Evidence map›Paper›PMID 38506074›Full record

ArticleHypertension (Dallas, Tex. : 1979)2024

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden.

Ludovico Messineo, Scott A Sands, Christopher Schmickl, Gonzalo Labarca, Wen-Hsin Hu, Neda Esmaeili, Daniel Vena, Laura Gell, Nicole Calianese, Atul Malhotra and 4 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Hypertension (Dallas, Tex. : 1979), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
8.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
  5. Oxygen overshoot burden of central sleep apnea and its association with cardiovascular outcomes.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026
    Article
  6. Sleep, Neural Circulatory Control, and Cardiovascular Disease: A Mechanistic Review.Arteriosclerosis, thrombosis, and vascular biology · 2026
    Review
  7. Impact of obstructive sleep apnoea on nocturnal blood pressure: mechanisms and treatment responses - a narrative review.European respiratory review : an official journal of the European Respiratory Society · 2026
    Review
  8. Review
  9. Article
  10. Article
  11. Article
  12. Mechanisms Linking Sleep-Disordered Breathing and Cardiometabolic Disease Risk.Arteriosclerosis, thrombosis, and vascular biology · 2026
    Review
  13. New evidence linking lifestyle factors to blood pressure: Focus on 2024 findings.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Review
  14. Review
  15. Rebreathing during CPAP therapy and its implications in obstructive sleep apnea.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2025
    Review
  16. Highlights of the Sleep and Breathing Conference 2025.Breathe (Sheffield, England) · 2025
    Article
  17. Perspective: Precision medicine in OSA: the future of a past and present riddle.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2025
    Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 2 institutions in 1 country.

Ludovico MessineoDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0002-4142-9124
Scott A SandsDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0003-3752-0328
Christopher SchmicklDivision of Pulmonary, Critical Care, and Sleep Medicine University of California San Diego (C.S., A.M.).ORCID 0000-0001-5417-9980
Gonzalo LabarcaDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0002-0069-3420
Wen-Hsin HuDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0009-0006-5736-865X
Neda EsmaeiliDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
Daniel VenaDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0003-1740-8777
Laura GellDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
Nicole CalianeseDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
Atul MalhotraDivision of Pulmonary, Critical Care, and Sleep Medicine University of California San Diego (C.S., A.M.).
Daniel J GottliebDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0001-8812-8751
Andrew WellmanDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0002-9000-3007
Susan RedlineDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).ORCID 0000-0002-6585-1610
Ali AzarbarzinDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
Brigham and Women's Hospital · USUniversity of California System · US

