"Obstructive sleep apnea (OSA) is associated with alterations in blood pressure (BP) regulation, influencing hypertension (HTN) control and increasing cardiovascular risk, with three nocturnal BP patterns described: a 10–20% decrease (“dipper”), a 0–10% decrease (“non-dipper”), or an increase during sleep (“riser”). This analytical cross-sectional observational study aimed to identify the distribution of dipper, non-dipper, and riser phenotypes in patients with untreated mild OSA evaluated at UMAA No. 68, Chihuahua. Patients with a diagnosis of mild OSA who were not receiving CPAP therapy were included, and data from 2021–2023 were obtained from the pulmonology service. Twenty-four–hour ambulatory blood pressure monitoring (ABPM) was performed, and SPSS v26 was used for statistical analysis. A total of 70 patients were analyzed (mean age 54.46 ± 15.9 years; 55.7% women), with hypertension documented in 31.4% of participants; overall, 82.9% exhibited a dipper phenotype and 17.1% a riser phenotype. The dipper phenotype predominated among patients with untreated mild OSA, while the riser phenotype was present in 17.1% of cases-approximately twice the prevalence reported in the general population-suggesting that nocturnal BP phenotype should be considered a relevant clinical feature in this population."
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Obstructive sleep apnea (OSA) is a disorder characterized by recurrent episodes of upper airway obstruction during sleep, leading to intermittent hypoxemia, sleep fragmentation, and sustained sympathetic activation
[1]
Hermida RC, Ayala DE, Mojón A, Fernández JR. Ambulatory blood pressure monitoring in 26, 170 individuals: clinical relevance of circadian patterns. Rev Port Cardiol. 2018.
[1]
. These alterations contribute to the development of arterial hypertension, endothelial dysfunction, and increased cardiovascular (CV) risk
[2]
Gavriilaki E, Doumas M, et al. The prognostic significance of nighttime blood pressure dipping and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2020; 22(3): 1951–1959.
Ambulatory blood pressure monitoring (ABPM) allows the identification of circadian BP phenotypes: dipper, non-dipper, and riser. In healthy individuals, nocturnal BP typically decreases by 10–20%. Smaller reductions define the non-dipper pattern, whereas a nocturnal increase in BP corresponds to the riser phenotype³, which is considered the one with the highest cardiovascular risk and is associated with left ventricular hypertrophy, arterial stiffness, and cardiovascular events
[4]
Kario K, Hettrick DA, Mahfoud F, et al. Obstructive Sleep Apnea–Induced Neurogenic Nocturnal Hypertension: A Potential Role of Renal Denervation? Hypertension. 2021; 77(4): 1047-1060.
Yang WY, Melgarejo JD, Thijs L, et al. Prognostic value of nighttime blood pressure: the International Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO). JAMA. 2019; 322(5): 409–420.
. The IDACO study demonstrated that nocturnal BP is the strongest predictor of total and cardiovascular mortality
[10]
Genta-Pereira M, Furlan SF, Gus M, et al. Nondipping blood pressure patterns predict obstructive sleep apnea in patients undergoing evaluation for suspected OSA. Arch Bronconeumol. 2018; 54(7): 368–374.
. A model of neurogenic nocturnal hypertension induced by OSA has also been described, related to hypoxia, heightened sympathetic activity, and activation of the ascending reticular activating system (ARAS)
[11]
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019; 15(2): 335–343.
Additionally, other studies report that non-dipper and riser patterns predict moderate-to-severe OSA
[12]
Randerath W, Verbraecken J, de Raaff CAL, et al. Non-CPAP therapies in obstructive sleep apnoea: European Respiratory Society guideline. Eur Respir Rev. 2021; 30: 210200.
. The 2021 ERS and 2019/2021 AASM guidelines state that nocturnal hemodynamic alterations should influence the evaluation and management of OSA, even in its mild stages
[13]
Martínez-García MA, et al. Effect of CPAP on blood pressure in patients with resistant hypertension and sleep apnea: The HIPARCO randomized clinical trial. JAMA. 2013; 310(22): 2407–2415.
