Obstructive sleep apnea and primary snoring in children are associated with oropharyngeal dysbiosis and a mild compositional imbalance in the gastrointestinal tract.
Hudson J, Akhand A, et al. • Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine • 2026
Children with obstructive sleep apnea and primary snoring exhibit similar altered oropharyngeal microbiomes distinct from healthy controls, while children with OSA show a mild gastrointestinal microbial imbalance, supporting a role of the microbiome as a possible mediator of comorbidities across the spectrum of sleep-disordered breathing.
Key Findings
Results
Oropharyngeal microbial diversity differed significantly between children with OSA and healthy controls, characterized by an increase in gastrointestinal-specific taxa and reduced oral commensals.
Two pediatric cohorts were examined using 16S rRNA gene profiling
Cohort A included participants with OSA, primary snoring (PS), and healthy controls (HC) with n=60 total
Oropharyngeal swabs were collected from all Cohort A participants
The shift in microbiome was characterized by an increase in gastrointestinal-specific taxa and a reduction in oral commensals in OSA compared to HC
Results
Oropharyngeal microbiome shifts in primary snoring were similar to those seen in OSA, with few taxa differing between OSA and PS groups.
Similar shifts in oropharyngeal microbiome composition were observed between PS and HC as between OSA and HC
Very few taxa differed when OSA and PS were compared directly to each other
This finding suggests shared pathophysiological factors, such as snoring, as possible drivers of microbiome disruption across the spectrum of sleep-disordered breathing
Both OSA and PS showed increases in gastrointestinal-specific taxa and reduced oral commensals relative to HC
Results
Children with OSA showed a gut microbial imbalance marked by an increase in opportunistic pathogens and reduced beneficial organisms.
Cohort B included children with OSA and HC (n=46) who provided stool samples
Gut microbiome was assessed via 16S rRNA gene profiling along with fecal calprotectin measurements and a dietary survey
The imbalance was characterized by increased opportunistic pathogens and reduced beneficial organisms in OSA compared to HC
Despite these compositional differences, diversity assessments did not indicate overt dysbiosis or inflammation
No overall differences in dietary intake were found between OSA and HC groups in Cohort B
Results
Gut microbiome diversity assessments and fecal calprotectin measurements did not indicate overt dysbiosis or intestinal inflammation in children with OSA.
Fecal calprotectin, a marker of intestinal inflammation, was measured in Cohort B stool samples
Diversity assessments showed no indication of dysbiosis despite compositional differences
There was no evidence of inflammation based on fecal calprotectin results
Authors described the gut findings as a 'mild microbial imbalance' rather than frank dysbiosis
Results
Dietary intake did not differ between children with OSA and healthy controls, suggesting diet is not a primary driver of the observed gut microbiome differences.
All Cohort B participants completed a dietary survey
No overall differences in dietary intake were found between OSA and HC groups
This finding helps exclude diet as a confounding factor in the observed gut microbial imbalance
Cohort B included n=46 participants with OSA and HC
Discussion
The mild gastrointestinal microbial imbalance in children with OSA may elicit harmful outcomes or manifest as dysbiosis if left untreated.
Authors speculate the mild imbalance could progress to dysbiosis without treatment
The findings are described as supporting a role of the microbiome as a 'possible mediator of comorbidities across the spectrum of sleep-disordered breathing'
This is framed in the context of known OSA-related comorbidities observed in adult and animal studies
The study suggests early microbiome changes may precede or contribute to comorbidity development
What This Means
This research suggests that children with obstructive sleep apnea (OSA) and children who snore without apnea (primary snoring) both have altered bacterial communities in their throat and mouth compared to healthy children. Specifically, these children had more gut-associated bacteria in their upper airways and fewer of the normal bacteria typically found in a healthy mouth and throat. Importantly, the bacterial changes in snoring children and OSA children looked very similar to each other, pointing to snoring itself — rather than the breathing pauses of apnea — as a likely driver of these changes.
In the gut, children with OSA showed a subtle imbalance in their microbiome, with more potentially harmful bacteria and fewer beneficial ones compared to healthy children. However, this imbalance was relatively mild: standard measures of microbial diversity and a marker of gut inflammation (fecal calprotectin) did not show signs of serious disruption, and the children's diets were not meaningfully different between groups. This suggests the gut changes are in an early stage and may not yet be causing obvious harm.
This research matters because the microbiome — the community of microorganisms living in and on the body — is increasingly recognized as influencing overall health and disease. These findings suggest that even relatively mild or early-stage sleep-disordered breathing in children may be enough to disrupt both airway and gut microbial communities, which could potentially contribute to the health complications associated with OSA. The authors propose that the microbiome may serve as a link between disrupted sleep breathing and related health problems, and that untreated conditions could allow these microbial imbalances to worsen over time.
Hudson J, Akhand A, Nwe M, Coffey M, van Dorst J, Chuang S, et al.. (2026). Obstructive sleep apnea and primary snoring in children are associated with oropharyngeal dysbiosis and a mild compositional imbalance in the gastrointestinal tract.. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. https://doi.org/10.1007/s44470-026-00058-y