Little known fact #11 is that most gout is caused by sleep apnea, which is why most gout flares originate while sleeping. And overcoming the sleep apnea can cure the gout. The hypoxemia of sleep apnea has three effects which lead to an gout flare in short order. Effect #1 is cellular catabolism in which ATP degradation is accelerated, culminating in the cellular generation of excess uric acid fed into the blood, faster than any food would cause. Effect #2 is hypercapnia and acidosis, so that the blood can hold less uric acid in solution. Effect #3 is a long term acceleration of the deterioration of the kidneys' glomerular filtration rate so that removal of uric acid from the blood is slowed. Thus, with sleep apnea there is an abrupt increase in the influx of uric acid in the blood, slowed efflux, and reduced storage capacity -- perfect storm conditions for monosodium urate precipitation. Furthermore, after awakening and normal breathing is restored, the first two effects dissipate so that a blood test taken during waking hours misses their peaks.

Gout experts should feel embarrassed for having missed this connection for so long, especially since gout has been reported to have so many of the same comorbidities already known to be consequences of long-term untreated sleep apnea (eg., cardiovascular diseases, diabetes, kidney disease.) One of the first steps for treating gout should be screening and diagnosis for sleep apnea, followed by treatment of the sleep apnea where indicated. I know from my own experience and the experiences of others that overcoming sleep apnea can prevent additional inflammatory gout flares immediately. More importantly, gout is an early warning of sleep apnea, which when heeded can lead to the early treatment of sleep apnea, thereby greatly reducing the risk for the development of sleep apnea's life-threatening consequences.