Duarte RL, Magalhães-da-Silva T, et al. CPAP reduces nocturnal blood pressure and sympathetic activity in patients with OSA: The RHOOSAS Trial. Front Neurol. 2018; 9: 318.
Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis. J Clin Med. 2019; 8(9): 1367.
Wang C, Zhang J, Liu X, Liu T, Wang F, Wang X, et al. Prognostic value of a reverse-dipper blood pressure pattern in patients with chronic kidney disease. Sci Rep. 2016; 6: 34932.
Therefore, characterizing the riser phenotype in mild OSA is essential for cardiovascular risk stratification and to optimize therapeutic decision-making.
Study Objective
The primary objective of this study was to identify the distribution of dipper, non-dipper, and riser blood pressure phenotypes in patients with untreated mild OSA evaluated at the Ambulatory Care Medical Unit No. 68 (UMAA No. 68) in Chihuahu.
2. Materials and Methods
Study Design and Population
This study was designed as an observational, cross-sectional, and analytical investigation including all patients evaluated between 2021 and 2023 at the Ambulatory Care Medical Unit No. 68 (UMAA 68) of the Mexican Institute of Social Security (IMSS) in Chihuahua, Mexico. Participants were selected based on a diagnosis of mild obstructive sleep apnea (OSA), defined by an apnea–hypopnea index (AHI) between 5 and 15 events per hour.
Home respiratory polygraphy was performed using the ApneaLink Air® system (ResMed, USA). The following parameters were recorded throughout the assessment: nasal airflow, oxygen saturation (SpO₂), heart rate, respiratory effort, snoring detection, and total recording time.
Eligible participants were adults aged ≥18 years who were not receiving continuous positive airway pressure (CPAP) therapy and who had provided written informed consent. After authorization, clinical records were reviewed to obtain sociodemographic and clinical information.
All patients also underwent 24-hour ambulatory blood pressure monitoring (ABPM) using the ABPM-50 device (CONTEC®, China). The monitoring protocol included daytime measurements every 20 minutes and nighttime measurements every 30 minutes, following international recommendations. This procedure allowed for the determination of each patient’s nocturnal blood pressure phenotype.
The collected data were subsequently analyzed using SPSS statistical software, version 26.
2.1. Statistical Analysis
The statistical analysis began with descriptive statistics. Qualitative variables were reported as absolute frequencies and percentages. A specific analysis was then performed to determine the prevalence of the different nocturnal blood pressure phenotypes within the study population. This analysis also considered participants’ general characteristics to provide a comprehensive overview of phenotype distribution in the selected cohort.
Next, a comparison was conducted to determine whether the proportion of patients exhibiting the riser (reverse dipper) phenotype among those with mild OSA (AHI 5–15) differed from the prevalence reported in the general population and in individuals without OSA. An exact binomial proportion test was applied, comparing the observed proportion with the expected prevalence in the general population.
In addition, inferential analyses were performed to compare qualitative variables among the identified groups. Chi-square (χ²) tests were used to assess associations between categorical variables. For quantitative variables, Student’s t-test was employed to compare means between groups, allowing the identification of statistically significant differences when present.
2.2. Ethical Considerations
This study complies with the Mexican General Health Law and with the ethical guidelines established by the Mexican Institute of Social Security (IMSS), and it is classified as a minimal-risk investigation for participants. Confidentiality and anonymity were strictly maintained throughout the study, ensuring that personal data were not disclosed or used outside the research context.
2.3. Equations
One-sample proportion test
This formula was used to compare an observed proportion with an expected proportion
[20]
Rosner B. Fundamentals of Biostatistics. 8th ed. Boston (MA): Cengage Learning; 2016.
[19]
Bland M. An Introduction to Medical Statistics. 4th ed. Oxford: Oxford University Press; 2015.
[20, 19]
.
Where:
1) = observed proportion
2) = expected proportion according to the null hypothesis
3) = sample size
2.4. Tables
Table 1. General Characteristics of the Study Sample.
Variable
Value
Age, years
54.46 ± 15.9
Female sex, n (%)
39 (55.7%)
Hypertension, n (%)
22 (31.4%)
BMI, kg/m²
29.59
Table 2. Distribution of Phenotypes.
Phenotype
Frequency
Percentage
Dipper
58
82.9%
Non-dipper
0
0%
Riser
12
17.1%
Total
70
100%
Table 3. BMI Category by Blood Pressure Phenotype.
BMI Category
Dipper
Riser
Normal weight
8
0
Overweight
27
8
Obesity Grade 1
16
2
Obesity Grade 2
6
2
Obesity Grade 3
1
0
Table 4. Hypertension Status by Blood Pressure Phenotype.
Hypertension Status
Dipper
Riser
Hypertensive
15
7
Non-hypertensive
43
5
3. Results
Study population and clinical characteristics
A total of 70 IMSS beneficiaries evaluated by pulmonology specialists between 2021 and 2023 were analyzed. The mean age of participants was 54.46 ± 15.9 years, with a predominance of female sex (55.7%). Among the total sample, 22% had a diagnosis of arterial hypertension (HTN).
Regarding the circadian blood pressure pattern, 82.9% presented a Dipper profile, whereas only 17.1% exhibited a Riser profile. The observed proportion was p̂ = 0.1714, with a 95% confidence interval (95% CI) of 0.101–0.276 (Wilson method).
A one-sample proportion test (exact binomial) was applied, comparing the observed proportion of Riser phenotype (17.1%) with the expected prevalence in the general population (8%)
[1]
Hermida RC, Ayala DE, Mojón A, Fernández JR. Ambulatory blood pressure monitoring in 26, 170 individuals: clinical relevance of circadian patterns. Rev Port Cardiol. 2018.
[7]
Lo SH, et al. Nocturnal blood pressure patterns and mortality in Asian hypertensive populations. J Clin Hypertens (Greenwich). 2021; 23: 1951–1959.
The clinical analysis of the study population showed that 88.6% of participants were overweight or obesity. The mean Body Mass Index (BMI) was 29.35. Additionally, 68.6% of the individuals included in the sample did not have hypertension.
Moreover, the statistical analysis revealed no significant association between categorized BMI and the dipper/riser circadian phenotype, according to the results obtained (χ² = 3.47, df = 4, p = 0.482). This indicates that, within this sample, variations in BMI were not statistically associated with the circadian blood pressure patterns known as dipper and riser.
A significant association was found between the presence of arterial hypertension and the circadian phenotype (χ² = 4.865, df = 1, p = 0.027). Hypertensive subjects showed a higher proportion of the riser phenotype (31.8%) compared to non-hypertensive individuals (10.4%). Fisher’s exact test confirmed this association (p = 0.041).
4. Discussion
In our cohort, the prevalence of the riser phenotype was 17.1%, notably higher than that reported in the general population (≈4–11%)
[1]
Hermida RC, Ayala DE, Mojón A, Fernández JR. Ambulatory blood pressure monitoring in 26, 170 individuals: clinical relevance of circadian patterns. Rev Port Cardiol. 2018.
[1]
. The meta-analysis by Gavriilaki (10,438 patients) demonstrated that the reverse-dipper phenotype carries the highest cardiovascular (CV) risk (RR 1.33–2.00)
[2]
Gavriilaki E, Doumas M, et al. The prognostic significance of nighttime blood pressure dipping and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2020; 22(3): 1951–1959.
. Cuspidi et al. further confirmed its strong association with early cardiovascular damage
[3]
Cuspidi C, Sala C, Tadic M, et al. Clinical and prognostic significance of reverse dipping pattern in untreated hypertensives: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2017; 19(7): 713–721.
The pathophysiological foundations of the riser pattern have been expanded by Kario et al. (2021), who described neurogenic nocturnal hypertension induced by OSA, mediated by intermittent hypoxia and excessive sympathetic tone
[4]
Kario K, Hettrick DA, Mahfoud F, et al. Obstructive Sleep Apnea–Induced Neurogenic Nocturnal Hypertension: A Potential Role of Renal Denervation? Hypertension. 2021; 77(4): 1047-1060.
