{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T20:59:06Z","timestamp":1789851546207,"version":"4.0.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"SkyLabs Inc"},{"name":"Core Innovation Research Group","award":["D-2025-0012"],"award-info":[{"award-number":["D-2025-0012"]}]},{"name":"Gangnam Severance Hospital, Yonsei University College of Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study objectives<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA) contributes to abnormal blood pressure (BP) variability (BPV). While OSA has been linked to increased BPV using intermittent or cuff-based measurements, the hemodynamic responses to individual respiratory events remain poorly understood. We aimed to delineate event-level BP dynamics of OSA using a cuffless continuous monitoring device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled adults who underwent overnight polysomnography for suspected OSA. Continuous systolic and diastolic BPs were recorded using a validated cuffless photoplethysmography-based ring device. Time-stamped respiratory events (apnea and hypopnea) were annotated and synchronized with cardiovascular signals. We analyzed the BP, heart rate (HR), and oxygen saturation (SpO\u2082) trajectories relative to each respiratory event, and applied linear mixed-effects models to evaluate factors influencing BP changes. Participant-level BPV indices, including the standard deviation and average real variability, were calculated throughout the night.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 12\u2009724 respiratory events from 62 patients were analyzed. Events were followed by a consistent pattern: a BP dip during the event, followed by a rebound surge that peaked at 11.4\u00a0s post-event. This peak occurred after the HR peak (8.2\u00a0s) but before the SpO\u2082 nadir (14.7\u00a0s). In mixed-effects analyses, longer event duration, apnea (vs. hypopnea), and REM sleep were associated with larger BP fluctuations. At the participant-level, the mean upward duration of event-related BP surges correlated with the SpO\u2082 nadir.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OSA induces BP fluctuations at the level of individual respiratory events. These findings demonstrate that OSA influences cardiovascular dynamics at event-level, beyond traditional measures of nocturnal BPV.<\/jats:p>\n                    <jats:p>Statement of Significance Obstructive sleep apnea (OSA) has been linked to increased nocturnal blood pressure (BP) variability and heightened cardiovascular risk. However, prior studies have largely relied on intermittent or cuff-based BP monitoring, limiting the temporal resolution needed to capture hemodynamic responses to individual apneic events. Using a cuffless wearable device, this study demonstrates that OSA induces transient BP fluctuations at the level of individual respiratory events, with characteristic dip-and-surge patterns. Longer events and apneas (vs. hypopneas) are associated with greater BP surges, and time-resolved BP metrics show closer associations with hypoxemia than with event frequency alone. Future research and clinical monitoring strategies may benefit from incorporating high-resolution, cuffless BP tracking to better quantify cardiovascular risk in sleep-disordered breathing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag122","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:05:25Z","timestamp":1777554325000},"source":"Crossref","is-referenced-by-count":2,"title":["Event-level nocturnal blood pressure dynamics in obstructive sleep apnea assessed by cuffless monitoring"],"prefix":"10.1093","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1188-449X","authenticated-orcid":false,"given":"Woo-Seok","family":"Ha","sequence":"first","affiliation":[{"name":"Department of Neurology, Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4723-8975","authenticated-orcid":false,"given":"Soomi","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurology, Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0796-4043","authenticated-orcid":false,"given":"Bo Kyu","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6221-1346","authenticated-orcid":false,"given":"Min Kyung","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0261-1687","authenticated-orcid":false,"given":"Kyung Min","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5850-010X","authenticated-orcid":false,"given":"Won-Joo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"issue":"9","key":"2026091405072946400_ref1","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","year":"2013","journal-title":"Am J Epidemiol"},{"issue":"4","key":"2026091405072946400_ref2","doi-asserted-by":"publisher","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":"6","key":"2026091405072946400_ref3","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1161\/01.hyp.28.6.937","article-title":"Short-term variability of blood pressure during sleep in snorers with or without apnea","volume":"28","author":"Leroy","year":"1996","journal-title":"Hypertension."