Paperdoi:10.3389/fneur.2026.1973505
Conventional and novel hypoxemia-related indices for obstructive sleep apnea severity and incident hypertension: a prospective cohort study
Frontiers in Neurology vol 17, published 2026-10-07
(opens in a new tab)Lixia Wang et al., "Conventional and novel hypoxemia-related indices for obstructive sleep apnea severity and incident hypertension: a prospective cohort study", doi:10.3389/fneur.2026.1973505, CC BY 4.0
TL;DR
Prospective analysis of 601 SHHS participants with OSA (AHI ≥ 15/h) free of hypertension at baseline; ~5-year median follow-up, 194 (32.3%) developed HTN. Compared oximetry-derived hypoxic burden (HB) and the sleep breathing impairment index (SBII) with AHI and ODI, by quartile and continuously. Fully adjusted: top quartile of SBII OR 1.71 (95% CI 1.02–2.90) and HB OR 1.69 (1.02–2.79) for incident HTN; AHI and ODI quartiles non-significant (also after T90 adjustment).
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Abstract
Background and objective
Obstructive sleep apnea (OSA) is associated with hypertension (HTN), but the apnea–hypopnea index (AHI) and oxygen desaturation index (ODI) may not fully characterize nocturnal hypoxemia relevant to HTN development. We evaluated the associations of the sleep breathing impairment index (SBII) and hypoxic burden (HB) with incident HTN and compared their discriminative performance with AHI and ODI.
Methods
This prospective study included 601 participants with OSA (AHI ≥ 15 events/h) from Sleep Heart Health Study who were free of HTN at baseline. SBII, HB, AHI and ODI were analyzed both in quartiles and as continuous variables. Multivariable logistic regression and restricted cubic spline analyses were used to evaluate their associations with incident HTN. Discrimination performance was assessed by comparing a clinical base model with models that separately incorporating each quartile-categorized index.
Results
During a median follow-up of approximately 5 years, 194 (32.3%) participants developed HTN. In the primary fully adjusted model, the highest quartiles of SBII (OR, 1.71; 95% CI, 1.02–2.90; p = 0.044) and HB (OR, 1.69; 95% CI, 1.02–2.79; p = 0.041) were associated with higher odds of incident HTN. In the T90-adjusted sensitivity model, both associations were significant, whereas AHI and ODI quartiles remained nonsignificant. The clinical base model had a C-statistic of 0.614; adding SBII or HB, did not significantly improve discrimination.
Conclusion
Exploratory quartile-based analyses suggested that the highest quartiles of SBII and HB were associated with higher odds of incident HTN among participants with OSA, whereas AHI and ODI were not. These findings indicate that marked elevation in SBII and HB may provide a more comprehensive characterization of OSA-related nocturnal hypoxemia relevant to incident HTN. However, the nonsignificant continuous and overall spline analyses and the limited incremental discrimination warrant cautious interpretation and further validation.
Verbatim from the publisher's DOI record (opens in a new tab) · Publisher licence: https://creativecommons.org/licenses/by/4.0/
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APA
Wang, L., Hui, X., Huang, R., & Xiao, Y. (2026). Conventional and novel hypoxemia-related indices for obstructive sleep apnea severity and incident hypertension: a prospective cohort study. Frontiers in Neurology vol 17. https://doi.org/10.3389/fneur.2026.1973505
BibTeX
@article{wang2026conventional,
title = {{Conventional and novel hypoxemia-related indices for obstructive sleep apnea severity and incident hypertension: a prospective cohort study}},
author = {Wang, Lixia and Hui, Xinjie and Huang, Rong and Xiao, Yi},
year = {2026},
journal = {Frontiers in Neurology vol 17},
doi = {10.3389/fneur.2026.1973505}
}Built from the hub record. Check it against the publisher before submitting.
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