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ABSTRACT
Introduction: Gut dysbiosis is assumed to play a role in obstructive sleep apnea (OSA)-associated morbidities. Pre- and probiotics, short chain fatty acids (SCFA) and fecal matter transplantation (FMT) may offer potential as novel therapeutic strategies that target this gut dysbiosis. As more mechanisms of OSA-induced dysbiosis are being elucidated, these novel approaches are being tested in preclinical and clinical development.
Areas covered: We examined the evidence linking OSA to gut dysbiosis and discuss the effects of pre- and probiotics on associated cardiometabolic, neurobehavioral and gastrointestinal disorders. The therapeutic potential of SCFA and FMT are also discussed. We reviewed the National Center for Biotechnology Information database, including PubMed and PubMed Central between 2000 − 2020.
Expert opinion: To date, there are no clinical trials and only limited evidence from animal studies describing the beneficial effects of pre- and probiotic supplementation on OSA-mediated dysbiosis. Thus, more work is necessary to assess whether prebiotics, probiotics and SCFA are promising future novel strategies for targeting OSA-mediated dysbiosis.
Article Highlights
Obstructive sleep apnea (OSA) is a chronic condition associated with multiple chronic disorders affecting multiple systems
The gut microbiome is integral to human health and imbalance in gut commensal bacteria is linked to many diseases
OSA can alter the gut microbiome leading to dysbiosis
Pre- and probiotics and short chain fatty acids (SCFA) can protect against dysbiosis by strengthening the gut barrier integrity and production of immunomodulatory compounds
Given the useful effects of pre-and probiotics in mitigating dysbiosis-related inflammation in cardiometabolic, gastrointestinal and neurobehavioral conditions, it is plausible that pre- and probiotic treatment can target OSA-induced dysbiosis
This box summarizes key points contained in the article.
List of abbreviations
| AD: Alzheimer’s disease | = | |
| AHI: apnea-hypopnea index | = | |
| Akt: protein kinase B | = | |
| ApoE-/-: apolipoprotein-E knockout | = | |
| BA: bile acid | = | |
| BBB: blood brain barrier | = | |
| BDNF: brain-derived neurotrophic factor | = | |
| CD: Crohn’s disease | = | |
| CKD: chronic kidney disease | = | |
| CNS: central nervous system | = | |
| CPAP: continuous positive airway pressure | = | |
| CRP: c- reactive protein | = | |
| EPM: elevated plus maze | = | |
| ERK1/2: extracellular signal-regulated kinase1/2 | = | |
| F/B ratio: Firmicutes/Bacteroidetes ratio | = | |
| FGF21: fibroblast growth factor 21 | = | |
| FIO2: fraction of oxygen inspired | = | |
| FMT: fecal matter transfer/fecal microbiota transplantation | = | |
| FOS: fructooligosaccharides | = | |
| FST: forced swim test | = | |
| GABA: λ-aminobutyric acid | = | |
| GLP-1: glucagon-like peptide-1 | = | |
| GOS: galactooligosaccharides | = | |
| GSH: glutathione | = | |
| HDL: high-density lipoprotein | = | |
| HFD: High fat diet | = | |
| IBD: inflammatory bowel disease | = | |
| IH: intermittent hypoxia | = | |
| LDL: low-density lipoprotein | = | |
| LPS: lipopolysaccharides | = | |
| MAD: Mandibular advancement devices | = | |
| MDA: malondialdehyde | = | |
| MDD: major depressive disorder | = | |
| MPO: myeloperoxidase | = | |
| mTOR: mammalian target of rapamycin | = | |
| Nf-ƘB: nuclear factor kappa B | = | |
| NO: nitric oxide | = | |
| NMDAR: N-Methyl-d-aspartate receptor | = | |
| Nrf2: nuclear factor erythroid2-related factor | = | |
| OSA: obstructive sleep apnea | = | |
| OFT: open field test | = | |
| PaO2: oxygen partial pressure | = | |
| PD: Parkinson’s disease | = | |
| PPAR-α: proliferator-activated receptor-α | = | |
| RCT: randomized control trail | = | |
| ROS: reactive oxygen species | = | |
| SCFA: short-chain fatty acids | = | |
| TAC: total antioxidant capacity | = | |
| TC: total cholesterol | = | |
| TER: trans-epithelial resistance | = | |
| TMA: trimethylamine | = | |
| TMAO: trimethylamine N-oxide | = | |
| WBCs: white blood cells | = | |
| UC: ulcerative colitis | = |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose