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Volume 14 No. 09
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Accepted Papers

Scientific Investigations

Gout and the Risk of Incident Obstructive Sleep Apnea in Adults 65 Years or Older: An Observational Study

Jasvinder A. Singh, MBBS, MPH1,2,3; John D. Cleveland, MS2
1Medicine Service, VA Medical Center, Birmingham, Alabama; 2Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; 3Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama

Study Objectives:

To assess whether gout is associated with a higher risk of obstructive sleep apnea (OSA) in older adults.


We used the 5% United States Medicare beneficiary sample from 2006–2012 to assess whether gout was independently associated with new diagnosis of OSA in adults 65 years or older, adjusting for demographics, medical comorbidity (Charlson-Romano index) and hypertension, hyperlipidemia and coronary artery disease, and the use of medications for cardiovascular diseases or gout (allopurinol, febuxostat).


Based on 10,448,472 person-years of follow-up in a cohort of 1.74 million adults 65 years or older, the crude incidence rates of OSA were 14.3 per 1,000 person-years in people with gout and 3.9 per 1,000 person-years in people without gout. In multivariable-adjusted analyses, gout was associated with higher risk of a new diagnosis of OSA during the follow-up, hazard ratio was 2.07 (95% confidence interval [CI] 2.00, 2.15). In sensitivity analyses that substituted continuous Charlson-Romano score with a categorical variable or individual Charlson-Romano comorbidities plus hypertension, hyperlipidemia and coronary artery disease, the main finding was confirmed, hazard ratios were 2.11 (95% CI 2.03, 2.18) and 1.79 (95% CI 1.73, 1.85).


The independent association of gout with a twofold higher risk of OSA in older adults indicates that common mechanisms may be shared by the two conditions. More studies are needed to investigate these mechanisms further.


Singh JA, Cleveland JD. Gout and the risk of incident obstructive sleep apnea in adults 65 years or older: an observational study. J Clin Sleep Med. 2018;14(9):1521–1527.

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