Sleep Apnea and Gout

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Sleep Apnea and Gout

Postby GoutPal » Mon Jun 18, 2007 6:42 am

As sleep apnea reduces oxygen and increases carbon dioxide in the blood, this can lead to rapid cell death which raises uric acid. Increased uric acid (hyperuricemia) often leads to gout.

For many gout sufferers, curing sleep apnea also cures gout, but if it doesn't, you must treat your uric acid levels to achieve 5mg/dL (0.30mmol/L) or lower.
Last edited by GoutPal on Thu Dec 22, 2011 1:17 pm, edited 1 time in total.
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Is it a fraud-- gout indicates sleep apnea?

Postby noapnea » Tue Feb 22, 2011 3:00 pm

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Is it a fraud to claim that "Gout Is an Indicator of Sleep Apnea" and "SLEEP APNEA IS A CAUSAL FACTOR FOR GOUT"[1]?

Anyone who is interested in the subject can google using the phrase "Gout Is an Indicator of Sleep Apnea -- fact, fiction, or fraud ?"

[1] Abrams B. "Gout is an indicator of sleep apnea". Sleep. 2005 Feb 1;28(2):275.[/b][b][u][/u][/b]
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Postby SleepyToo » Tue Feb 22, 2011 10:11 pm

As gout reflects an abnormal metabolism, if you can correct the cause of the abnormality you may claim you have "cured" gout. However, you CAN NOT cure sleep apnea. Treat it, yes, cure no. I did see a report recently that repeated the suggestion that there may be an association between sleep apnea and gout. But that doesn't cement the relationship in stone, nor does it exclude other possible causes. For people with sleep apnea and gout, I would say get the gout treated effectively, and get the apnea treated effectively. Take the effects of both treatments and be thankful. If treating the apnea allows your doc to reduce your gout medication, you have had a benefit of sleep apnea, and there was an association. If not, get on with whatever treatment your docs prescribe.
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It is a fraud that gout indicates sleep apnea

Postby noapnea » Mon Feb 28, 2011 2:09 pm

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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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Postby noapnea » Sat Mar 12, 2011 7:25 pm

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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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Postby painfree » Sat Apr 23, 2011 2:51 pm

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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Postby noapnea » Tue May 03, 2011 1:41 pm

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. Therefore, 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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Postby Vicki » Tue May 03, 2011 8:27 pm

Here is a full-length peer reviewed journal article by Burton Abrams which is more current. He also published an article on the topic in 2010. However there is no abstract and the 2010 article is not free:

Sleep apnea as a cause of gout flares

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Being defeated is often a temporary condition. Giving up is what makes it permanent.
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That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Recycling the Hoax

Postby noapnea » Sun May 08, 2011 1:25 pm

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"Sleep Apnea as a Cause of Gout Flares", a Letter published in Medscape journal [6], is a recycling of the hoax made earlier in Sleep journal [7]. The following explains why ref. [6] is a hoax.

1) In ref. [6], the Author states: "Pulmonology journal literature [1,2] describes 2 mechanisms by which the hypoxemia of sleep apnea leads to MSU precipitation." The facts are: refs. [1,2] do not contain words: "gout", "hyperuricemia", "MSU", "monosodium urate", and "precipitation". And, they do not state, imply, or discuss that "sleep apnea leads to MSU precipitation". How these two references can be stretched out so much to mean "sleep apnea leads to MSU precipitation" is beyond anyone's imagination.

2) In ref. [6], the Author also states: "Other pulmonology journal literature has confirmed that hyperuricemia is a result of sleep apnea. [3–5]". Again, this statement is pure fabrication and is false because:

* Refs. [3-4] re-confirm the well-known fact that obesity causes both hyperuricemia and sleep apnea. They do not show sleep apnea alone causes hyperuricemia and gout.

* Ref. [5] shows that the mean uric acid concentration of 1,135 patients suspected to have sleep apnea is in normal range (6.31 mg/dL) -- i.e., sleep apnea does not cause hyperuricemia. Therefore, sleep apnea alone cannot cause gout.

So, where is the proof that "sleep apnea leading to the precipitation of MSU..." [6]? The answer is: nowhere. Why then the Author publishes ref. [6]? It appears that the purpose of the Letter to the Editor of Medscape [6] is to recycle the hoax started in ref. [7] to publicize the Author's imaginary "personal discovery" under the covers of the five unfairly mis-represented references.

