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Abstract

Multi-Level Analysis of Pulse Arrival Time During Respiratory Events and Baseline Sleep Physiology: Insights from the MESA Sleep Heart Health Study

Perisa Ashar, Bill Chen, and Jessilyn Dunn, PhD | Duke University

Background: Pulse arrival time (PAT), the delay between ventricular contraction and peripheral pulse detection, is a noninvasive marker of vascular tone and cardiovascular health. Respiratory disturbances during sleep, such as apneas and desaturations, may acutely alter PAT through changes in intrathoracic pressure and sympathetic activation. However, PAT dynamics during natural sleep remain poorly understood.

Objective: To characterize differences in PAT between respiratory and non-respiratory sleep segments and evaluate how baseline and event-related PAT vary across BMI, sex, and sleep apnea status.

Methods: Using ECG and PPG signals from 203 participants in the MESA Sleep Study, we computed PAT across >1.2 million 5-second segments. Segments were labeled as respiratory or non-respiratory based on polysomnography annotations. Segment-level comparisons employed the Mann–Whitney U test and a mixed-effects linear model. Patient-level means were compared using the Wilcoxon Signed-Rank test with subgroup analyses.

Results: PAT was significantly higher during respiratory events (+6.33 ms; 95% CI: 6.19–6.46; p < 0.0001). At the patient level, 78.8% exhibited higher average PAT during respiratory segments (p < 0.0001). Baseline PAT was significantly elevated in males, individuals with sleep apnea, and those with higher BMI, whereas event-related PAT did not significantly differ across subgroups.

Conclusion: Respiratory events during sleep elicit a consistent acute vascular response detectable via increased PAT, independent of individual characteristics. PAT may serve as a useful physiological marker for personalized cardiovascular risk profiling in sleep-disordered breathing.