{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:57:12Z","timestamp":1789390632520,"version":"build-2803163510"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,10,29]],"date-time":"2022-10-29T00:00:00Z","timestamp":1667001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objectives<\/jats:title><jats:p>Obstructive sleep apnea (OSA) is linked to the emergence and progression of cardiovascular complications including hypertension, stroke, arrhythmias, coronary artery disease, and heart failure. Epidemiological studies have reported that hypertension is associated with respiratory events during REM sleep. We examined the relationship between respiratory events during REM and morning and evening hypertensive blood pressure (BP) levels in a clinical sleep population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included data from in-laboratory diagnostic polysomnographic studies (n = 797) from adults attending for investigation of OSA. Hypertensive BP levels were defined using BP measurements taken in the evening before and morning after polysomnography, and the use of antihypertensive medication. Regression modeling was undertaken to examine the probability of evening and morning hypertensive BP levels according to REM apnea-hypopnea index (AHI), NREM AHI, gender, age, body mass index (BMI), alcohol use, total sleep time (TST), sleep time SpO2 &amp;lt;90%, and smoking status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The probability of morning hypertensive BP levels was significantly independently associated with age (p &amp;lt; .001), BMI (p &amp;lt; .001), and REM AHI (p &amp;lt; .001). No significant effect was found for the male gender, NREM AHI, alcohol use, TST, sleep time SpO2 &amp;lt;90%, or smoking (p &amp;gt; .05 for all). The probability of evening hypertensive BP levels was only significantly associated with age (p &amp;lt; .001), male gender (p = .012), BMI (p &amp;lt; .001), and TST (p = .032).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Respiratory events during REM sleep are significantly associated with morning hypertensive BP levels. Future research is needed to determine whether treatment of these events can prevent or reverse morning hypertensive BP levels.<\/jats:p><\/jats:sec>","DOI":"10.1093\/sleep\/zsac259","type":"journal-article","created":{"date-parts":[[2022,10,29]],"date-time":"2022-10-29T15:03:15Z","timestamp":1667055795000},"source":"Crossref","is-referenced-by-count":17,"title":["Obstructive sleep apnea during REM sleep: effects on morning and evening blood pressure"],"prefix":"10.1093","volume":"46","author":[{"given":"Catherine","family":"Falla","sequence":"first","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Eastern Health , Victoria , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0718-1564","authenticated-orcid":false,"given":"Alan","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Eastern Health , Victoria , Australia"},{"name":"Eastern Health Clinical School, Monash University , Victoria , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5726-1661","authenticated-orcid":false,"given":"Alun","family":"Pope","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University , Victoria , Australia"},{"name":"Analytical Insight Pty Ltd , Crawley, Western Australia , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-1601","authenticated-orcid":false,"given":"Denise M","family":"O\u2019Driscoll","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Eastern Health , Victoria , Australia"},{"name":"Eastern Health Clinical School, Monash University , Victoria , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,29]]},"reference":[{"issue":"7","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.jacc.2016.11.069","article-title":"Sleep apnea: types, mechanisms, and clinical cardiovascular consequences","volume":"69","author":"Javaheri","year":"2017","journal-title":"J Am Coll Cardiol."},{"issue":"4","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir Med."},{"issue":"10","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1164\/rccm.201406-1136OC","article-title":"Obstructive sleep apnea during REM sleep and hypertension. Results of the Wisconsin Sleep Cohort","volume":"190","author":"Mokhlesi","year":"2014","journal-title":"Am J Respir Crit Care Med."},{"issue":"2","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jacc.2010.08.627","article-title":"Obstructive sleep apnea and heart failure","volume":"57","author":"Kasai","year":"2011","journal-title":"J Am Coll Cardiol."},{"issue":"2","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1702484","DOI":"10.1183\/13993003.02484-2017","article-title":"REM-associated sleep apnoea: prevalence and clinical significance in the HypnoLaus cohort","volume":"52","author":"Acosta-Castro","year":"2018","journal-title":"Eur Respir J."