Assessing the causal associations of obstructive sleep apnea with serum uric acid levels and gout: a bidirectional two-sample Mendelian randomization study

• DOI: 10.1016/j.semarthrit.2022.152095
• Publication Date: 2022-09-09T09:28:20Z
• Authors: Zhen Zeng; Ting Jin; Jing Ni; Li Huang; Yanqing Xie; Wenming He; Lina Zhang; Changhai Ding; Han Cen
• Keywords: Sleep Apnea, Obstructive; 03 medical and health sciences; 0302 clinical medicine; Diabetes Mellitus, Type 2; Gout; Humans; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide; Uric Acid; Genome-Wide Association Study; 3. Good health

Multiple observational studies have reported the close associations of obstructive sleep apnea (OSA) with serum uric acid (SUA) levels and gout. However, the causal nature and direction remains unclear.A bidirectional two-sample Mendelian randomization (MR) study was performed, based on publicly available genome-wide association studies (GWAS) summary statistics, to investigate whether OSA is causally related to SUA levels, gout and vice versa. The inverse-variance weighted (IVW) was used as the primary analysis approach, supplemented with four sensitive analysis methods applied to assess the robustness of the results. Moreover, multivariable MR (MVMR) was utilized to evaluate the independent causal effect of OSA on SUA and gout after adjusting for body mass index (BMI), hypertension, type 2 diabetes (T2D), coronary artery disease (CAD), and chronic kidney disease (CKD).Genetically predicted OSA liability was significantly associated with increased levels of SUA (IVW method: β = 0.19, 95% CI = 0.11 - 0.26, P = 7.24 × 10-7) and risk of gout [IVW method: odds ratio (OR) = 1.75 95% CI = 1.13 - 2.69, P = 0.01] in univariable MR. The MVMR results suggested that OSA retained its significant association with increased SUA levels, whereas the significant association between OSA and gout was attenuated to null after adjusting for BMI and T2D. No causal effect of OSA on SUA levels and gout was found in the reverse direction.Our findings suggest that OSA was causally associated with increased levels of SUA, but was not independently associated with gout risk.