},{"issue":"3","key":"2026091405072946400_ref4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1161\/hypertensionaha.114.03694","article-title":"Added predictive value of night-time blood pressure variability for cardiovascular events and mortality: the Ambulatory Blood Pressure-International Study","volume":"64","author":"Palatini","year":"2014","journal-title":"Hypertension."},{"issue":"8","key":"2026091405072946400_ref5","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1164\/rccm.200309-1305OC","article-title":"Twenty-four-hour ambulatory blood pressure in children with sleep-disordered breathing","volume":"169","author":"Amin","year":"2004","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"2026091405072946400_ref6","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1111\/jch.13202","article-title":"The association between different features of sleep-disordered breathing and blood pressure: a cross-sectional study","volume":"20","author":"Khoshkish","year":"2018","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"4","key":"2026091405072946400_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsad031","article-title":"Polysomnographic characterization of circadian blood pressure patterns in patients with obstructive sleep apnea","volume":"46","author":"Pinilla","year":"2023","journal-title":"Sleep."},{"issue":"10","key":"2026091405072946400_ref8","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1093\/ajh\/6.10.888","article-title":"The effect of blood pressure cuff inflation on sleep","volume":"6","author":"Dimsdale","year":"1993","journal-title":"A polysomnographic examination. Am J Hypertens"},{"issue":"6932","key":"2026091405072946400_ref9","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1136\/bmj.308.6932.820","article-title":"Effect of measuring ambulatory blood pressure on sleep and on blood pressure during sleep","volume":"308","author":"Davies","year":"1994","journal-title":"BMJ."},{"issue":"2","key":"2026091405072946400_ref10","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1097\/mbp.0000000000000426","article-title":"Blood pressure monitoring in sleep: time to wake up","volume":"25","author":"Kwon","year":"2020","journal-title":"Blood Press Monit"},{"issue":"9","key":"2026091405072946400_ref11","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1097\/hjh.0000000000002445","article-title":"Clinical impact of sleep-disordered breathing on very short-term blood pressure variability determined by pulse transit time","volume":"38","author":"Misaka","year":"2020","journal-title":"J Hypertens"},{"key":"2026091405072946400_ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.sleep.2021.05.005","article-title":"Associations between nocturnal continuous blood pressure fluctuations and the characteristics of oxygen desaturation in patients with obstructive sleep apnea: a pilot study","volume":"84","author":"Huang","year":"2021","journal-title":"Sleep Med"},{"issue":"2","key":"2026091405072946400_ref13","doi-asserted-by":"publisher","first-page":"361","DOI":"10.5664\/jcsm.9564","article-title":"Nocturnal blood pressure and nocturnal blood pressure fluctuations: the effect of short-term CPAP therapy and their association with the severity of obstructive sleep apnea","volume":"18","author":"Picard","year":"2022","journal-title":"J Clin Sleep Med"},{"key":"2026091405072946400_ref14","volume-title":"ISO 81060-2:2018 Non-invasive sphygmomanometers \u2014 Part 2: Clinical investigation of intermittent automated measurement type","author":"International Order for Standardization","year":"2018"},{"issue":"2","key":"2026091405072946400_ref15","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.3346\/jkms.2024.39.e18","article-title":"First-in-human study for evaluating the accuracy of smart ring based cuffless blood pressure measurement","volume":"39","author":"Kim","year":"2024","journal-title":"J Korean Med Sci"},{"issue":"2","key":"2026091405072946400_ref16","doi-asserted-by":"publisher","first-page":"93","DOI":"10.4070\/kcj.2023.0303","article-title":"Feasibility and effectiveness of a ring-type blood pressure measurement device compared with 24-hour ambulatory blood