TITLE: Severe Obstructive Sleep Apnea is Associated with Alterations in the Nasal Microbiome and Increase in Inflammation Benjamin G. Wu 1 , Imran Sulaiman 1 , Jing Wang 1,2 , Nan Shen 6 , Jose C. Clemente 6 , Yonghua Li 1 , Robert J. Laumbach 3,5 , Shou-En Lu 4 , Iris Udasin 4 , Oanh Le-Hoang 3 , Alan Perez 5 , Shahnaz Alimokhtari 5 , Kathleen Black 5 , Michael Plietz 3 , Akosua Twumasi 8 , Haley Sanders 8 , Patrick Melacha 1 , Bianca Kapoor 1 , Benjamin D. Scaglione 1 , Anbang Wang 1 , Cameron Blazoski 1 , Michael D. Weiden 1 , David M. Rapoport 8 , Denise Harrison 1 , Nishay Chitkara 1 , Eugenio Vicente 7 , José M. Marin 7 , Jag Sunderram 3 , Indu Ayappa 8 , Leopoldo N. Segal* 1 1 Division of Pulmonary, Critical Care, & Sleep Medicine, New York University School of Medicine, NY 2 Beijing Division of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, The Capital University of Medicine, Beijing, China 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School - New Brunswick, NJ/USA 4 Rutgers School of Public Health - Piscataway, NJ/US 5 Environment and Occupational Health Sciences Institute, Rutgers Biomedical Health Sciences- Piscataway, NJ/USA 6 Department of Genetics and Genomic Sciences and Immunology Institute, Icahn School of Medicine at Mount Sinai, NY 7 Hospital Universitario Miguel Servet, IISAragón & CIBER Enfermedades Respiratorias, Zaragoza, Spain 8 Division of Pulmonary, Critical Care, & Sleep Medicine, Icahn School of Medicine at Mount Sinai Benjamin G. Wu, MD Benjamin.Wu@nyumc.org Imran Sulaiman, MD SheikMohammadImran.Sulaiman@nyumc.org Jing Wang, MD wangjing@bjcyh.com Nan Shen Nan.Shen@mssm.edu Jose C. Clemente, PhD Jose.Clemente@mssm.edu Yonghua Li, MD, PhD Yonghua.Li@nyumc.org Robert J. Laumbach, MD Laumbach@eohsi.rutgers.edu Shou-En Lu Shouen.lu@rutgers.edu Iris Udasin Udasin@eohsi.rutgers.edu Oanh Le-Hoang Lehoanoa@rwjms.rutgers.edu Alan Perez Aperez@eohsi.rutgers.edu Shahnaz Alimokhtari Shahnaz@eohsi.rutgers.edu Kathleen Black Kgb3@eohsi.rutgers.edu Michael Plietz Michael.plietz@mountsinai.org Akosua Twumasi akosua.twumasi@mssm.edu Haley Sanders haley.sanders@mssm.edu Patrick Melacha pmalecha@partners.org Page 1 of 69 AJRCCM Articles in Press. Published on 03-July-2018 as 10.1164/rccm.201801-0119OC Copyright © 2018 by the American Thoracic Society