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It is plausible that apnea with elevated loop gain has a disproportionate effect on development or worsening of hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Subjects from two cohort studies, Sleep Heart Health Study (SHHS) and Osteoporotic Fractures in Men Study (MrOS), were included in this analysis. Respiratory self-similarity (SS, and the related central respiratory event index, CREI) is a method of detecting expressed HLG sleep apnea independent of conventional scoring. The relationship between SS and the risk of blood pressure rise of more than 20\u00a0mm Hg was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 5947 subjects, 3546 from SHHS and 2401 from MrOS with about 4.6\u00a0years follow-up was included in the final analysis. After adjustment for common confounders, higher SS% (OR 1.409, 95%CI = 1.050-1.890, p: 0.006) and CREI (OR 1.936, 95%CI = 1.208-3.102, p: 0.006) was related to delta SBP\u2009\u2265\u200920\u00a0mmHg in MrOS. In SHHS, we did not find any overall relationship between SS%\/CREI and blood pressure trajectory. However, a significant gender effect was found. In males, a higher SS% (OR1.424, 95%CI = 1.008-2.013, p: 0.045) was related to increasing SBP and potentially associated with increasing DBP (OR 3.355, 95%CI = 0.979-11.495, p: 0.054); CREI was related to increasing DBP (OR 3.204, 95%CI = 1.033-9.937, p: 0.044). However, in females, no potential relationship was found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HLG sleep apnea can increase the future risk of rising blood pressure.<\/jats:p>\n                    <jats:p>Statement of Significance High loop gain sleep apnea, detected using novel metrics of respiratory self-similarity and a central respiratory event index, independently predicts a clinically significant increase in systolic blood pressure (\u226520\u00a0mmHg). A significant sex difference in the relationship between high loop gain sleep apnea and blood pressure progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag125","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:26:41Z","timestamp":1777980401000},"source":"Crossref","is-referenced-by-count":0,"title":["Respiratory chemoreflex and risk of incident increase in blood pressure"],"prefix":"10.1093","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8912-5525","authenticated-orcid":false,"given":"Yuenan","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University , 610041 ,","place":["China"]},{"name":"Department of Respiratory Care, West China School of Medicine and West China Hospital, Sichuan University , Chengdu 610041 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University , 610041 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0150-306X","authenticated-orcid":false,"given":"Eline","family":"Oppersma","sequence":"additional","affiliation":[{"name":"Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente , Enschede ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6029-2450","authenticated-orcid":false,"given":"Wolfgang","family":"Ganglberger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5575-3953","authenticated-orcid":false,"given":"Robert Joseph","family":"Thomas","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"3","key":"2026081400270445900_ref1","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1016\/j.chest.2017.06.011","article-title":"Personalized management approach for OSA","volume":"153","author":"Carberry","year":"2018","journal-title":"Chest"},{"issue":"20","key":"2026081400270445900_ref2","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1001\/jama.2012.3418","article-title":"Association between treated and untreated obstructive sleep apnea and risk of hypertension","volume":"307","author":"Marin","year":"2012","journal-title":"JAMA"},{"issue":"10","key":"2026081400270445900_ref3","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1161\/CIRCULATIONAHA.118.036675","article-title":"Association between sleep apnea and blood pressure control among Blacks","volume":"139","author":"Johnson","year":"2019","journal-title":"Circulation"},{"key":"2026081400270445900_ref4","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.sleep.2024.10.025","article-title":"Cardiopulmonary coupling predictors of blood pressure response to positive airway pressure therapy","volume":"124","author":"Ni","year":"2024","journal-title":"Sleep Med"},{"issue":"2","key":"2026081400270445900_ref5","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1513\/AnnalsATS.202305-437OC","article-title":"Loop gain as a predictor of blood pressure response in patients treated for obstructive sleep apnea: secondary analysis of a clinical trial","volume":"21","author":"Schmickl","year":"2024","journal-title":"Ann Am Thorac Soc"},{"issue":"5","key":"2026081400270445900_ref6","doi-asserted-by":"publisher","first-page":"1901945","DOI":"10.1183\/13993003.01945-2019","article-title":"Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? 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