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We hypothesized that the overnight stiffness index (OSI), derived from nocturnal finger PPG, could be used to assess cardiovascular risk and vascular ageing. Subjects with confirmed or suspected hypertension (<jats:italic>n<\/jats:italic>\u2009=\u200979, 56 males) underwent simultaneous ambulatory blood pressure monitoring (ABPM) and overnight sleep polygraphy with a continuous PPG registration. Overnight PPG-based pulse propagation time was used to calculate OSI. Associations between OSI and markers of cardiovascular risk, blood pressure, and indices of arterial stiffness, as indicators of vascular ageing, were assessed. Subjects were stratified into low and high OSI (according to median, 10.9\u00a0m\/s). SCORE2\/SCORE2-OP and Framingham risk scores were calculated. The high OSI group had higher SCORE2\/SCORE2-OP (9.5 [5.5;12.5] vs 5.0 [4.0;6.5]), and OSI correlated with SCORE2\/SCORE2-OP and Framingham risk score (<jats:italic>r<\/jats:italic>\n            <jats:sub>s<\/jats:sub>\u2009=\u20090.40 and <jats:italic>r<\/jats:italic>\n            <jats:sub>s<\/jats:sub>\u2009=\u20090.41; both <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Indices of arterial stiffness were increased in the high OSI group including ABPM awake and asleep pulse pressures (59\u2009\u00b1\u200914 vs 50\u2009\u00b1\u20099\u00a0mmHg, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01, and 54\u2009\u00b1\u200914 vs 45\u2009\u00b1\u20097\u00a0mmHg, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and ambulatory arterial stiffness index (0.47\u2009\u00b1\u20090.12 vs 0.37\u2009\u00b1\u20090.11, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), respectively. OSI correlated with 24-h and asleep pulse pressure also after adjusting for confounders. OSI was related to systolic ABPM (awake <jats:italic>r<\/jats:italic>\u2009=\u20090.42, asleep <jats:italic>r<\/jats:italic>\u2009=\u20090.55; both <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and diastolic ABPM (asleep <jats:italic>r<\/jats:italic>\u2009=\u20090.36, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). OSI, a novel PPG-based measure of nocturnal arterial stiffness, correlates with established cardiovascular risk scores and with blood pressure-derived indices of vascular ageing. This simple method may facilitate cardiovascular risk assessment using readily available medical and wearable consumer devices.<\/jats:p>","DOI":"10.1007\/s00380-025-02537-3","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T09:55:05Z","timestamp":1741946105000},"page":"895-904","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Overnight stiffness index from finger photoplethysmography in relation to markers of cardiovascular risk and vascular ageing"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4367-7692","authenticated-orcid":false,"given":"Henrik","family":"Hellqvist","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermine","family":"Rietz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludger","family":"Grote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hedner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Sommermeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Spaak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"issue":"12","key":"2537_CR1","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","volume":"41","author":"G Mancia","year":"2023","unstructured":"Mancia G, Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank JK, Cunha PG, Danser AHJ, Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernandez-Alfonso MS, Halimi JM, Jarai Z, Jelakovic B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE (2023) 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). 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JH reports a clinical advisory function to Somnomed, and part ownership of two licensed patents related to sleep apnoea therapy. HH is a shareholder in Beat Vascular Health AB and has received consultancy compensation as principal investigator for Neko Health AB. JS has received speaker honoraria from Medtronics, AstraZeneca, Sanofi, Boehringer Ingelheim, and Bayer, and is a shareholder in Beat Vascular Health AB. TK has received research grants to Karolinska Institutet from Medtronic and ReCor Medical, all outside the current study. The other authors report no conflicts.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}