. This mechanism aligns with the presence of the riser phenotype even in mild OSA. The IDACO analysis concluded that nocturnal blood pressure is the strongest predictor of total and cardiovascular mortality
[5]
Yang WY, Melgarejo JD, Thijs L, et al. Prognostic value of nighttime blood pressure: the International Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO). JAMA. 2019; 322(5): 409–420.
. In coronary artery disease, Du et al. (2024) showed that the riser phenotype doubled the risk of CV events (HR 2.687), although nocturnal systolic BP remained the dominant predictor
[8]
Du Y, et al. Riser pattern and cardiovascular outcomes in coronary heart disease. J Clin Hypertens (Greenwich). 2024. (Ahead of print).
[8]
.
In patients with chronic kidney disease (CKD), Wang et al. demonstrated that the riser phenotype increases overall and cardiovascular mortality up to five-fold
[9]
Wang C, et al. Reverse dipping and all-cause mortality in chronic kidney disease: A cohort study. Sci Rep. 2016; 6: 30102.
Genta-Pereira M, Furlan SF, Gus M, et al. Nondipping blood pressure patterns predict obstructive sleep apnea in patients undergoing evaluation for suspected OSA. Arch Bronconeumol. 2018; 54(7): 368–374.
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019; 15(2): 335–343.
Randerath W, Verbraecken J, de Raaff CAL, et al. Non-CPAP therapies in obstructive sleep apnoea: European Respiratory Society guideline. Eur Respir Rev. 2021; 30: 210200.
Martínez-García MA, et al. Effect of CPAP on blood pressure in patients with resistant hypertension and sleep apnea: The HIPARCO randomized clinical trial. JAMA. 2013; 310(22): 2407–2415.
Duarte RL, Magalhães-da-Silva T, et al. CPAP reduces nocturnal blood pressure and sympathetic activity in patients with OSA: The RHOOSAS Trial. Front Neurol. 2018; 9: 318.
Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis. J Clin Med. 2019; 8(9): 1367.
Wang C, Zhang J, Liu X, Liu T, Wang F, Wang X, et al. Prognostic value of a reverse-dipper blood pressure pattern in patients with chronic kidney disease. Sci Rep. 2016; 6: 34932.
, reinforcing its prognostic relevance in high-risk populations. The consistency of findings between CKD and mild OSA suggests that the riser pattern is an early hemodynamic marker of autonomic dysfunction shared across both pathophysiological processes.
On the other hand, recent studies of lifestyle factors and clinical variables-such as that of Kim et al.-have shown that advanced age, obesity, diabetes, and unhealthy sleep behaviors are strongly associated with non-dipper and riser nocturnal patterns
[17]
Kim BS, Lee H, Kim YA, Kim K, Cho JH, Kim S, et al. Clinical and lifestyle factors related to the nighttime blood-pressure dipping pattern. Clin Hypertens. 2023; 29(1): 6.
. These findings partially align with our cohort, in which the high prevalence of overweight/obesity may modulate nocturnal BP behavior, even though no direct statistical association was found between BMI and circadian phenotype.
Additionally, modern pathophysiological evidence indicates that obstructive sleep apnea is itself a primary trigger of the non-dipper/riser pattern, independent of traditional risk factors. Crinion et al. demonstrated that intermittent hypoxemia, micro-arousals, and sustained sympathetic activation in OSA directly explain the loss of the physiological nocturnal BP dip
[18]
Crinion SJ, Ryan S, McNicholas WT. Obstructive sleep apnoea as a cause of nocturnal non-dipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms. Eur Respir J. 2017; 49(1): 1601818.
. This supports the observation that even individuals with mild OSA may present with a riser phenotype, as occurred in our sample.
The riser pattern also predicts the presence of moderate-to-severe OSA. Genta-Pereira reported an OR ≈ 4 for identifying reverse-dippers
[10]
Genta-Pereira M, Furlan SF, Gus M, et al. Nondipping blood pressure patterns predict obstructive sleep apnea in patients undergoing evaluation for suspected OSA. Arch Bronconeumol. 2018; 54(7): 368–374.
