The microbiome in obstructive sleep apnea

Abstract

Recent evidence has highlighted important associations between obstructive sleep apnea and the microbiome. Although the intricacies of the pathophysiologic mechanisms are not well understood, available evidence suggests a bidirectional relationship between OSA and microbiota composition. Sleep fragmentation, intermittent hypoxia, and intermittent hypercapnia all play significant roles in altering the microbiome, and initial evidence has shown that alterations of the microbiota affect sleep patterns. Animal model evidence strongly supports the idea that the microbiome mediates disease states associated with OSA including hypertension, atherosclerosis, and obesity. The majority of evidence focuses on changes in the gut microbiome, which may result from OSA as well as contribute to sleep pattern changes, OSA-related CVD, and obesity. Meanwhile, a developing body of work suggests changes in the upper airway microbiome may be associated with OSA and periodontitis-related oral cavity microbiome changes may have significance in OSA-related CVD. Lastly, while evidence is limited, several studies suggest there may be a role for treatment of OSA and OSA-related comorbidities through alteration of the microbiome with probiotics, prebiotics, and microbiota transplantation. These early animal and human studies begin to characterize the interrelationships of the microbiome and OSA and may lead to new avenues for treatment.

Gut Microbiome in Patients with Obstructive Sleep Apnoea

“…Obstructive sleep apnoea may lead to gut dysbiosis via various mechanisms. First, some of the bacteria are oxygen-sensitive [4], and intermittent hypoxaemia in animal models was related to alterations in the gut microbiome and a consequential increase in circulating bacterial toxins and bile acids [3,5,6]. Second, sleep fragmentation in animals and humans is itself also related to gut dysbiosis [3,5,6].…”

“…First, some of the bacteria are oxygen-sensitive [4], and intermittent hypoxaemia in animal models was related to alterations in the gut microbiome and a consequential increase in circulating bacterial toxins and bile acids [3,5,6]. Second, sleep fragmentation in animals and humans is itself also related to gut dysbiosis [3,5,6]. In addition, OSA is related to high fat and high carbohydrate intake [7] which can alter the composition of the gut microbiome [8] and is associated with a pro-atherosclerotic microbiome profile [2].…”

“Leaky Gut” as a Keystone of the Connection between Depression and Obstructive Sleep Apnea Syndrome? A Rationale and Study Design

“…Although evidence is limited, several studies suggest that treatment of OSA and associated cardiometabolic, neuropsychiatric or gastrointestinal disorders may be based on modulation of the microbiota through pro-, prebiotics, SCFAs, and faecal matter transplantation (FMT) [39,70]. However, to date, there are no clinical trials in this area.…”

“…Additionally, the level of dysbiosis (a state of a disruption in the microbiota homeostasis) was shown to be associated with the severity of clinical depression [37,38]. Moreover, there is scientific data available on bidirectional connection of dysbiosis with hypoxia and its implication in the etiopathogenesis of OSA [39][40][41][42][43][44]. Animal model evidence strongly supports the idea that the impact of sleep fragmentation, intermittent hypoxia and intermittent hypercapnia on microbiota mediates disease states associated with OSA apnoea, including hypertension, atherosclerosis, and obesity [13,39].…”

Lifestyle Medicine and Otolaryngology: Embracing the Future

“…For example, research linking the microbiome and obstructive sleep apnea suggests possibilities of treating it by altering the microbiota through dietary intervention. 11 …”