Sleep Apnea Can Increase Your Risk for Gout

By Dr. Mercola

An estimated 22 million Americans suffer from sleep apnea,¹ the most common type being obstructive sleep apnea (OSA), which causes the airway to become blocked during sleep, leading to reduced or blocked airflow.

Up to 80 percent of moderate and severe obstructive sleep apnea cases are undiagnosed, according to the American Sleep Apnea Association (ASAA), which presents a dangerous scenario because, left untreated, the condition increases the risk of high blood pressure, heart failure, atrial fibrillation, stroke and other heart problems.²

OSA is also associated with obesity, high blood pressure and diabetes, conditions also linked with gout, a form of arthritis. Now, research published in Arthritis & Rheumatology also suggests that the two conditions — gout and OSA — may be connected, with OSA increasing the risk of gout considerably.³

People With Obstructive Sleep Apnea at Greater Risk of Gout

The study involved nearly 16,000 patients with OSA, and another 63,000 without, who were followed for about six years. Nearly 5 percent of those with OSA developed gout during the study period compared to 2.6 percent of those without.

Gout is a painful condition that causes swelling and tenderness in the joints. It's caused by an accumulation of urate crystals in your joints. The crystals may form due to high levels of uric acid in your body, which are formed when your body breaks down purines. Purines are found in food and are also produced naturally in your body.

Uric acid is typically dissolved and passed through your urine for elimination, but if a buildup occurs, sharp urate crystals may form, leading to pain and inflammation associated with gout.⁴ It's unclear why OSA may increase the risk of gout, but it's known that a reduced oxygen supply during sleep, as occurs during apnea, may increase your body's production of uric acid.⁵

Continuous positive airway pressure (CPAP) is a special type of sleeping mask prescribed for severe sleep apnea that mechanically restores your breathing by using air pressure to open your airway. "It's possible that people who use CPAP could reduce the risk or severity of gout," the study's lead author said.⁶

The Connections Between Sleep Apnea and Gout

It's interesting to note that gout attacks — which often wake up sufferers from a sound sleep with intense pain and burning in their big toe — are 2.4 times more likely to occur at night than during the day.⁷ Sleep apnea may be one explanation for this phenomenon.

In addition, past studies have found up to 50 percent of patients with sleep apnea may have hyperuricemia, or an excess of uric acid in the blood, "and therefore sleep apnea could predispose individuals to gout attacks," researchers wrote in a 2015 study published in Arthritis & Rheumatology.⁸

That study found patients with sleep apnea had a 50 percent higher risk of gout compared with people without gout (but who were at very high risk of developing it). It's also been suggested that patients with gout should be screened for sleep apnea, as it often goes undiagnosed and gout could be a red flag indicating the potential presence of the condition.

This is true even in people who are not overweight, as 30 percent of those with sleep apnea and gout are normal weight. A letter to the editor published in The Medscape Journal of Medicine added:

"Screening patients with gout for sleep apnea is an important tool for treating their gout, even if they are not overweight.

Using their gout as an indicator leading to diagnosis and treatment, if warranted, of the sleep apnea not only may prevent further gout flares, but more importantly will greatly lower their risks for the very serious — even life-threatening — cardiovascular, neurologic, and metabolic consequences of sleep apnea.

The lifestyle focus for treating gout needs to consider not only how the patient eats or drinks, but also how the patient sleeps."

Eating the Right Diet May Help Both Sleep Apnea and Gout

While gout is a condition often associated with diet, fewer people are aware that sleep apnea may also be influenced by what you eat. In fact, processed foods, which tend to acidify your blood, will make you breathe heavier and can lead to chronic overbreathing.

The reason for this is because carbon dioxide, which is in your blood, helps regulate pH. Besides water, raw fruits and vegetables have the least impact on your breathing, followed by cooked vegetables. Processed, high-protein and high-grain meals have the greatest adverse effect on the way you breathe.

Processed foods are also better off avoided to prevent and treat gout, especially those containing high-fructose corn syrup. High-fructose corn syrup increases your uric acid levels,⁹ with research showing consumption of sugar-sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men.¹⁰ Even fructose-rich fruits and fruit juices may increase gout risk.

