{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T10:54:00Z","timestamp":1771671240681,"version":"3.50.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T00:00:00Z","timestamp":1716940800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T00:00:00Z","timestamp":1716940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK075154"],"award-info":[{"award-number":["DK075154"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["DK075154"],"award-info":[{"award-number":["DK075154"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Respir Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The soft palate and back of the throat represent vulnerable early infection sites for SARS-CoV-2, influenza, streptococci, and many other pathogens. We demonstrate that snoring causes aerosolization of pharyngeal fluid that covers these surfaces, which previously has escaped detection because the inspired airstream carries the micron-sized droplets into the lung, inaccessible to traditional aerosol detectors. While many of these droplets will settle in the lower respiratory tract, a fraction of the respirable smallest droplets remains airborne and can be detected in exhaled breath. We distinguished these exhaled droplets from those generated by the underlying breathing activity by using a chemical tracer, thereby proving their existence. The direct transfer of pharyngeal fluids and their pathogens into the deep lung by snoring represents a plausible mechanistic link between the previously recognized association between sleep-disordered breathing and pneumonia incidence.<\/jats:p>","DOI":"10.1186\/s12931-024-02856-5","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T17:02:04Z","timestamp":1717002124000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Snoring-generated fluid droplets as a potential mechanistic link between sleep-disordered breathing and pneumonia"],"prefix":"10.1186","volume":"25","author":[{"given":"Tayeb","family":"Kakeshpour","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin P.","family":"Fennelly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriaan","family":"Bax","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,29]]},"reference":[{"issue":"2","key":"2856_CR1","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1001\/archinternmed.2007.8","volume":"168","author":"I Baik","year":"2008","unstructured":"Baik I, Kim J, Abbott RD, et al. Association of snoring with chronic bronchitis. Arch Intern Med. 2008;168(2):167\u201373. https:\/\/doi.org\/10.1001\/archinternmed.2007.8.","journal-title":"Arch Intern Med"},{"issue":"5","key":"2856_CR2","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1378\/chest.11-1998","volume":"141","author":"AD Goldbart","year":"2012","unstructured":"Goldbart AD, Tal A, Givon-Lavi N, et al. Sleep-disordered breathing is a risk factor for community-acquired alveolar pneumonia in early childhood. Chest. 2012;141(5):1210\u201315. https:\/\/doi.org\/10.1378\/chest.11-1998.","journal-title":"Chest"},{"issue":"5","key":"2856_CR3","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1378\/chest.111.5.1266","volume":"111","author":"K Gleeson","year":"1997","unstructured":"Gleeson K, Maxwell SL, Eggli DF. Quantitative aspiration during sleep in normal subjects. Chest. 1997;111(5):1266\u201372. https:\/\/doi.org\/10.1378\/chest.111.5.1266.","journal-title":"Chest"},{"key":"2856_CR4","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1146\/annurev-physiol-021115-105238","volume":"78","author":"RP Dickson","year":"2016","unstructured":"Dickson RP, Erb-Downward JR, Martinez FJ, et al. The Microbiome and the respiratory tract. Ann Rev Physiol. 2016;78:481\u2013504. https:\/\/doi.org\/10.1146\/annurev-physiol-021115-105238.","journal-title":"Ann Rev Physiol"},{"issue":"2","key":"2856_CR5","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.cell.2020.05.042","volume":"182","author":"YXJ Hou","year":"2020","unstructured":"Hou YXJ, Okuda K, Edwards CE, et al. SARS-CoV-2 Reverse Genetics reveals a variable infection gradient in the respiratory tract. Cell. 2020;182(2):429\u201342. https:\/\/doi.org\/10.1016\/j.cell.2020.05.042.","journal-title":"Cell"},{"issue":"7","key":"2856_CR6","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1056\/NEJMra1714562","volume":"380","author":"LA Mandell","year":"2019","unstructured":"Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med. 2019;380(7):651\u201363. https:\/\/doi.org\/10.1056\/NEJMra1714562.","journal-title":"N Engl J Med"},{"issue":"6","key":"2856_CR7","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1097\/00005537-200406000-00002","volume":"114","author":"M Beal","year":"2004","unstructured":"Beal M, Chesson A, Garcia T, et al. A pilot study of quantitative aspiration in patients with symptoms of obstructive sleep apnea: comparison to a historic control group. Laryngoscope. 2004;114(6):965\u201368. https:\/\/doi.org\/10.1097\/00005537-200406000-00002.","journal-title":"Laryngoscope"},{"key":"2856_CR8","doi-asserted-by":"publisher","unstructured":"Strausz S, Kiiskinen T, Broberg M, et al. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respiratory Res. 2021;8(1). https:\/\/doi.org\/10.1136\/bmjresp-2020-000845.","DOI":"10.1136\/bmjresp-2020-000845"},{"key":"2856_CR9","unstructured":"Hinds WC, Zhu Y. Aerosol technology. Properties, behavior, and measurement of airborne particles. 3d ed: Wiley. 2022:205."},{"issue":"1","key":"2856_CR10","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s12879-019-3707-y","volume":"19","author":"R Tellier","year":"2019","unstructured":"Tellier R, Li Y, Cowling BJ, et al. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis. 2019;19(1):101. https:\/\/doi.org\/10.1186\/s12879-019-3707-y.","journal-title":"BMC Infect Dis"},{"issue":"3","key":"2856_CR11","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/0160-9327(95)97493-R","volume":"19","author":"L Huang","year":"1995","unstructured":"Huang L, James Quinn S, Ellis PDM, et al. Biomechanics of snoring. Endeavour. 1995;19(3):96\u2013100. https:\/\/doi.org\/10.1016\/0160-9327(95)97493-R.","journal-title":"Endeavour"},{"key":"2856_CR12","doi-asserted-by":"publisher","unstructured":"Abkarian M, Stone HA. Stretching and break-up of saliva filaments during speech: a route for pathogen aerosolization and its potential mitigation. Phys Rev Fluids. 2020;5(10). https:\/\/doi.org\/10.1103\/PhysRevFluids.5.102301.","DOI":"10.1103\/PhysRevFluids.5.102301"},{"key":"2856_CR13","doi-asserted-by":"publisher","first-page":"110966","DOI":"10.1016\/j.mehy.2022.110966","volume":"168","author":"A Bax","year":"2022","unstructured":"Bax A, Shen Y, Kakeshpour T, et al. Snoring may transmit infectious aerosols from the upper to the lower respiratory tract. Med Hypotheses. 2022;168:110966. https:\/\/doi.org\/10.1016\/j.mehy.2022.110966.","journal-title":"Med Hypotheses"},{"key":"2856_CR14","unstructured":"Guide for the Practical Application of the ICRP Human Respiratory Tract Model. ICRP Supporting Guidance 3 Ann ICRP, 2002:41\u201355."},{"issue":"3","key":"2856_CR15","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1089\/jamp.2008.0720","volume":"22","author":"GR Johnson","year":"2009","unstructured":"Johnson GR, Morawska L. The mechanism of Breath Aerosol formation. J Aerosol Med Pulm Drug Deliv. 2009;22(3):229\u201337. https:\/\/doi.org\/10.1089\/jamp.2008.0720.","journal-title":"J Aerosol Med Pulm Drug Deliv"},{"issue":"11","key":"2856_CR16","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1038\/s42254-022-00506-7","volume":"4","author":"L Morawska","year":"2022","unstructured":"Morawska L, Buonanno G, Mikszewski A, et al. The physics of respiratory particle generation, fate in the air, and inhalation. Nat Reviews Phys. 2022;4(11):723\u201334. https:\/\/doi.org\/10.1038\/s42254-022-00506-7.","journal-title":"Nat Reviews Phys"},{"issue":"7571","key":"2856_CR17","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1038\/nature15379","volume":"526","author":"SS Lakdawala","year":"2015","unstructured":"Lakdawala SS, Jayaraman A, Halpin RA, et al. The soft palate is an important site of adaptation for transmissible influenza viruses. Nature. 2015;526(7571):122\u201325. https:\/\/doi.org\/10.1038\/nature15379.","journal-title":"Nature"},{"key":"2856_CR18","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1038\/s41591-022-01780-9","volume":"28","author":"B Killingley","year":"2022","unstructured":"Killingley B, Mann AJ, Kalinova M, et al. Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults. Nat Med. 2022;28:1031\u201341. https:\/\/doi.org\/10.1038\/s41591-022-01780-9.","journal-title":"Nat Med"},{"issue":"11","key":"2856_CR19","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.3201\/eid1211.060426","volume":"12","author":"R Tellier","year":"2006","unstructured":"Tellier R. Review of Aerosol Transmission of Influenza A Virus. Emerg Infect Dis. 2006;12(11):1657. https:\/\/doi.org\/10.3201\/eid1211.060426.","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"2856_CR20","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1111\/ina.12751","volume":"31","author":"SL Miller","year":"2021","unstructured":"Miller SL, Nazaroff WW, Jimenez JL, et al. Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event. Indoor Air. 2021;31(2):314\u201323. https:\/\/doi.org\/10.1111\/ina.12751.","journal-title":"Indoor Air"},{"issue":"27","key":"2856_CR21","doi-asserted-by":"publisher","first-page":"e2200109119","DOI":"10.1073\/pnas.2200109119","volume":"119","author":"HP Oswin","year":"2022","unstructured":"Oswin HP, Haddrell AE, Otero-Fernandez M, et al. The dynamics of SARS-CoV-2 infectivity with changes in aerosol microenvironment. Proc Natl Acad Sci USA. 2022;119(27):e2200109119. https:\/\/doi.org\/10.1073\/pnas.2200109119.","journal-title":"Proc Natl Acad Sci USA"}],"container-title":["Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-024-02856-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12931-024-02856-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-024-02856-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T17:04:50Z","timestamp":1717002290000},"score":1,"resource":{"primary":{"URL":"https:\/\/respiratory-research.biomedcentral.com\/articles\/10.1186\/s12931-024-02856-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,29]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2856"],"URL":"https:\/\/doi.org\/10.1186\/s12931-024-02856-5","relation":{},"ISSN":["1465-993X"],"issn-type":[{"value":"1465-993X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,29]]},"assertion":[{"value":"4 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The work was carried out under an exemption by the NIH Institutional Review Board (IRB ID# IRB001838).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The volunteer provided written consent to participate in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"224"}}