{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:05:16Z","timestamp":1785409516988,"version":"3.56.0"},"posted":{"date-parts":[[2026,6,1]]},"group-title":"Microbiology","reference-count":52,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["R01HL155691-01"],"award-info":[{"award-number":["R01HL155691-01"]}],"id":[{"id":"https:\/\/ror.org\/001d55x84","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background and Objectives<\/jats:title>\n                  <jats:p>Children with Down syndrome (DS) have a high prevalence of obstructive sleep apnea (OSA) due to anatomic, neuromuscular, immunological and metabolic factors, yet the contribution of the tonsillar microbiome to airway obstruction in this population remains unexplored. We hypothesized that DS-associated OSA would be associated with a distinct tonsillar microbiome compared to non-DS OSA.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Tonsillar tissue from 22 DS and 18 NDS participants were analyzed by 16S rRNA sequencing. Alpha and beta diversity were assessed using Faith\u2019s phylogenetic diversity and UniFrac distances, respectively, and significantly different taxa were identified with ANCOM-BC and Mann\u2013Whitney testing.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Although overall microbial richness and community structure were similar between groups, overweight DS participants demonstrated increased phylogenetic diversity compared to normal-weight DS peers. Taxonomic profiling of the entire patient cohort revealed that in DS tonsils there were selective alterations in key genera with selective depletion of\n                    <jats:italic>Haemophilus<\/jats:italic>\n                    and enrichment of\n                    <jats:italic>Staphylococcus<\/jats:italic>\n                    ,\n                    <jats:italic>Rothia<\/jats:italic>\n                    , and\n                    <jats:italic>Lactobacillales<\/jats:italic>\n                    .\n                    <jats:italic>Haemophilus<\/jats:italic>\n                    abundance correlated positively with tonsil weight in both cohorts.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These findings suggest that while global diversity is preserved, specific microbial shifts distinguish the DS tonsillar niche, potentially reflecting altered immune and metabolic environments associated with trisomy 21. Understanding these microbial differences may reveal mechanisms underlying the higher incidence and persistence of OSA in DS and inform targeted therapeutic strategies.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.29.728812","type":"posted-content","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T23:00:14Z","timestamp":1780354814000},"source":"Crossref","is-referenced-by-count":0,"title":["Altered Tonsillar Microbiome in Children with Down Syndrome and Obstructive Sleep Apnea"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0360-5606","authenticated-orcid":false,"given":"E","family":"Woods","sequence":"first","affiliation":[{"name":"Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Gorden","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Nusbacher","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Kofonow","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Dumont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D N","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"},{"name":"Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N R","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology - Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"},{"name":"Department of Pediatric Otolaryngology, Children\u2019s Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B W","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology - Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"},{"name":"Department of Pediatric Otolaryngology, Children\u2019s Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Lozupone","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M R","family":"Verneris","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026060402201036000_2026.05.29.728812v1.1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20735"},{"key":"2026060402201036000_2026.05.29.728812v1.2","doi-asserted-by":"publisher","DOI":"10.2147\/nss.s154723"},{"issue":"2","key":"2026060402201036000_2026.05.29.728812v1.3","first-page":"142","article-title":"A comprehensive review of obstructive sleep apnea","volume":"14","year":"2021","journal-title":"Sleep Sci (Sao Paulo, Brazil)"},{"key":"2026060402201036000_2026.05.29.728812v1.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2016.22"},{"key":"2026060402201036000_2026.05.29.728812v1.5","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/134202"},{"key":"2026060402201036000_2026.05.29.728812v1.6","doi-asserted-by":"crossref","unstructured":"Kraus O , Schwarz Y , Motro Y , Marom T , Lamdan R , Kapuller V , et al. 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