{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:33Z","timestamp":1782366513462,"version":"3.54.5"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous study focused on the relationship between morning blood pressure (BP) and OSA severity, and the effect of sex on hypertension in OSA. This study was undertaken to investigate the potential effect of evening systolic BP (SBP) and diastolic BP (DBP) on morning SBP and DBP for different genders in OSA patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of 911 patients diagnosed with OSA via polysomnography (PSG). The association between evening and morning blood pressure was evaluated using multivariable-adjusted logistic regression models and restricted cubic splines (RCS) to assess linearity and dose-response relationships. All analyses were stratified by sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 911 participants, 766 (84.08%) were male and 145 (15.92%) were female. Multivariable-adjusted analyses revealed a consistent positive association between evening and morning BP in both sexes. However, subgroup analyses identified distinct effect modifiers: in males, the association was intensified by diabetes mellitus, whereas in females, it was most evident among those with non-severe OSA. Furthermore, severe OSA significantly exacerbated morning BP surges in males with high evening BP, a synergistic effect notably absent in females.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evening SBP and DBP exhibited a linear association with morning BP across both sexes. However, this relationship was subject to significant effect modification: in males, diabetes mellitus intensified the association, whereas in females, it was most evident among those with non-severe OSA. Consequently, elevated evening BP precipitated marked morning BP surges in males, a phenomenon notably absent in females.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1845145","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:31:28Z","timestamp":1782365488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between nocturnal and morning blood pressure in patients with obstructive sleep apnea analysis: according to sex"],"prefix":"10.3389","volume":"13","author":[{"given":"Yifei","family":"Fang","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenran","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumei","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingzhu","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyue","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyang","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonyyun","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, The First Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawei","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanyang Central Hospital","place":["Nanyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1056\/NEJMcp1816152","article-title":"Obstructive sleep apnea in adults","volume":"380","author":"Veasey","year":"2019","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1161\/CIRCULATIONAHA.107.189420","article-title":"Sleep apnea and cardiovascular disease: an American heart association\/American college of cardiology foundation scientific statement from the American heart association council for high blood pressure research professional education committee, council on clinical cardiology, stroke council, and council on cardiovascular nursing. In collaboration with the national heart, lung, and blood institute national center on sleep disorders research (national institutes of health)","volume":"118","author":"Somers","year":"2008","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1136\/bmj.320.7233.479","article-title":"Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study","volume":"320","author":"Lavie","year":"2000","journal-title":"BMJ"},{"key":"B4","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s11906-001-0040-8","article-title":"Are sleep-related breathing disorders important contributing factors to the production of essential hypertension?","volume":"3","author":"Silverberg","year":"2001","journal-title":"Curr Hypertens Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1093\/sleep\/31.6.795","article-title":"Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin sleep cohort study","volume":"31","author":"Hla","year":"2008","journal-title":"Sleep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1038\/hr.2010.153","article-title":"Non-dipping pattern of hypertension and obstructive sleep apnea syndrome","volume":"33","author":"Wolf","year":"2010","journal-title":"Hypertens Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"449","DOI":"10.3109\/10641963.2015.1057833","article-title":"Impact of non-dipping on cardiovascular outcomes in patients with obstructive sleep apnea syndrome","volume":"37","author":"Sasaki","year":"2015","journal-title":"Clin Exp Hypertens"},{"key":"B8","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1093\/ajh\/hpt280","article-title":"Obstructive sleep apnea syndrome is associated with higher diastolic blood pressure in men but not in women","volume":"27","author":"Lee","year":"2014","journal-title":"Am J Hypertens"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1980","DOI":"10.1002\/oby.21960","article-title":"Diastolic