title: Sleep Apnea and the Risk of Incident Gout: A Population-Based, Body Mass Index-Matched Cohort Study.
abstract: OBJECTIVE
  Sleep apnea is associated with hyperuricemia owing to hypoxia-induced nucleotide turnover. We undertook this study to assess the relationship between incident sleep apnea and the risk of incident gout.
  
  
  METHODS
  Using data from The Health Improvement Network in the UK, we identified individuals with a first-ever physician diagnosis of sleep apnea. For each patient with sleep apnea, up to 5 individuals without sleep apnea were matched by sex, age, birth year, and body mass index (within ±0.5 kg/m(2) ). We estimated the incidence rates of gout and examined the relationship between sleep apnea and the risk of incident gout using a Cox proportional hazards model, adjusting for potential confounders. In addition, we assessed the rate difference in gout due to sleep apnea using an additive hazard model.
  
  
  RESULTS
  Among 9,865 patients with newly diagnosed sleep apnea and 43,598 matched individuals without sleep apnea, we identified 270 incident cases of gout over 1 year of followup, resulting in incidence rates of 8.4 per 1,000 person-years and 4.8 per 1,000 person-years, respectively. The crude and multivariable rate ratios of incident gout in patients with sleep apnea were 1.7 (95% confidence interval [95% CI] 1.3, 2.2) and 1.5 (95% CI 1.1, 2.1), respectively. The corresponding rate differences between patients with sleep apnea and the comparison cohort were 3.6 (95% CI 1.6, 5.6) and 2.8 (95% CI 0.7, 4.9) per 1,000 person-years. The effect of sleep apnea persisted across subgroups.
  
  
  CONCLUSIONS
  This general population-based study indicates that sleep apnea is independently associated with an increased risk of incident gout. Future research should examine the potential benefits of correcting sleep apnea-induced hypoxia on the risk of hyperuricemia and gout flares.
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Peloquin
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Maureen
authors.initials: M
authors.lastname: Dubreuil
authors.affiliation: Keele University, Keele, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Roddy
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.affiliation: Boston University School of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006073:Gout / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult