Viewing Gout as an Early Symptom of Sleep Apnea

The chronic intermittent hypoxemia which results from sleep apnea causes three effects which quickly elevate the concentration of serum uric acid, often leading to the precipitation of monosodium urate crystals, namely, gout: cell catabolism which culminates irreversibly in the generation of excess uric acid fed into the blood; serum acidosis and hypercapnia which reduces the solubility of uric acid in the blood; and gradual reduction of the kidneys’ glomerular filtration rate so that the removal of serum uric acid is slowed. This physiologic connection of gout to sleep apnea leads to the view that gout is a symptom of sleep apnea, a view supported by epidemiologic studies, common comorbidities, and clinical evidence. The importance of this view is that the incidence of gout should be used to trigger diagnosis and treatment for sleep apnea, before its life-threatening consequences develop.