From a therapeutic perspective, the 2019 AASM guidelines recommend CPAP as first-line treatment for OSA, including patients with nocturnal hypertension
[11]
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019; 15(2): 335–343.
. The 2021 ERS guidelines highlight that individuals with the riser phenotype may require earlier intervention
[12]
Randerath W, Verbraecken J, de Raaff CAL, et al. Non-CPAP therapies in obstructive sleep apnoea: European Respiratory Society guideline. Eur Respir Rev. 2021; 30: 210200.
. Studies such as HIPARCO and RHOOSAS confirmed that CPAP reduces nocturnal blood pressure and can revert the riser pattern
[13]
Martínez-García MA, et al. Effect of CPAP on blood pressure in patients with resistant hypertension and sleep apnea: The HIPARCO randomized clinical trial. JAMA. 2013; 310(22): 2407–2415.
Taken together, the available evidence-including recent findings in CKD
[16]
Wang C, Zhang J, Liu X, Liu T, Wang F, Wang X, et al. Prognostic value of a reverse-dipper blood pressure pattern in patients with chronic kidney disease. Sci Rep. 2016; 6: 34932.
Kim BS, Lee H, Kim YA, Kim K, Cho JH, Kim S, et al. Clinical and lifestyle factors related to the nighttime blood-pressure dipping pattern. Clin Hypertens. 2023; 29(1): 6.
Crinion SJ, Ryan S, McNicholas WT. Obstructive sleep apnoea as a cause of nocturnal non-dipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms. Eur Respir J. 2017; 49(1): 1601818.
positions the riser phenotype as an early marker of cardiovascular risk and a priority therapeutic target in the management of mild OSA, supporting the systematic use of ABPM and the consideration of CPAP initiation even in the absence of severe symptoms.
5. Conclusions
The riser phenotype showed a prevalence of 17.1% in mild OSA, doubling that observed in the general population¹. Epidemiological, pathophysiological, and prognostic evidence demonstrates that this pattern represents the highest cardiovascular (CV) risk among circadian phenotypes, being associated with increased mortality, cardiovascular events, and target-organ damage
[2]
Gavriilaki E, Doumas M, et al. The prognostic significance of nighttime blood pressure dipping and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2020; 22(3): 1951–1959.
Cuspidi C, Sala C, Tadic M, et al. Clinical and prognostic significance of reverse dipping pattern in untreated hypertensives: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2017; 19(7): 713–721.
Kario K, Hettrick DA, Mahfoud F, et al. Obstructive Sleep Apnea–Induced Neurogenic Nocturnal Hypertension: A Potential Role of Renal Denervation? Hypertension. 2021; 77(4): 1047-1060.
Yang WY, Melgarejo JD, Thijs L, et al. Prognostic value of nighttime blood pressure: the International Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO). JAMA. 2019; 322(5): 409–420.
The neurogenic model of nocturnal hypertension induced by OSA explains its presence even in mild disease¹¹. Since CPAP therapy can reverse this pattern, the identification of the riser phenotype through ABPM should be considered an additional criterion for initiating treatment in mild OSA, in alignment with the 2021 ERS and 2019/2021 AASM recommendations
[11]
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019; 15(2): 335–343.
Randerath W, Verbraecken J, de Raaff CAL, et al. Non-CPAP therapies in obstructive sleep apnoea: European Respiratory Society guideline. Eur Respir Rev. 2021; 30: 210200.
Martínez-García MA, et al. Effect of CPAP on blood pressure in patients with resistant hypertension and sleep apnea: The HIPARCO randomized clinical trial. JAMA. 2013; 310(22): 2407–2415.
Duarte RL, Magalhães-da-Silva T, et al. CPAP reduces nocturnal blood pressure and sympathetic activity in patients with OSA: The RHOOSAS Trial. Front Neurol. 2018; 9: 318.
Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis. J Clin Med. 2019; 8(9): 1367.
Wang C, Zhang J, Liu X, Liu T, Wang F, Wang X, et al. Prognostic value of a reverse-dipper blood pressure pattern in patients with chronic kidney disease. Sci Rep. 2016; 6: 34932.
Nternational Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes
IMSS
Mexican Institute of Social Security
OSA
Obstructive Sleep Apnea
RR
Relative Risk
SPSS
Statistical Package for the Social Sciences
UMAA
Ambulatory Medical Care Unit
χ²
Chi-square test
Conflicts of Interest
The authors declare no conflicts of interest.
References
[1]
Hermida RC, Ayala DE, Mojón A, Fernández JR. Ambulatory blood pressure monitoring in 26, 170 individuals: clinical relevance of circadian patterns. Rev Port Cardiol. 2018.
[2]
Gavriilaki E, Doumas M, et al. The prognostic significance of nighttime blood pressure dipping and cardiovascular outcomes: a systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2020; 22(3): 1951–1959.
Cuspidi C, Sala C, Tadic M, et al. Clinical and prognostic significance of reverse dipping pattern in untreated hypertensives: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2017; 19(7): 713–721.
Kario K, Hettrick DA, Mahfoud F, et al. Obstructive Sleep Apnea–Induced Neurogenic Nocturnal Hypertension: A Potential Role of Renal Denervation? Hypertension. 2021; 77(4): 1047-1060.
Yang WY, Melgarejo JD, Thijs L, et al. Prognostic value of nighttime blood pressure: the International Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO). JAMA. 2019; 322(5): 409–420.
Genta-Pereira M, Furlan SF, Gus M, et al. Nondipping blood pressure patterns predict obstructive sleep apnea in patients undergoing evaluation for suspected OSA. Arch Bronconeumol. 2018; 54(7): 368–374.
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019; 15(2): 335–343.
Randerath W, Verbraecken J, de Raaff CAL, et al. Non-CPAP therapies in obstructive sleep apnoea: European Respiratory Society guideline. Eur Respir Rev. 2021; 30: 210200.
Martínez-García MA, et al. Effect of CPAP on blood pressure in patients with resistant hypertension and sleep apnea: The HIPARCO randomized clinical trial. JAMA. 2013; 310(22): 2407–2415.
Duarte RL, Magalhães-da-Silva T, et al. CPAP reduces nocturnal blood pressure and sympathetic activity in patients with OSA: The RHOOSAS Trial. Front Neurol. 2018; 9: 318.
Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis. J Clin Med. 2019; 8(9): 1367.
Wang C, Zhang J, Liu X, Liu T, Wang F, Wang X, et al. Prognostic value of a reverse-dipper blood pressure pattern in patients with chronic kidney disease. Sci Rep. 2016; 6: 34932.
Kim BS, Lee H, Kim YA, Kim K, Cho JH, Kim S, et al. Clinical and lifestyle factors related to the nighttime blood-pressure dipping pattern. Clin Hypertens. 2023; 29(1): 6.
Crinion SJ, Ryan S, McNicholas WT. Obstructive sleep apnoea as a cause of nocturnal non-dipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms. Eur Respir J. 2017; 49(1): 1601818.