References

[1]. Grum CM. Cells in crisis: cellular bioenergetics and inadequate oxygenation in the intensive care unit. Chest. 1992;102:329–330. [PubMed]
]2]. Hasday JD, Grum CM. Nocturnal increase of urinary uric acid:creatine ratio: a biological correlate of sleep-associated hypoxemia. Am Rev Respir Dis. 1987;135:534–538. [PubMed]
]3]. Plywaczewski R, Bednarek M, Jonczak L, Górecka D, Sliwiñiski P. Hyperuricemia in males with obstructive sleep apnea (OSA) [in Polish] Pneumonol Alergol Pol. 2005;73:254–259. [PubMed]
[4]. Plywaczewski R, Bednarek M, Jonczak L, Górecka D, Sliwiñiski P. Hyperuricemia in females with obstructive sleep apnea [in Polish] Pneumonol Alergol Pol. 2005;74:159–165. [PubMed]
[5]. Ruiz Garcia A, Sanchez Armenqol A, Luque Crespo E, et al. Blood uric acid levels in patients with sleep-disordered breathing [in Spanish] Arch Bronconeumol. 2006;42:492–500. [PubMed]
[6] Sleep Apnea as a Cause of Gout Flares. Burton Abrams, Medscape J Med. 2009; 11(1): 3.
[7] Gout is an indicator of sleep apnea. Abrams B., Sleep. 2005 Feb 1;28(2):275.
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Re: Sleep Apnea and Gout

Postby heavybreather » Fri Jul 29, 2011 12:50 pm

The debate is pretty simple for me. Gout cannot be directly related to Sleep Apnea, but Sleep Apnea can be directly related to not only gout but a number of other health issues. Unfortunately my father has also been having lots of heart issues as of late after being diagnosed with gout, on top of SA of course...
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Re: Sleep Apnea and Gout

Postby tjschmitt » Wed Nov 09, 2011 10:51 am

heavybreather wrote:The debate is pretty simple for me. Gout cannot be directly related to Sleep Apnea, but Sleep Apnea can be directly related to not only gout but a number of other health issues. Unfortunately my father has also been having lots of heart issues as of late after being diagnosed with gout, on top of SA of course...


I am in the same boat with him sleep apnea can be caused by gout but not the other way around.
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Re: Sleep Apnea and Gout

Postby petersimon786 » Wed Dec 21, 2011 2:04 pm

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Re: Sleep Apnea and Gout

Postby xm41907 » Wed Dec 21, 2011 5:18 pm

There is no home cure for gout. Believe me, I tried them all. Any anecdotal evidence such as someone drank a glass of baking soda and water then their gout went away is not scientific evidence. Also, for most people with gout they are asymptomatic the majority of the time. The best method for gout control is frequent (2 times a year or so) blood tests for uric acid level, and appropriate dosage of medicine. I'm on Allopurinol and it's worked great for me at the starting dosage of 100mg. I tried for several years to treat it with all the various remedies and nothing really worked. I would have random attacks with them all. Once I gave in and went on the medicine, I've not had a single attack. Concurrently, my toe joints are no longer inflamed and reddish as they were when I was not on the medicine. And to top it off, I have had no observable side effects to the medicine. I feel so stupid for suffering for several years with spending way more than I would have for the meds themselves. If you have gout, get treated by a doctor that will monitor your uric acid levels. Many will throw you on the medicine and not monitor it. Some people need to increase to higher doses.
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Re: Sleep Apnea and Gout

Postby GoutPal » Thu Dec 22, 2011 11:33 am

xm41907 wrote:The best method for gout control is frequent (2 times a year or so) blood tests for uric acid level, and appropriate dosage of medicine. I'm on Allopurinol and it's worked great for me at the starting dosage of 100mg. [...] If you have gout, get treated by a doctor that will monitor your uric acid levels. Many will throw you on the medicine and not monitor it. Some people need to increase to higher doses.


It has been a long time since I started this thread, and I have learned a lot in that time. xm41907's message holds the most accurate and helpful information so far. It does not really matter what gout is related to. If you can find a cause of excess uric acid, remove that cause, and lower uric acid to 5mg/dL (0.30mmol/L) or below, then that is fine. However, as a person who has had gout, you must follow this advice about testing (ALWAYS) and treatment (if necessary).

Do not worry about causes, triggers, ridiculous diets or any of the other rubbish that is written to confuse the gout issue. If high uric acid has given you gout, then you must get it back to a safe level. The safe level (always worth repeating because people confuse medical safety with statistical norms) is 5mg/dL (0.30mmol/L).
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Re: Sleep Apnea and Gout

Postby greatunclebill » Sun Feb 26, 2012 12:06 am

i take 300mg of allopurinol daily (max dose) and will still have gout attacks if i don't watch what i eat. i can eat the wrong thing tonight and be on crutches in the morning. i looked at the main trigger foods for gout and discontinued all of them. i miss shrimp the most. by taking my medicine and not eating the trigger foods i haven't had an attack for probably at least 5 years. before that i was in and out of the doctors office or ER on crutches getting oxycodone and prednisone treatments.
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