Severe obstructive sleep apnea is associated with alterations in the nasal microbiome and an increase in inflammation

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 WangCameron Blazoski, Michael D. Weiden, David M. Rapoport, Denise Harrison, Nishay Chitkara, Eugenio Vicente, José M. Marin, Jag Sunderram, Indu Ayappa, Leopoldo N. Segal

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Rationale: Obstructive 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. Objectives: To evaluate whether the composition of the nasal microbiota is associated with obstructive sleep apnea and inflammatory biomarkers. Methods: Two 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 Results: In 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. Conclusions: We 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.

Original languageEnglish
Pages (from-to)99-109
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume199
Issue number1
DOIs
StatePublished - 1 Jan 2019

Keywords

  • Biomarkers
  • Chronic rhinosinusitis
  • Inflammation
  • Microbiome

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