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

Wu BG; Sulaiman I; Wang J; Shen N; Clemente JC; Li Y; Laumbach RJ; Lu S-E; Udasin I; Le-Hoang O; Perez A; Alimokhtari S; Black K; Plietz M; Twumasi A; Sander H; Malecha P; Kapoor B; Scaglione BD; Wang A; Blazoski C; Weiden MD; Rapoport DM; Harrison D; Chitkara N; Vicente E; Marin JM; Sunderram J; Ayappa I; Segal LN

Am J Respir Crit Care Med 2019 Jan; 199(1):99-109

https://doi.org/10.1164/rccm.201801-0119OC

20054347

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.

Breathing; Respiratory diseases; Airway obstruction; Nasal cavity; Biomarkers; Cohort studies; World Trade Center; WTC; Sleep disorders; Author Keywords: microbiome; inflammation; chronic rhinosinusitis; biomarkers

Leopoldo N. Segal, M.D., New York University School of Medicine, 462 First Avenue 7N24, New York, NY 10016

AJCMED

20190101

Journal Article

leopoldo.segal@nyumc.org

Cooperative Agreement

2019

Cooperative-Agreement-Number-U01-OH-010415

1

1073-449X

American Journal of Respiratory and Critical Care Medicine

NY; NJ

RBHS-Robert Wood Johnson Medical School, Piscataway, New Jersey