Gauff, who beat Sabalenka to win the 2023 US Open, took a 4-2 lead in the second set after an early break as she continued her form from the first set.
But Gauff’s service game suddenly collapsed, allowing the Belarusian world number two to record successive breaks as she won four games in a row to take the second set.
Gauff’s service game deteriorated further in the decider and the American’s anger at failing to see out the match threatened to spill over.
Sabalenka, who has never lost in Wuhan, extended her winning run to seven games in a row by taking the first three games of the third set,
Gauff showed her resilience by winning four of the next five to level at 4-4.
But, after Sabalenka held her serve, Gauff double faulted on match point to hand the former world number one the win.
“Coco is an incredible player,” said Sabalenka.
“We’ve had a lot of tough battles in the past. She’s in great shape and I knew going into this match that it would be tough and that I would have to work really hard to get the win.
“A couple of mistakes from her and and I felt I probably still have chances.”
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