Bustillos, M. H. S., Campos, L. H. B., Leal, J. L. (2025). Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico. European Journal of Clinical and Biomedical Sciences, 11(5), 73-77. https://doi.org/10.11648/j.ejcbs.20251105.12
Bustillos, M. H. S.; Campos, L. H. B.; Leal, J. L. Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico. Eur. J. Clin. Biomed. Sci.2025, 11(5), 73-77. doi: 10.11648/j.ejcbs.20251105.12
Bustillos MHS, Campos LHB, Leal JL. Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico. Eur J Clin Biomed Sci. 2025;11(5):73-77. doi: 10.11648/j.ejcbs.20251105.12
@article{10.11648/j.ejcbs.20251105.12,
author = {Marco Hugo Sánchez Bustillos and Luis Héctor Basurto Campos and Jorge López Leal},
title = {Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico},
journal = {European Journal of Clinical and Biomedical Sciences},
volume = {11},
number = {5},
pages = {73-77},
doi = {10.11648/j.ejcbs.20251105.12},
url = {https://doi.org/10.11648/j.ejcbs.20251105.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20251105.12},
abstract = {"Obstructive sleep apnea (OSA) is associated with alterations in blood pressure (BP) regulation, influencing hypertension (HTN) control and increasing cardiovascular risk, with three nocturnal BP patterns described: a 10–20% decrease (“dipper”), a 0–10% decrease (“non-dipper”), or an increase during sleep (“riser”). This analytical cross-sectional observational study aimed to identify the distribution of dipper, non-dipper, and riser phenotypes in patients with untreated mild OSA evaluated at UMAA No. 68, Chihuahua. Patients with a diagnosis of mild OSA who were not receiving CPAP therapy were included, and data from 2021–2023 were obtained from the pulmonology service. Twenty-four–hour ambulatory blood pressure monitoring (ABPM) was performed, and SPSS v26 was used for statistical analysis. A total of 70 patients were analyzed (mean age 54.46 ± 15.9 years; 55.7% women), with hypertension documented in 31.4% of participants; overall, 82.9% exhibited a dipper phenotype and 17.1% a riser phenotype. The dipper phenotype predominated among patients with untreated mild OSA, while the riser phenotype was present in 17.1% of cases-approximately twice the prevalence reported in the general population-suggesting that nocturnal BP phenotype should be considered a relevant clinical feature in this population."},
year = {2025}
}
TY - JOUR
T1 - Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico
AU - Marco Hugo Sánchez Bustillos
AU - Luis Héctor Basurto Campos
AU - Jorge López Leal
Y1 - 2025/12/31
PY - 2025
N1 - https://doi.org/10.11648/j.ejcbs.20251105.12
DO - 10.11648/j.ejcbs.20251105.12
T2 - European Journal of Clinical and Biomedical Sciences
JF - European Journal of Clinical and Biomedical Sciences
JO - European Journal of Clinical and Biomedical Sciences
SP - 73
EP - 77
PB - Science Publishing Group
SN - 2575-5005
UR - https://doi.org/10.11648/j.ejcbs.20251105.12
AB - "Obstructive sleep apnea (OSA) is associated with alterations in blood pressure (BP) regulation, influencing hypertension (HTN) control and increasing cardiovascular risk, with three nocturnal BP patterns described: a 10–20% decrease (“dipper”), a 0–10% decrease (“non-dipper”), or an increase during sleep (“riser”). This analytical cross-sectional observational study aimed to identify the distribution of dipper, non-dipper, and riser phenotypes in patients with untreated mild OSA evaluated at UMAA No. 68, Chihuahua. Patients with a diagnosis of mild OSA who were not receiving CPAP therapy were included, and data from 2021–2023 were obtained from the pulmonology service. Twenty-four–hour ambulatory blood pressure monitoring (ABPM) was performed, and SPSS v26 was used for statistical analysis. A total of 70 patients were analyzed (mean age 54.46 ± 15.9 years; 55.7% women), with hypertension documented in 31.4% of participants; overall, 82.9% exhibited a dipper phenotype and 17.1% a riser phenotype. The dipper phenotype predominated among patients with untreated mild OSA, while the riser phenotype was present in 17.1% of cases-approximately twice the prevalence reported in the general population-suggesting that nocturnal BP phenotype should be considered a relevant clinical feature in this population."
