Marshall researchers explore gut microbiota’s role in sleep apnea in new review published in Sleep Medicine

HUNTINGTON, W.Va. – A new scientific review from researchers at the Marshall University Joan C. Edwards School of Medicine highlights emerging connections between gut health and sleep apnea, pointing to potential new therapeutic approaches for managing this common and serious disorder. 

The article, published earlier this month in the journal Sleep Medicine, was led by Marshall medical student Rebecca Hicks, in collaboration with faculty researchers. It explores how gut microbiota—the diverse community of microorganisms living in the digestive tract—may influence the development and severity of sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA). Alterations in gut microbiota composition have been consistently observed in individuals with sleep apnea, and may induce “Leaky gut,” or impaired intestinal barrier integrity, that in turn promotes systemic inflammation that worsens sleep apnea symptoms and facilitates the emergence of end-organ injury. 

“Recent studies suggest that changes in gut microbiota diversity and composition may play a role in the onset or progression of sleep apnea,” said Hicks, lead author on the review. “This connection may be mediated by impaired gut barrier function, inflammation, immune responses and gut-brain communication pathways.” 

The review also highlights the role of extracellular vesicles (EVs)—tiny particles released by cells that carry molecular signals—as potential messengers between the gut and brain. These EVs may affect sleep regulation by modulating immune responses or transporting microbial signals to the brain and could serve as biomarkers or therapeutic targets in modulating the gut–brain axis in sleep apnea. 

The authors, which include David Gozal, M.D., M.B.A., Ph.D. (Hon); Sarfraz Ahmed, Ph,D.; and Abdelnaby Khalyfa, M.S., Ph.D., all of Marshall University, call for future longitudinal studies to better understand how gut microbiome changes over time may influence the development or consequences of sleep apnea. They also advocate for deeper investigation into the mechanisms by which microbial species and their metabolites affect sleep, and for development of new treatments aimed at improving gut health as a strategy for managing sleep apnea. 

“It is exciting to see medical students taking the lead in exploring complex and emerging areas like the gut–sleep connection,” said Khalyfa, professor of biomedical sciences at Marshall University, corresponding author on this study and Rebecca’s mentor. “This kind of research not only advances our understanding of sleep apnea but also demonstrates the vital role early career trainees can play in shaping the future of medicine in general, and of sleep medicine in particular through innovation and collaboration.” 

To read the article “Interplay between gut microbiota and exosome dynamics in sleep apnea” in its entirety, please visit https://doi.org/10.1016/j.sleep.2025.106493.