},{"issue":"5","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1164\/rccm.201706-1112OC","article-title":"Obstructive sleep apnea during REM sleep and cardiovascular disease","volume":"197","author":"Aurora","year":"2018","journal-title":"Am J Respir Crit Care Med."},{"issue":"3","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"561","DOI":"10.5665\/sleep.3498","article-title":"Physiological mechanisms of upper airway hypotonia during REM sleep","volume":"37","author":"McSharry","year":"2014","journal-title":"Sleep."},{"issue":"19","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1161\/CIRCULATIONAHA.117.029400","article-title":"Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science","volume":"136","author":"Drager","year":"2017","journal-title":"Circulation."},{"issue":"3","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.chest.2016.03.047","article-title":"Growing evidence linking OSA during rapid eye movement sleep to systemic hypertension","volume":"150","author":"Mokhlesi","year":"2016","journal-title":"Chest."},{"issue":"3","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.chest.2016.03.010","article-title":"Hypertension is associated with undiagnosed OSA during rapid eye movement sleep","volume":"150","author":"Appleton","journal-title":"Chest."},{"issue":"05","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events","volume":"08","author":"Berry","year":"2012","journal-title":"J Clin Sleep Med."},{"key":"2023030906563647600_","volume-title":"AUDIT: The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care","author":"Babor","year":"2001"},{"key":"2023030906563647600_","author":"Douglas","year":"2022"},{"issue":"4","key":"2023030906563647600_","doi-asserted-by":"crossref","DOI":"10.1093\/sleep\/zsab264","article-title":"Continuous positive airway pressure and adverse cardiovascular events in obstructive sleep apnea: are participants of randomized trials representative of sleep clinic patients?","volume":"45","author":"Reynor","year":"2022","journal-title":"Sleep."},{"issue":"8","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"e1000132","DOI":"10.1371\/journal.pmed.1000132","article-title":"Sleep-disordered breathing and mortality: a prospective cohort study","volume":"6","author":"Punjabi","year":"2009","journal-title":"PLoS Med."},{"issue":"5","key":"2023030906563647600_","first-page":"758","article-title":"Hypercapnic ventilatory response in sleeping adults","volume":"126","author":"Douglas","year":"1982","journal-title":"Am Rev Respir Dis."},{"issue":"3","key":"2023030906563647600_","first-page":"286","article-title":"Hypoxic ventilatory response decreases during sleep in normal men","volume":"125","author":"Douglas","year":"1982","journal-title":"Am Rev Respir Dis."},{"issue":"4","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1378\/chest.112.4.875","article-title":"Respiratory effort during obstructive sleep apnea: role of age and sleep state","volume":"112","author":"Krieger","year":"1997","journal-title":"Chest."},{"issue":"4","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1172\/JCI118235","article-title":"Sympathetic neural mechanisms in obstructive sleep apnea","volume":"96","author":"Somers","year":"1995","journal-title":"J Clin Invest."},{"issue":"7","key":"2023030906563647600_","first-page":"709","article-title":"Long-term facilitation of ventilation in humans during NREM sleep","volume":"21","author":"Babcock","year":"1998","journal-title":"Sleep."},{"issue":"4","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1378\/chest.123.4.1119","article-title":"Impact of sleep apnea on sympathetic nervous system activity in heart failure","volume":"123","author":"Solin","year":"2003","journal-title":"Chest."},{"issue":"6","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.5664\/jcsm.7176","article-title":"Sleep duration and hypertension: analysis of &gt; 700,000 adults by age and sex","volume":"14","author":"Grandner","year":"2018","journal-title":"J Clin Sleep Med."},{"issue":"1","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40463-016-0156-0","article-title":"Trends in CPAP adherence over twenty years of data collection: a flattened curve","volume":"45","author":"Rotenberg","year":"2016","journal-title":"J Otolaryngol Head Neck Surg."},{"issue":"2","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1161\/HYPERTENSIONAHA.106.085175","article-title":"Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea","volume":"50","author":"Bazzano","year":"2007","journal-title":"Hypertension."},{"issue":"8","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1001\/archinte.167.8.757","article-title":"The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials","volume":"167","author":"Haentjens","year":"2007","journal-title":"Arch Intern Med."},{"issue":"20","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1001\/jama.2012.4366","article-title":"Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial","volume":"307","author":"Barb\u00e9","year":"2012","journal-title":"JAMA."