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Hypoxemia is a recognized marker of OSA severity; however, it remains unclear which specific desaturation parameters during sleep, such as oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO\n                      <jats:sub>2<\/jats:sub>\n                      ), percentage of sleep time with peripheral oxygen saturation\u2009&lt;\u200990% (T90%) or hypoxic burden (HB) are most consistently associated with elevated blood pressure (BP). This systematic review aims to evaluate, in patients with OSA, the impact between nocturnal desaturation parameters and elevated BP as measured by ambulatory blood pressure monitoring (ABPM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A literature search was performed in PubMed, Web of Science, Scopus and Embase databases, covering all records available up to June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 5,587 records were identified through database searches, and 24 studies met the inclusion criteria. The studies revealed heterogeneous results, with some showing significant associations between hypoxemia indices and hypertension, while others did not. Evidence suggests that ODI3% is commonly related to increased BP, whereas minimum SpO\n                      <jats:sub>2<\/jats:sub>\n                      , mean SpO\n                      <jats:sub>2<\/jats:sub>\n                      and T90% yielded variable findings. HB was evaluated in only one study, suggesting a potential role in BP reduction after CPAP; however, the available evidence remains preliminary.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ODI3% showed the most consistent association with increased BP across studies, whereas other hypoxemia indices yielded more variable results. Evidence regarding HB remains preliminary and warrants further investigation. These findings suggest that although ODI currently appears to be the most reliable marker, evidence from a single study indicates that composite indices such as HB may represent more informative predictors of BP outcomes and deserve further investigation in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11325-026-03742-8","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:03:38Z","timestamp":1783073018000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Which nocturnal hypoxemia parameters are associated with ambulatory blood pressure monitoring in adults with obstructive sleep apnea? 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Ethical approval and informed consent were not applicable, as no new data were collected from human participants or animals. One of the included studies was conducted by two of the co-authors and had received prior approval from the appropriate institutional ethics committee. No new data involving human participants were collected for the present review.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"There is no clinical trial registration number because this is not a clinical trial.","order":2,"name":"Ethics","label":"Clinical trial","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The present study did not receive financial support from funding agencies or companies. Michel Burihan Cahali: Stockholder in the Brazilian company\u00a0Biologix, that markets a home sleep apnea test (not used in this study).","order":3,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"206"}}