Preprints.org · Oct 10, 2026

Obstructive Sleep Apnea Is Associated with Adverse Cardiovascular Events Related to Sleep Blood Pressure

By Castriotta RJ, Hermida RC, Smolensky MH et al.

Background: Obstructive sleep apnea (OSA) causes increased sleep systemic systolic blood pressure (SBP) and cardiovascular (CV) risk. Methods: This secondary analysis encompassed data of 2,065 Spanish polysomnography-confirmed OSA hypertensives (61±11.9 years, 79.5% male) and 32,471 Spanish non-OSA hypertensives (60.2±14.0 years, 51% male) from the Hygia Project. Annually throughout the 5.1-year median follow-up, they underwent comprehensive clinical evaluation and 48-h ambulatory blood pressure (BP) monitoring, with bed and wake-up times diary-recorded to calculate individualized awake and sleep BP means and sleep-time relative declines. Results: OSA subjects experienced higher CV event rates (p<0.001), including a 1.79-fold higher rate of the primary composite study outcome: myocardial infarction, surgical coronary revascularization, heart failure, stroke, and CV death. Cox survival analyses revealed the baseline asleep SBP mean most strongly predicted the primary composite study outcome [HRadjusted =1.37 (1.23, 1.52); p<0.001], while baseline enhanced sleep-time relative SBP decline most strongly predicted protection against it (HRadjusted=0.75 (0.67, 0.83); p<0.001]. Furthermore, when the Cox statistical model included adjustment for the sleep SBP mean, office BP was not predictive of risk. Conclusion: The sleep SBP mean and decline were the BP parameters most predictive of CV events in OSA subjects, constituting major targets of clinical management.

doi.org/10.20944/preprints202610.0833.v1Open accessBiomarkers