blood pressure rises with the exacerbation of obstructive sleep apnea in males","volume":"25","author":"Hu","year":"2017","journal-title":"Obesity"},{"key":"B10","doi-asserted-by":"publisher","first-page":"905","DOI":"10.5664\/jcsm.6664","article-title":"Morning diastolic blood pressure may be independently associated with severity of obstructive sleep apnea in non-hypertensive patients: a cross-sectional study","volume":"13","author":"Mokros","year":"2017","journal-title":"J Clin Sleep Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1183\/09031936.06.00042105","article-title":"Hypertension prevalence in obstructive sleep apnoea and sex: a population-based case-control study","volume":"27","author":"Hedner","year":"2006","journal-title":"Eur Respir J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1016\/j.amjhyper.2006.02.018","article-title":"Evening-morning differences in blood pressure in sleep apnea syndrome: effect of gender","volume":"19","author":"Lavie-Nevo","year":"2006","journal-title":"Am J Hypertens"},{"key":"B13","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.sleep.2008.09.005","article-title":"The effect of gender on the prevalence of hypertension in obstructive sleep apnea","volume":"10","author":"Mohsenin","year":"2009","journal-title":"Sleep Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s11325-019-01869-5","article-title":"The effect of high evening blood pressure on obstructive sleep apnea-related morning blood pressure elevation: does sex modify this interaction effect?","volume":"23","author":"Han","year":"2019","journal-title":"Sleep Breath"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1001\/jama.283.14.1829","article-title":"Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep heart health study","volume":"283","author":"Nieto","year":"2000","journal-title":"JAMA"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1056\/NEJM200005113421901","article-title":"Prospective study of the association between sleep-disordered breathing and hypertension","volume":"342","author":"Peppard","year":"2000","journal-title":"N Engl J Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1038\/sj.jhh.1002012","article-title":"Phenotypic characteristics associated with hypertension in patients with obstructive sleep apnea","volume":"20","author":"Drager","year":"2006","journal-title":"J Hum Hypertens"},{"key":"B18","doi-asserted-by":"publisher","first-page":"334","DOI":"10.14744\/AnatolJCardiol.2020.71429","article-title":"Clinical and polysomnographic features of hypertension in obstructive sleep apnea: a single-center cross-sectional study","volume":"23","author":"Kaya A","year":"2020","journal-title":"Anatol J Cardiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s11325-020-02047-8","article-title":"Polysomnographic characteristics of severe obstructive sleep apnea vary significantly between hypertensive and normotensive patients of both genders","volume":"25","author":"Lepp\u00e4nen","year":"2021","journal-title":"Sleep Breath"},{"key":"B20","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1097\/HJH.0000000000002026","article-title":"2018 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH\/ESC Task Force for the Management of Arterial Hypertension: erratum","volume":"37","author":"Williams","year":"2019","journal-title":"J Hypertens"},{"key":"B21","doi-asserted-by":"publisher","first-page":"752","DOI":"10.5664\/jcsm.27034","article-title":"Phasic or transient? Comment on the terminology of the AASM manual for the scoring of sleep and associated events","volume":"3","author":"Schulz","year":"2007","journal-title":"J Clin Sleep Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"228","DOI":"10.7326\/M16-2472","article-title":"Association of coffee consumption with total and cause-specific mortality among nonwhite populations","volume":"167","author":"Park","year":"2017","journal-title":"Ann Intern Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1194\/jlr.P067686","article-title":"Association of peripheral differential leukocyte counts with dyslipidemia risk in Chinese patients with hypertension: insight from the China stroke primary prevention trial","volume":"58","author":"Liu","year":"2017","journal-title":"J Lipid Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1001\/jama.2017.17606","article-title":"Association between wait time and 30-day mortality in adults undergoing hip fracture surgery","volume":"318","author":"Pincus","year":"2017","journal-title":"JAMA"},{"key":"B25","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1093\/sleep\/19.5.382","article-title":"Blood pressure \u201cdipping\u201d and \u201cnon-dipping\u201d in obstructive sleep apnea syndrome patients","volume":"19","author":"Suzuki","year":"1996","journal-title":"Sleep"},{"key":"B26","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1097\/01.hjh.0000160207.58781.4e","article-title":"Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients","volume":"23","author":"Baguet","year":"2005","journal-title":"J Hypertens"},{"key":"B27","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"},{"key":"B28","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1378\/chest.14-0500","article-title":"Intermittent hypoxemia and OSA: implications for