Funding

CTSA INFRASTRUCTURE FOR PEDIATRIC RESEARCHUL1RR024989 · NCRR · CASE WESTERN RESERVE UNIVERSITY · PI DAVIS, PAMELA B · 2007 to 2011
$53.7M
Clinical and Translational Science Collaborative of ClevelandUL1TR002548 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI MCCOMSEY, GRACE A · 2018 to 2022
$35.5M
Clinical and Translational Science Collaborative of Northern Ohio, Catalyzing Linkages to Equity in Health (CLE Health)UM1TR004528 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI GRACE A MCCOMSEY · 2023 to 2026
$32.1M
National Sleep Research Resource (NSRR)R24HL114473 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI REDLINE, SUSAN S., ZHANG, GUO-QIANG · 2013 to 2017
$7.5M
PHASE II TRIAL OF SLEEP APNEA TREATMENT TO REDUCE CARDIOVASCULAR MORBIDITYRC2HL101417 · NHLBI · CASE WESTERN RESERVE UNIVERSITY · PI REDLINE, SUSAN S. · 2009 to 2010
$4.4M
Is Obstructive Sleep Apnea Important in the Development of Alzheimer's DiseaseR01AG063925 · NIA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL · 2020 to 2024
$3.7M
Elucidation of the Influence of Sleep Apnea on Risk of Atrial FibrillationR01HL109493 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI MEHRA, REENA · 2011 to 2015
$3.7M
Sleep Apnea-Specific Nocturnal Blood Pressure Surge to Determine Cardiovascular Risks and Therapeutic Benefits in Patients with Obstructive Sleep ApneaR01HL158765 · NHLBI · UNIVERSITY OF WASHINGTON · PI KWON, YOUNGHOON · 2021 to 2025
$3.5M
Underlying mechanisms of obesity-induced obstructive sleep apneaR01HL148436 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Atul Malhotra · 2020 to 2026
$3.4M
Phenotyping Mechanistic Pathways for Adverse Health Outcomes in Sleep ApneaR01HL153874 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI AZARBARZIN, ALI · 2020 to 2024
$3.3M
Sleep Apnea Endophenotypes: One Size Does Not Fit AllR01HL154926 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL · 2021 to 2025
$3.3M
The cardiovascular consequences of sleep apnea plus COPD (Overlap syndrome)R01HL166485 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Atul Malhotra · 2023 to 2026
$3.1M
American Heart Association-American Stroke Association 940501NCATS NIH HHS UL1 TR002548NCATS NIH HHS UM1 TR004528NCRR NIH HHS UL1 RR024989NHLBI NIH HHS K23 HL161336NHLBI NIH HHS R01 HL109493NHLBI NIH HHS R01 HL148436NHLBI NIH HHS R01 HL153874NHLBI NIH HHS R01 HL154926NHLBI NIH HHS R01 HL157985NHLBI NIH HHS R01 HL158765NHLBI NIH HHS R01 HL166485NHLBI NIH HHS R21 HL108226NHLBI NIH HHS R21 HL161766NHLBI NIH HHS R21 HL167126NHLBI NIH HHS R24 HL114473NHLBI NIH HHS RC2 HL101417NHLBI NIH HHS T32 HL166127NIA NIH HHS R01 AG063925
6 · The paper itself

Abstract

backgroundObstructive sleep apnea is associated with increased blood pressure (BP). Obstructive sleep apnea treatment reduces BP with substantial variability, not explained by the apnea-hypopnea index, partly due to inadequate characterization of obstructive sleep apnea's physiological consequences, such as oxygen desaturation, cardiac autonomic response, and suboptimal treatment efficacy. We sought to examine whether a high baseline heart rate response (ΔHR), a marker of high cardiovascular risk in obstructive sleep apnea, predicts a larger reduction in post-treatment systolic BP (SBP). Furthermore, we aimed to assess the extent to which a reduction in SBP is explained by a treatment-related reduction in hypoxic burden (HB).

methodsΔHR and HB were measured from pretreatment and posttreatment polygraphy, followed by a 24-hour BP assessment in 168 participants treated with continuous positive airway pressure or nocturnal supplemental oxygen from the HeartBEAT study (Heart Biomarker Evaluation in Apnea Treatment). Multiple linear regression models assessed whether high versus mid (reference) ΔHR predicted a larger reduction in SBP (primary outcome) and whether there was an association between treatment-related reductions in SBP and HB.

resultsA high versus mid ΔHR predicted improvement in SBP (adjusted estimate, 5.8 [95% CI, 1.0-10.5] mm Hg). Independently, a greater treatment-related reduction in HB was significantly associated with larger reductions in SBP (4.2 [95% CI, 0.9-7.5] mm Hg per 2 SD treatment-related reduction in HB). Participants with substantial versus minimal treatment-related reductions in HB had a 6.5 (95% CI, 2.5-10.4) mm Hg drop in SBP.

conclusionsA high ΔHR predicted a more favorable BP response to therapy. Furthermore, the magnitude of the reduction in BP was partly explained by a greater reduction in HB.

Indexed as

HypertensionSleep Apnea, ObstructiveSleep Apnea SyndromesBlood PressureContinuous Positive Airway PressureHeart RateHumansHypoxiaOxygenOxygenblood pressurecardiovascular diseasescontinuous positive airway pressureheart raterisk factors

Identifiers

PMID38506074
PMCPMC11056868
OpenAlexW4393007632

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.