{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T18:24:46Z","timestamp":1782930286282,"version":"3.54.5"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001658","name":"Minerva Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001658","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001658","name":"Minerva Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001658","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Obstructive sleep apnea (OSA) is characterized by recurrent respiratory events that trigger autonomic arousals and blood pressure (BP) surges, contributing to elevated cardiovascular risk. Photoplethysmography (PPG)-derived timing markers such as pulse arrival time (PAT) are frequently used as noninvasive surrogates of BP dynamics, yet their interpretation is confounded by the pre-ejection period and peripheral vascular effects. Here, we used detrended fluctuation analysis (DFA) to quantify short- and long-term scaling exponents of continuous blood pressure (Portapres), PPG-, and PAT-derived signals across sleep stages in healthy individuals and patients with OSA. Directly measured systolic and diastolic BP exhibited a robust short- to long-term crossover across all sleep stages, with elevated short-range exponents (\n                    <jats:inline-formula id=\"pone.0339755.e001\">\n                      <jats:alternatives>\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"pone.0339755.e001g\" mimetype=\"image\" position=\"anchor\" xlink:href=\"info:doi\/10.1371\/journal.pone.0339755.e001\" xlink:type=\"simple\"\/>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" id=\"M1\">\n                          <mml:mrow>\n                            <mml:msub>\n                              <mml:mi>\u03b1<\/mml:mi>\n                              <mml:mrow>\n                                <mml:mn>1<\/mml:mn>\n                              <\/mml:mrow>\n                            <\/mml:msub>\n                            <mml:mo>&gt;<\/mml:mo>\n                            <mml:mn>1<\/mml:mn>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ) and lower long-range exponents (\n                    <jats:inline-formula id=\"pone.0339755.e002\">\n                      <jats:alternatives>\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"pone.0339755.e002g\" mimetype=\"image\" position=\"anchor\" xlink:href=\"info:doi\/10.1371\/journal.pone.0339755.e002\" xlink:type=\"simple\"\/>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" id=\"M2\">\n                          <mml:mrow>\n                            <mml:msub>\n                              <mml:mi>\u03b1<\/mml:mi>\n                              <mml:mrow>\n                                <mml:mn>2<\/mml:mn>\n                              <\/mml:mrow>\n                            <\/mml:msub>\n                            <mml:mo>&lt;<\/mml:mo>\n                            <mml:mn>1<\/mml:mn>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ), reflecting well-organized autonomic and vascular control. In OSA, this crossover persisted but was visibly attenuated, consistent with reduced short-term adaptability of cardiovascular regulation. In contrast, PAT-based indices showed substantially weaker short-range correlations and minimal crossover structure. Systolic PAT displayed almost no separation between\n                    <jats:inline-formula id=\"pone.0339755.e003\">\n                      <jats:alternatives>\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"pone.0339755.e003g\" mimetype=\"image\" position=\"anchor\" xlink:href=\"info:doi\/10.1371\/journal.pone.0339755.e003\" xlink:type=\"simple\"\/>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" id=\"M3\">\n                          <mml:mrow>\n                            <mml:msub>\n                              <mml:mi>\u03b1<\/mml:mi>\n                              <mml:mrow>\n                                <mml:mn>1<\/mml:mn>\n                              <\/mml:mrow>\n                            <\/mml:msub>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    and\n                    <jats:inline-formula id=\"pone.0339755.e004\">\n                      <jats:alternatives>\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"pone.0339755.e004g\" mimetype=\"image\" position=\"anchor\" xlink:href=\"info:doi\/10.1371\/journal.pone.0339755.e004\" xlink:type=\"simple\"\/>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" id=\"M4\">\n                          <mml:mrow>\n                            <mml:msub>\n                              <mml:mi>\u03b1<\/mml:mi>\n                              <mml:mrow>\n                                <mml:mn>2<\/mml:mn>\n                              <\/mml:mrow>\n                            <\/mml:msub>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    , and PPG-derived measures exhibited scaling patterns that differed fundamentally from BP. Across modalities, PAT (whether derived from BP or PPG) failed to reproduce the multiscale organization characteristic of beat-to-beat BP dynamics. Group comparisons further identified systolic BP scaling, particularly the short-range exponent\n                    <jats:inline-formula id=\"pone.0339755.e005\">\n                      <jats:alternatives>\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"pone.0339755.e005g\" mimetype=\"image\" position=\"anchor\" xlink:href=\"info:doi\/10.1371\/journal.pone.0339755.e005\" xlink:type=\"simple\"\/>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" id=\"M5\">\n                          <mml:mrow>\n                            <mml:msub>\n                              <mml:mi>\u03b1<\/mml:mi>\n                              <mml:mrow>\n                                <mml:mn>1<\/mml:mn>\n                              <\/mml:mrow>\n                            <\/mml:msub>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    , as the most sensitive marker of cardiovascular dysregulation in OSA, whereas PAT and PPG provided complementary but physiologically distinct information related to peripheral vascular and autonomic modulation. These findings demonstrate that PAT and PPG timing measures should not be used as surrogates for BP in fractal or scaling analyses and underscore the unique diagnostic value of BP-derived scaling behavior for assessing cardiovascular regulation during sleep.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0339755","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:39:18Z","timestamp":1782927558000},"page":"e0339755","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Short- and long-term scaling behavior of blood pressure and pulse arrival time during sleep in healthy controls and patients with obstructive sleep apnea"],"prefix":"10.1371","volume":"21","author":[{"given":"Karsten","family":"Berg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan W.","family":"Kantelhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7819-0444","authenticated-orcid":true,"given":"Martin","family":"Glos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4304-0112","authenticated-orcid":true,"given":"Thomas","family":"Penzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Wessel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-5141","authenticated-orcid":true,"given":"Ronny P.","family":"Bartsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"issue":"2","key":"pone.0339755.ref001","first-page":"142","article-title":"A comprehensive review of obstructive sleep apnea","volume":"14","author":"A Abbasi","year":"2021","journal-title":"Sleep Sci"},{"issue":"7","key":"pone.0339755.ref002","article-title":"Sleep architecture, obstructive sleep apnea, and cognitive function in adults","volume":"6","author":"MP Pase","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"8","key":"pone.0339755.ref003","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis","volume":"7","author":"AV Benjafield","year":"2019","journal-title":"Lancet Respir Med"},{"issue":"2","key":"pone.0339755.ref004","doi-asserted-by":"crossref","first-page":"333","DOI":"10.3390\/clockssleep5020025","article-title":"The burden of comorbidities in obstructive sleep apnea and the pathophysiologic mechanisms and effects of CPAP","volume":"5","author":"V Sircu","year":"2023","journal-title":"Clock Sleep"},{"issue":"19","key":"pone.0339755.ref005","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1001\/jama.2022.18357","article-title":"Screening for obstructive sleep apnea in adults: updated evidence report and systematic review for the US Preventive Services Task Force","volume":"328","author":"C Feltner","year":"2022","journal-title":"JAMA"},{"issue":"9","key":"pone.0339755.ref006","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1161\/HYPERTENSIONAHA.124.20433","article-title":"Sleep apnea, autonomic disturbances, and blood pressure variability","volume":"81","author":"T Tobushi","year":"2024","journal-title":"Hypertension"},{"issue":"4","key":"pone.0339755.ref007","doi-asserted-by":"crossref","DOI":"10.1016\/j.chest.2021.07.2080","article-title":"Impaired baroreflex sensitivity in OSA","volume":"160","author":"R Espinosa","year":"2021","journal-title":"Chest"},{"key":"pone.0339755.ref008","doi-asserted-by":"crossref","unstructured":"Mietus JE, Peng CK, Ivanov PC, Goldberger AL. 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