Inducers of post-apneic blood pressure fluctuation monitored by pulse transfer time measurement in obstructive sleep apnea varied with syndrome severity

  • Jing Xu
  • Ning Ding
  • Liang Chen
  • Yi Zhang
  • Mao Huang
  • Yanli Wang
  • Zili MengEmail author
  • Xilong ZhangEmail author
Sleep Breathing Physiology and Disorders • Original Article



This study investigated the properties of blood pressure (BP) fluctuation and sympathovagal imbalance with the severity of OSAS.


Nocturnal BP was continuously monitored by polysomnography for mild (n = 33), moderate (n = 34), and severe (n = 37) OSAS patients. Apnea-related systolic BP elevation (△SBP) indicated the amplitude of BP fluctuation. The SBP index, number of △SBP > 10 mmHg/h of sleep, indicated the frequency of significant BP fluctuations. The low frequency/high frequency (LF/HF) ratios indicated heart rate variability and sympathovagal imbalance.


△SBP and the SBP index were the highest in severe OSAS (12.9 ± 2.3 mmHg and 33.7 ± 14.7/h), followed by moderate OSAS (9.5 ± 2.6 mmHg and 7.1 ± 4.4/h), and mild OSAS (8.3 ± 1.6 mmHg and 3.4 ± 2.1/h). The LF/HF ratios in severe OSAS were significantly higher than that in moderate and mild OSAS. In mild OSAS, arousal played a more important role in BP fluctuation. In moderate OSAS, the oxygen desaturation index (ODI) and the SBP index were correlated. The difference in △SBP induced by hypoxia or by arousal was not significant. In severe OSAS, the apnea-hypopnea index (AHI) and LF/HF ratio were correlated with the SBP index, and △SBP was larger with hypoxia than arousal.


BP fluctuation and sympathovagal imbalance were both related to obstructive sleep apnea severity. The influence of arousal and hypoxia on BP fluctuation varied with OSAS severity.

Trial registration



Blood pressure fluctuation Obstructive sleep apnea Hypoxia Arousal Sympathovagal imbalance 



The authors would like to thank all patients included in this research.


The study was supported by National Natural Science Foundation of China (81500069).

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Scientific Research and Technology Ethics Committee of Huai’an First People’s Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Respiratory, Huai’an First People’s HospitalNanjing Medical UniversityHuai’anPeople’s Republic of China
  2. 2.Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital with Nanjing Medical UniversityNanjingChina

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