VL - 11
IS - 5
ER -
Bustillos, M. H. S., Campos, L. H. B., Leal, J. L. (2025). Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico. European Journal of Clinical and Biomedical Sciences, 11(5), 73-77. https://doi.org/10.11648/j.ejcbs.20251105.12
Bustillos, M. H. S.; Campos, L. H. B.; Leal, J. L. Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico. Eur. J. Clin. Biomed. Sci.2025, 11(5), 73-77. doi: 10.11648/j.ejcbs.20251105.12
Bustillos MHS, Campos LHB, Leal JL. Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico. Eur J Clin Biomed Sci. 2025;11(5):73-77. doi: 10.11648/j.ejcbs.20251105.12
@article{10.11648/j.ejcbs.20251105.12,
author = {Marco Hugo Sánchez Bustillos and Luis Héctor Basurto Campos and Jorge López Leal},
title = {Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico},
journal = {European Journal of Clinical and Biomedical Sciences},
volume = {11},
number = {5},
pages = {73-77},
doi = {10.11648/j.ejcbs.20251105.12},
url = {https://doi.org/10.11648/j.ejcbs.20251105.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20251105.12},
abstract = {"Obstructive sleep apnea (OSA) is associated with alterations in blood pressure (BP) regulation, influencing hypertension (HTN) control and increasing cardiovascular risk, with three nocturnal BP patterns described: a 10–20% decrease (“dipper”), a 0–10% decrease (“non-dipper”), or an increase during sleep (“riser”). This analytical cross-sectional observational study aimed to identify the distribution of dipper, non-dipper, and riser phenotypes in patients with untreated mild OSA evaluated at UMAA No. 68, Chihuahua. Patients with a diagnosis of mild OSA who were not receiving CPAP therapy were included, and data from 2021–2023 were obtained from the pulmonology service. Twenty-four–hour ambulatory blood pressure monitoring (ABPM) was performed, and SPSS v26 was used for statistical analysis. A total of 70 patients were analyzed (mean age 54.46 ± 15.9 years; 55.7% women), with hypertension documented in 31.4% of participants; overall, 82.9% exhibited a dipper phenotype and 17.1% a riser phenotype. The dipper phenotype predominated among patients with untreated mild OSA, while the riser phenotype was present in 17.1% of cases-approximately twice the prevalence reported in the general population-suggesting that nocturnal BP phenotype should be considered a relevant clinical feature in this population."},
year = {2025}
}
TY - JOUR
T1 - Distribution of Dipper, Non-dipper, or Riser Phenotypes in Patients with Mild OSA Untreated with CPAP at UMAA No. 68 in Chihuahua, Mexico
AU - Marco Hugo Sánchez Bustillos
AU - Luis Héctor Basurto Campos
AU - Jorge López Leal
Y1 - 2025/12/31
PY - 2025
N1 - https://doi.org/10.11648/j.ejcbs.20251105.12
DO - 10.11648/j.ejcbs.20251105.12
T2 - European Journal of Clinical and Biomedical Sciences
JF - European Journal of Clinical and Biomedical Sciences
JO - European Journal of Clinical and Biomedical Sciences
SP - 73
EP - 77
PB - Science Publishing Group
SN - 2575-5005
UR - https://doi.org/10.11648/j.ejcbs.20251105.12
AB - "Obstructive sleep apnea (OSA) is associated with alterations in blood pressure (BP) regulation, influencing hypertension (HTN) control and increasing cardiovascular risk, with three nocturnal BP patterns described: a 10–20% decrease (“dipper”), a 0–10% decrease (“non-dipper”), or an increase during sleep (“riser”). This analytical cross-sectional observational study aimed to identify the distribution of dipper, non-dipper, and riser phenotypes in patients with untreated mild OSA evaluated at UMAA No. 68, Chihuahua. Patients with a diagnosis of mild OSA who were not receiving CPAP therapy were included, and data from 2021–2023 were obtained from the pulmonology service. Twenty-four–hour ambulatory blood pressure monitoring (ABPM) was performed, and SPSS v26 was used for statistical analysis. A total of 70 patients were analyzed (mean age 54.46 ± 15.9 years; 55.7% women), with hypertension documented in 31.4% of participants; overall, 82.9% exhibited a dipper phenotype and 17.1% a riser phenotype. The dipper phenotype predominated among patients with untreated mild OSA, while the riser phenotype was present in 17.1% of cases-approximately twice the prevalence reported in the general population-suggesting that nocturnal BP phenotype should be considered a relevant clinical feature in this population."
VL - 11
IS - 5
ER -
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