comorbidities","volume":"147","author":"Dewan","year":"2015","journal-title":"Chest"},{"key":"B29","doi-asserted-by":"publisher","first-page":"99","DOI":"10.2147\/HP.S103091","article-title":"Chronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach","volume":"4","author":"Sforza","year":"2016","journal-title":"Hypoxia"},{"key":"B30","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/j.1582-4934.2009.00929.x","article-title":"Mechanisms of intermittent hypoxia induced hypertension","volume":"14","author":"Bosc","year":"2010","journal-title":"J Cell Mol Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1097\/MCP.0000000000000102","article-title":"Bidirectional relationship of hypertension with obstructive sleep apnea","volume":"20","author":"Jhamb","year":"2014","journal-title":"Curr Opin Pulm Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1161\/HYPERTENSIONAHA.110.154427","article-title":"Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension","volume":"56","author":"Friedman","year":"2010","journal-title":"Hypertension"},{"key":"B33","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1111\/j.1463-1326.2005.00508.x","article-title":"Obesity-related cardiovascular disease: implications of obstructive sleep apnea","volume":"8","author":"Wolk","year":"2006","journal-title":"Diabet Obesity Metab"},{"key":"B34","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1111\/jch.12581","article-title":"Obstructive sleep apnea using Watch-PAT 200 is independently associated with an increase in morning blood pressure surge in never-treated hypertensive patients","volume":"17","author":"Cho","year":"2015","journal-title":"J Clin Hyperten"},{"key":"B35","first-page":"136","article-title":"Sex-related factors in acute hypoxia survival in one strain of mice","volume":"55","author":"Stupfel","year":"1984","journal-title":"Aviat Space Environ Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"761","DOI":"10.7326\/0003-4819-139-9-200311040-00011","article-title":"Pathogenesis of hypertension","volume":"139","author":"Oparil","year":"2003","journal-title":"Ann Intern Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1183\/09031936.00225113","article-title":"Nocturnal intermittent hypoxia predicts prevalent hypertension in the European sleep apnoea database cohort study","volume":"44","author":"Tkacova","year":"2014","journal-title":"Eur Respir J"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002454","article-title":"Impact of obstructive sleep apnea syndrome on endothelial function, arterial stiffening, and Serum inflammatory markers: an updated meta-analysis and metaregression of 18 studies","volume":"4","author":"Wang","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1161\/01.HYP.0000175477.33816.f3","article-title":"Sex differences in blood pressure response to intermittent hypoxia in rats","volume":"46","author":"Hinojosa-Laborde","year":"2005","journal-title":"Hypertension"},{"key":"B40","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/S0895-7061(01)02043-X","article-title":"Blunted nighttime blood pressure dipping in postmenopausal women","volume":"14","author":"Sherwood","year":"2001","journal-title":"Am J Hypertens"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1097\/00004872-200211000-00017","article-title":"Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study","volume":"20","author":"Ohkubo","year":"2002","journal-title":"J Hypertens"},{"key":"B42","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1161\/01.HYP.0000170138.56903.7a","article-title":"Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study","volume":"46","author":"Dolan","year":"2005","journal-title":"Hypertension"},{"key":"B43","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1161\/HYPERTENSIONAHA.109.133900","article-title":"Predictive role of the nighttime blood pressure","volume":"57","author":"Hansen","year":"2011","journal-title":"Hypertension"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1007\/s11325-018-1634-6","article-title":"Nocturnal blood pressure fluctuation and associated influential factors in severe obstructive sleep apnea patients with hypertension","volume":"22","author":"Xu","year":"2018","journal-title":"Sleep Breath"},{"key":"B45","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1097\/HJH.0000000000000371","article-title":"Evening versus morning dosing of antihypertensive drugs in hypertensive patients with sleep apnoea: a cross-over study","volume":"33","author":"Kasiakogias","year":"2015","journal-title":"J Hypertens"},{"key":"B46","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1136\/thoraxjnl-2016-209504","article-title":"Chronotherapy for hypertension in obstructive sleep apnoea (CHOSA): a randomised, double-blind, placebo-controlled crossover trial","volume":"72","author":"Serinel","year":"2017","journal-title":"Thorax"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1845145\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:31:28Z","timestamp":1782365488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1845145\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":46,"alternative-id":["10.3389\/fcvm.2026.1845145"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1845145","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"article-number":"1845145"}}