Alterations of the salivary microbiome in obstructive sleep apnea and their association with periodontitis.

Objective: Obstructive sleep apnea (OSA) and periodontitis have demonstrated epidemiological and clinical associations. This study aimed to characterize salivary microbiome alterations in patients with OSA, periodontitis, and their comorbidity (OSA+PD), and to explore potential microbial markers. Materials and methods: This cross-sectional study included 125 adults divided into four groups: healthy controls (H, n=26), patients with OSA (OSA/O, n=42), patients with periodontitis (PD/P, n=15), and patients with OSA and periodontitis (OSA+PD/OP, n=42). Participants underwent nocturnal polysomnography and comprehensive periodontal examinations. Saliva samples were collected and analyzed using 16S ribosomal DNA gene sequencing to evaluate microbial distribution and community structure across groups. Receiver operating characteristic (ROC) curves were generated for key taxa combining with clinical indicators, and the area under the curve (AUC) values were calculated to assess diagnostic relevance. Results: Oral microbial diversity was significantly altered in OSA, PD, and OSA+PD groups. Alpha diversity was reduced in all patient groups compared to healthy controls, with the periodontitis group showing the highest diversity and evenness. Beta diversity revealed that periodontitis having the strongest impact and the comorbid group exhibiting intermediate characteristics between OSA and periodontitis. Key taxa, including Conclusion: OSA is associated with distinct changes in salivary microbiota, including reduced microbial richness and altered functional profiles, which may contribute to early periodontal dysbiosis.