pressure monitoring device","volume":"54","author":"Lee","year":"2024","journal-title":"Korean Circ J"},{"issue":"1","key":"2026091405072946400_ref17","doi-asserted-by":"publisher","first-page":"8605","DOI":"10.1038\/s41598-023-35492-y","article-title":"Continuous cuffless blood pressure monitoring using photoplethysmography-based PPG2BP-net for high intrasubject blood pressure variations","volume":"13","author":"Joung","year":"2023","journal-title":"Sci Rep"},{"key":"2026091405072946400_ref18","volume-title":"The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications","author":"Berry","year":"2018","edition":"Version 2.5"},{"key":"2026091405072946400_ref19","volume-title":"Model 7500 Pulse Oximeter Operator\u2019s Manual","author":"Nonin Medical Inc","year":"2019"},{"issue":"4","key":"2026091405072946400_ref20","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1111\/jch.14647","article-title":"Nocturnal blood pressure surge in seconds is associated with arterial stiffness independently of conventional nocturnal blood pressure variability in suspected obstructive sleep apnea patients","volume":"25","author":"Kokubo","year":"2023","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"6","key":"2026091405072946400_ref21","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1038\/s41440-024-01631-9","article-title":"Development of beat-by-beat blood pressure monitoring device and nocturnal sec-surge detection algorithm","volume":"47","author":"Kokubo","year":"2024","journal-title":"Hypertens Res"},{"issue":"6","key":"2026091405072946400_ref22","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1001\/jamacardio.2025.0662","article-title":"Cuffless blood pressure measurement devices\u2013international perspectives on accuracy and clinical use: a narrative review","volume":"10","author":"Yang","year":"2025","journal-title":"JAMA Cardiol"},{"issue":"8","key":"2026091405072946400_ref23","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.5664\/jcsm.10566","article-title":"The association between sleep disturbances and blood pressure variability: a review of the literature","volume":"19","author":"Al Haddad","year":"2023","journal-title":"J Clin Sleep Med"},{"issue":"9","key":"2026091405072946400_ref24","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1161\/hypertensionaha.124.20433","article-title":"Sleep apnea, autonomic disturbances, and blood pressure variability","volume":"81","author":"Tobushi","year":"2024","journal-title":"Hypertension."},{"issue":"1","key":"2026091405072946400_ref25","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1152\/physrev.00043.2008","article-title":"Pathophysiology of sleep apnea","volume":"90","author":"Dempsey","year":"2010","journal-title":"Physiol Rev"},{"issue":"5","key":"2026091405072946400_ref26","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1161\/hypertensionaha.118.11794","article-title":"Associations between characteristics of obstructive sleep apnea and nocturnal blood pressure surge","volume":"72","author":"Sasaki","year":"2018","journal-title":"Hypertension."},{"issue":"8","key":"2026091405072946400_ref27","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.5665\/sleep.1168","article-title":"Functional role of diverse changes in sympathetic nerve activity in regulating arterial pressure during REM sleep","volume":"34","author":"Yoshimoto","year":"2011","journal-title":"Sleep."},{"issue":"6","key":"2026091405072946400_ref28","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1161\/hypertensionaha.125.24822","article-title":"Cuffless blood pressure measurement: where do we actually stand?","volume":"82","author":"Mukkamala","year":"2025","journal-title":"Hypertension."}],"container-title":["SLEEP"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/sleep\/advance-article-pdf\/doi\/10.1093\/sleep\/zsag122\/68194314\/zsag122.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/article-pdf\/49\/9\/zsag122\/68194314\/zsag122.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/article-pdf\/49\/9\/zsag122\/68194314\/zsag122.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:07:40Z","timestamp":1789376860000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/sleep\/article\/doi\/10.1093\/sleep\/zsag122\/8665626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,4,30]]},"published-print":{"date-parts":[[2026,9,9]]}},"URL":"https:\/\/doi.org\/10.1093\/sleep\/zsag122","relation":{},"ISSN":["0161-8105","1550-9109"],"issn-type":[{"value":"0161-8105","type":"print"},{"value":"1550-9109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,4,30]]},"article-number":"zsag122"}}