• Benjamin G Wu, Imran Sulaiman, Jing Wang, Nan Shen, Jose C Clemente, Yonghua Li, Robert J Laumbach, Shou-En Lu, Iris Udasin, Oanh Le-Hoang, Alan Perez, Shahnaz Alimokhtari, Kathleen Black, Michael Plietz, Akosua Twumasi, Haley Sanders, Patrick Malecha, Bianca Kapoor, Benjamin D Scaglione, Anbang Wang, Cameron Blazoski, Michael D Weiden, David M Rapoport, Denise Harrison, Nishay Chitkara, Eugenio Vicente, José M Marin, Jag Sunderram, Indu Ayappa, and Leopoldo N Segal.
• 1 Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York.
• Am. J. Respir. Crit. Care Med. 2019 Jan 1; 199 (1): 99-109.

RationaleObstructive sleep apnea (OSA) is associated with recurrent obstruction, subepithelial edema, and airway inflammation. The resultant inflammation may influence or be influenced by the nasal microbiome.ObjectivesTo evaluate whether the composition of the nasal microbiota is associated with obstructive sleep apnea and inflammatory biomarkers.MethodsTwo large cohorts were used: 1) a discovery cohort of 472 subjects from the WTCSNORE (Seated, Supine and Post-Decongestion Nasal Resistance in World Trade Center Rescue and Recovery Workers) cohort, and 2) a validation cohort of 93 subjects rom the Zaragoza Sleep cohort. Sleep apnea was diagnosed using home sleep tests. Nasal lavages were obtained from cohort subjects to measure: 1) microbiome composition (based on 16S rRNA gene sequencing), and 2) biomarkers for inflammation (inflammatory cells, IL-8, and IL-6). Longitudinal 3-month samples were obtained in the validation cohort, including after continuous positive airway pressure treatment when indicated.Measurements And Main ResultsIn both cohorts, we identified that: 1) severity of OSA correlated with differences in microbiome diversity and composition; 2) the nasal microbiome of subjects with severe OSA were enriched with Streptococcus, Prevotella, and Veillonella; and 3) the nasal microbiome differences were associated with inflammatory biomarkers. Network analysis identified clusters of cooccurring microbes that defined communities. Several common oral commensals (e.g., Streptococcus, Rothia, Veillonella, and Fusobacterium) correlated with apnea-hypopnea index. Three months of treatment with continuous positive airway pressure did not change the composition of the nasal microbiota.ConclusionsWe demonstrate that the presence of an altered microbiome in severe OSA is associated with inflammatory markers. Further experimental approaches to explore causal links are needed.

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