Association between obstructive sleep apnea and gout risk, and the urate-lowering effects of continuous positive airway pressure: A meta-analysis

Sleep Med. 2026 Jul 27;147:109171. doi: 10.1016/j.sleep.2026.109171. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this meta-analysis was to examine if obstructive sleep apnea (OSA) is associated with gout risk and the effect of continuous positive airway pressure (CPAP) therapy on serum uric acid in patients with OSA.

METHODS: We conducted a systematic search of PubMed, Embase, Cochrane Library, Web of Science and Ovid Medline for articles published up to April 8, 2025. A total of 17 studies (4 cohort studies and 3 non-cohort studies on the association between OSA and gout, 2 randomized controlled trials and 8 non-RCT on urate-lowering effects of CPAP) met the inclusion criteria for this meta-analysis. Our registration number is CRD42024520049.

RESULTS: The meta-analysis revealed that (1) OSA patients have higher gout risk (RR = 1.29, 95% CI: 1.11-1.48, p < 0.001); (2) CPAP lowers serum uric acid levels in OSA patients with an effect size approaching moderate magnitude (Hedges’s g = -0.49, 95%CI: -0.79 to -0.18). The effects are further enhanced by daily CPAP usage of 4 h or more or a treatment duration of 6 months or longer; (3) Baseline uric acid levels, age, and CPAP adherence are key modulating factors influencing treatment efficacy. Patients with higher baseline uric acid levels and younger age are likely to experience a better response to treatment.

CONCLUSIONS: Patients with OSA are prone to developing gout compared to patients without OSA, and sufficient CPAP therapy may serve as an adjunctive treatment to lower serum uric acid levels in patients with OSA.

PMID:42526100 | DOI:10.1016/j.sleep.2026.109171