},{"issue":"10","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1513\/AnnalsATS.202203-260OC","article-title":"Long-term effect of OSA and CPAP treatment on blood pressure in patients with acute coronary syndrome","volume":"19","author":"S\u00e1nchez-de-la-Torre","year":"2022","journal-title":"Ann Am Thorac Soc."},{"issue":"2","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"355","DOI":"10.2337\/dc13-0933","article-title":"Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in type 2 diabetes: therapeutic implications","volume":"37","author":"Grimaldi","year":"2014","journal-title":"Diabetes Care."},{"issue":"12","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1056\/NEJMoa041832","article-title":"Day-night pattern of sudden death in obstructive sleep apnea","volume":"352","author":"Gami","year":"2005","journal-title":"N Engl J Med."},{"issue":"5","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/WNP.0000000000000821","article-title":"Stroke: what\u2019s sleep got to do with it?","volume":"39","author":"Zafar","year":"2022","journal-title":"J Clin Neurophysiol."},{"issue":"10","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"3755","DOI":"10.21037\/jtd.2017.09.57","article-title":"Long-term adherence to continuous positive airway pressure in patients with rapid eye movement-only obstructive sleep apnea: a prospective cohort study","volume":"9","author":"Almeneessier","year":"2017","journal-title":"J Thorac Dis."},{"issue":"6","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1177\/0300060518758583","article-title":"Effect of rapid eye movement-related obstructive sleep apnea on adherence to continuous positive airway pressure","volume":"46","author":"Hoshino","year":"2018","journal-title":"J Int Med Res."},{"issue":"5","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1097\/00004872-200205000-00020","article-title":"The morning surge in blood pressure and heart rate is dependent on levels of physical activity after waking","volume":"20","author":"Leary","year":"2002","journal-title":"J Hypertens."},{"issue":"3","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s00421-013-2692-x","article-title":"Blood pressure regulation VII. The \u201cmorning surge\u201d in blood pressure: measurement issues and clinical significance","volume":"114","author":"Atkinson","year":"2014","journal-title":"Eur J Appl Physiol."},{"issue":"1","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"3342","DOI":"10.1038\/s41598-020-60281-2","article-title":"Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time","volume":"10","author":"Almeneessier","year":"2020","journal-title":"Sci Rep."},{"issue":"1-2","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.autneu.2005.04.002","article-title":"The interaction between respiratory and autonomic function during sleep-related changes in pharyngeal airway patency","volume":"120","author":"O\u2019Driscoll","year":"2005","journal-title":"Auton Neurosci."},{"issue":"48","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"e5493","DOI":"10.1097\/MD.0000000000005493","article-title":"Mean apnea-hypopnea duration (but not apnea-hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea","volume":"95","author":"Wu","year":"2016","journal-title":"Medicine (Baltimore)."},{"issue":"2","key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1378\/chest.101.2.379","article-title":"Evening-to-morning blood pressure variations in snoring patients with and without obstructive sleep apnea","volume":"101","author":"Hoffstein","year":"1992","journal-title":"Chest."},{"key":"2023030906563647600_","doi-asserted-by":"crossref","first-page":"721","DOI":"10.2147\/NSS.S275051","article-title":"The associations of gender, menopause, age, and asthma with REM-Predominant obstructive sleep apnea: a prospective observational study","volume":"12","author":"Bahammam","year":"2020","journal-title":"Nat Sci Sleep."}],"container-title":["Sleep"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/sleep\/advance-article-pdf\/doi\/10.1093\/sleep\/zsac259\/47660060\/zsac259.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/article-pdf\/46\/3\/zsac259\/49453202\/zsac259.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/article-pdf\/46\/3\/zsac259\/49453202\/zsac259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T14:33:13Z","timestamp":1678458793000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/sleep\/article\/doi\/10.1093\/sleep\/zsac259\/6780023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,29]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,10,29]]},"published-print":{"date-parts":[[2023,3,9]]}},"URL":"https:\/\/doi.org\/10.1093\/sleep\/zsac259","relation":{},"ISSN":["0161-8105","1550-9109"],"issn-type":[{"value":"0161-8105","type":"print"},{"value":"1550-9109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3,1]]},"published":{"date-parts":[[2022,10,29]]},"article-number":"zsac259"}}