Obstructive sleep apnea and primary snoring in children are associated with oropharyngeal dysbiosis and a mild compositional imbalance in the gastrointestinal tract

BACKGROUND: Obstructive sleep apnea (OSA) and primary snoring (PS) represent a spectrum of sleep-related breathing conditions. Emerging evidence links OSA to perturbations in the oropharyngeal and gut microbiomes and the pathogenesis of OSA-related comorbidities. However, the microbiome composition and factors driving dysbiosis in children remain unresolved. METHODS: Two pediatric cohorts were examined to assess the microbiome associated with sleep-disordered breathing in the airway (Cohort A) and gut (Cohort B) using 16S rRNA gene profiling. Oropharyngeal swabs were collected from participants with OSA, PS, and healthy controls (HC) (n = 60). Cohort B participants (OSA and HC, n = 46) provided stool samples for microbiome and fecal calprotectin measurements and completed a dietary survey. RESULTS: Oropharyngeal microbial diversity differed between OSA and HC, characterized by an increase in gastrointestinal specific taxa and reduced oral commensals. Similar shifts were observed between PS and HC, with few taxa differing between OSA and PS. In the gut, children with OSA showed an imbalance marked by an increase in opportunistic pathogens and reduced beneficial organisms. However, diversity assessments did not show any indication of dysbiosis or inflammation, and there were no overall differences in dietary intake. CONCLUSIONS: Dysbiosis in the oropharyngeal microbiomes of OSA and PS points to shared pathophysiological factors (e.g., snoring) as possible drivers of microbiome disruption across the spectrum of sleep-disordered breathing. The gastrointestinal microbiome of children with OSA indicates a mild microbial imbalance that may elicit harmful outcomes or manifest as dysbiosis if left untreated. Together, these findings support a role of the microbiome as a possible mediator of comorbidities across the spectrum of sleep-disordered breathing. Current knowledge/study rationale: Obstructive sleep apnea (OSA) and primary snoring (PS) represent a continuum of sleep-related breathing disorders. While adult and animal studies suggest OSA-induced microbiome disruptions contribute to the onset of comorbidities, the factors driving dysbiosis in children remain unresolved. This study investigated the airway and gut microbiomes in pediatric OSA, PS, and healthy controls to identify microbial alterations linked to these conditions. Study impact: This study revealed that children with obstructive sleep apnea and primary snoring exhibit similar altered oropharyngeal microbiomes, distinct from that of healthy controls, suggesting common underlying pathophysiological factors.