are usually prescribed under the auspices of a sleep medicine specialist.

There are some steps that someone with sleep apnea can try without medical assistance. They include:
(1) Lose excess weight because the flab on the outside usually goes along with flab on the inside linings of your airway;
(2) Don't smoke, because smoking inflames the lining of the airway;
(3) Don't drink any alcoholic beverages for several hours before bed, because they can exacerbate your sleep apnea;
(4) Be very wary about using sleep medications, either prescription or over-the-counter. They can cause your sleep apnea to be exacerbated.

You may not consider all these things to be "cures" in the same sense that ten days use of an antibiotic cures a bacterial infection. But the right approach can be just as effective as a "cure". In my case, position therapy works. Others may need a different form of treatment to be effective. Good luck in pursuing this extremely important goal. If you "cure" your sleep apnea, there's a good chance that you'll "cure" your gout as well. Position therapy produced that benefit for me.

By the way there are medical journal studies conducted in the USA and in the UK which have found gout attacks to occur more frequently during spring and early summer, which is the high allergy season.
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replied March 24th, 2011
Hi, I always feel than one has to do first things first and in this case I agree with what has been stipulated above. First try the home treatment, the things you can control before you think of trying the other stuff. Maybe you are lucky and you can sort out both conditions without to much hassle. Good luck.
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replied May 3rd, 2011
Sleep apnea can be a serious disease and needs to be taken care of properly. However, there is no point to test for or treat sleep apnea unless a person has risk factors or symptoms of sleep apnea, which do not include gout.

It is the well-known fact that for anything to cause gout, it must cause high level of uric acid in the blood (hyperuricemia) first before it can cause gout. Many studies have shown that sleep apnea alone does not cause hyperuricemia. Therefore, sleep apnea cannot cause gout. Furthermore, there is no epidemiological evidence to support that sleep apnea causes hyperuricemia and gout. Thus, the claim that sleep apnea causes hyperuricemia and gout, is just a hoax being used to promote someone's imaginary "personal discovery".

It is also well-known that hyperuricemia and gout can be caused by numerous diseases, conditions, and medication such as: genetics, kidney diseases, leukemias, lymphomas, myeloma, lead poisoning, insulin resistance, polycythemia, sickle cell anemia, hemolytic anemia, diuretics, chemotherapy, low dose aspirin,... How could treating sleep apnea improve these gout causing diseases, conditions, and medication? And, why should gout sufferers waste their time and resources in treating the unrelated sleep apnea to treat gout?

To have the claims published in the Sleep and other journals do not mean these claims are always true. From time to time, the fraudulent claims published in the medical journals are retracted and discredited when the fraud are exposed. We will see what the Sleep and other medical journals will do to the hoax that sleep apnea causes hyperuricemia and gout.

Most of all, it is unconscionable for poster "painfree" to gloat over that gout sufferers "can lead to life-shortening and quality diminishing consequences" unless they believe his hoax and be treated for the non-existing sleep apnea.
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replied May 18th, 2011
Experienced User
Here are several medical journal articles that report on hyperuricemia as a result of sleep apnea (also referred to as sleep disordered breathing):

Hasday JD, Grum CM. "Nocturnal Increase of Urinary Uric Acid:Creatine Ratio: a Biological Correlate of Sleep-Associated Hypoxemia," American Review of Respiratory Diseases 135, 1987, pp.534-38.

Plywaczewski, R., et al. "Hyperuricemia in Males with Obstructive Sleep Apnea (OSA)," Pneumonol Alergol Pol. 73(3) 2005, pp. 254-259.

Plywaczewski, R., et al. "Hyperuricemia in Females with Obstructive Sleep Apnea," Pneumonol Alergol Pol. 74(2) 2006, pp. 159-165.

Ruiz Garcia, A., et al, "Blood Uric Acid Levels in Patients with Sleep-Disordered Breathing." Archivos de Bronconeumologia 42 (10), October 2006, pp. 492-500.

Garcia Panchon, E., et al, "Uric Acid and Its Relationship to Creatinine Levels and Hypoxia," Archivos de Bronconeumologia 43 (9), September 2007, p. 523.

There are three important factors in the body's processing of uric acid which can lead to such a high concentration in the blood that it precipitates as the monosodium urate crystals which cause gout. The first factor is the cellular rate of generation of uric acid fed into the blood, which the above papers show is increased by sleep apnea. The second factor is the amount of uric acid which the blood can hold in solution, which previously has been shown to be reduced by the increased blood acidity (reduced serum pH) which results from the hypoxia of sleep apnea. The third factor is the rate at which the kidneys remove uric acid from the blood. A recent paper shows that kidney function is reduced by the hypoxia of sleep apnea:

Ahmed, SB, et al, "Nocturnal Hypoxia and Loss of Kidney Function," PLos One, 2011 Apr 29; 6(4):e19029.

Thus the hypoxia of sleep apnea triggers a gout attack by its effect on all three mechanisms. It is foolhardy to ignore the possibility of sleep apnea as a major cause of gout attacks, particularly because so many of the long term consequences of sleep apnea are life-threatening.
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replied October 22nd, 2011
Gout and Sleep Apnea
I have been suffering from gout for 20 years. Also had trouble with snoring and being tired. Finally was diagnosed with sleep apnea. Been on the APAP machine since and have been gout free.

In my case there is a direct relationship between gout and sleep apnea. I really wish I had known about this long ago.
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replied October 22nd, 2011
Experienced User
Congtats Paul. I had the same disappointment with the medical profession as you did when overcoming my sleep apnea cured my gout. The physiological connection, the high prevalence of sleep apnea, and the vast majority who are undiagnosed with sleep apnea would imply that many other gout sufferers could benefit as you and I did, if only the gout practitioners paid attention to the connection. Until that happens gout sufferers should insist on a sleep test without waiting for their doctors to initiate it.
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