Elevated uric acid in patients with obstructive sleep apnea increases the risk of stroke: A systematic review and meta-analysis combined with a retrospective cohort study.

BACKGROUND

Obstructive sleep apnea (OSA) is linked to stroke events, but the role of serum uric acid (UA) in stroke remains controversial and analyses of changes in UA and stroke are limited. Furthermore, their combined effect on stroke risk remains unclear. This study investigated the relationship between OSA severity and serum UA, and whether elevated UA increases stroke risk in OSA patients.

METHODS

A systematic search of PubMed and Web of Science (up to Dec 2024) identified relevant studies for a meta-analysis. Concurrently, a retrospective analysis was conducted on OSA patients (2020–2024) from Zhongda Hospital affiliated with Southeast University along with healthy controls. Patients and controls were stratified by apnea-hypopnea index (AHI) and UA levels. Multivariable logistic regression identified stroke risk factors.

RESULTS

The meta-analysis showed OSA severity was positively correlated with UA levels (p < 0.001). The retrospective analysis showed each unit increase in UA was associated with a 1% higher stroke risk (adjusted OR: 1.01; p < 0.001). Hyperuricemia increased the odds of stroke 2.88-fold (adjusted OR: 2.88; p = 0.020).

CONCLUSIONS

OSA severity is associated with hyperuricemia, and elevated UA independently predicts stroke risk in OSA patients. Monitoring UA may help identify high-risk individuals for intervention.