Further, refined fructose essentially "programs" your body to consume more calories and store fat, which could lead to obesity — a key risk factor for sleep apnea. If you are obese, you can dramatically improve the effects of sleep apnea by losing weight, which will reduce pressure on your abdomen and chest, thereby allowing your breathing muscles to function more normally

Losing weight if you're overweight or obese will also improve gout, as excess body weight plays a role in gout attacks, resulting in increased uric acid production and reduced ability of the kidneys to eliminate it from the body.¹¹ If you drink alcohol, reducing or eliminating it is another strategy, as alcohol consumption is associated with both a higher risk of sleep apnea¹² and gout.¹³

Is Sleep Apnea Causing Your Gout?

If you suffer from gout, it's worth considering whether sleep apnea could be involved, especially since many cases of the latter go undiagnosed. If you snore loudly and often wake up feeling tired, sleep apnea could be to blame. Other symptoms include:¹⁴

Snoring, along with snorting or choking in your sleep, is a common sign of sleep apnea that occurs when your brain lets you know you don't have enough oxygen in your blood. You'll awaken briefly so your airway can be cleared, but probably won't remember awakening.

Such episodes can occur up to 30 times an hour in severe cases,¹⁵ seriously interfering with your ability to get deep periods of restful sleep. Sleep apnea is diagnosed via your sleep history, which may be reported personally (with the help of someone you sleep near) or by spending the night in a sleep disorder center where your breathing can be monitored overnight.

Home sleep tests are also available to help with sleep apnea diagnosis. In mild cases, lifestyle changes like losing weight and quitting smoking may be all that's needed to keep the condition under control.

Exercise is also important and can reduce the severity of sleep apnea, even without major changes in body weight.¹⁶ In moderate or severe cases, CPAP is often effective to keep your airway open while you sleep.

The only downside to CPAP is that some people find it uncomfortable to sleep in, but most are able to adjust (you can try different types of masks for a better fit). Other potential treatment options include:

• Buteyko Breathing Method — Named after the Russian doctor who developed it, the Buteyko technique can be used to reverse health problems caused by improper breathing, including sleep apnea.
• Orofacial Myofunctional Therapy — Myofunctional therapy involves the neuromuscular re-education or repatterning of your oral and facial muscles. It includes facial and tongue exercises and behavior modification techniques to promote proper tongue position, improved breathing, chewing and swallowing. Proper head and neck postures are also addressed.
• Oral appliance — If your mild to moderate sleep apnea is related to jaw or tongue issues, specially trained dentists can design a custom oral appliance, similar to a mouth guard, that you can wear while sleeping to facilitate proper breathing.

Can Sleep Apnea Be Prevented?

It's possible for anyone to develop sleep apnea, but there are steps you can take to significantly lower the risk. One of the first is breastfeeding, as breastfeeding longer than one month is linked to a lower risk of habitual snoring and apneas.

Researchers believe there may be a "beneficial effect of the breast in the mouth on oropharyngeal (middle part of the throat, behind the mouth) development with consequent protection against upper airway dysfunction causing sleep-disordered breathing."¹⁷

It's thought that breastfeeding helps expand the size of the child's palate and shift the jaw forward, helping prevent sleep apnea by creating enough room for unobstructed breathing. Sleeping on your side or on your abdomen or with your body elevated from the waist up, rather than on your back, is another preventive measure.¹⁸

Sleeping on your back can cause your tongue and soft palate to rest against the back of the throat and block the airway. Sewing a tennis ball into the back of your pajamas, or positioning pillows strategically, can help prevent you from sleeping on your back.

Leading a healthy lifestyle, including eating right, not smoking and avoiding alcohol, can also help lower sleep apnea risk. If you suspect you may have sleep apnea, it's important to get a proper diagnosis and treatment.

Left unchecked, it increases your risk of a number of conditions, including cognitive and neurobehavioral dysfunction, memory impairment, metabolic impairment and mood changes such as depression.¹⁹ Further, the lack of sound, deep sleep leads to progressively worsening daytime sleepiness that may impair your performance at work or lead to accidents while driving.

In fact, sleep deprivation, or a lack of quality sleep, has a significant impact on your brain health and your overall health and may lead to the following:

The good news is that sleep apnea is typically highly treatable using a combination of lifestyle factors and interventions like CPAP. If you've been struggling with any of its related symptoms, or enduring gout, and you can't figure out why, get evaluated for sleep apnea — addressing this underlying condition could be key to significant health improvement.