Obstructive sleep apnea and comorbidities: A specific focus on cardiometabolic comorbidities

The chapter begins by establishing obstructive sleep apnoea (OSA) as a systemic condition associated with a wide range of comorbidities. It highlights the strong links between OSA and cardiometabolic disorders, including hypertension, type 2 diabetes, non-alcoholic fatty liver disease, dyslipidaemia, and chronic kidney disease. These comorbidities frequently coexist and share common risk factors such as obesity and physical inactivity.

Mechanistically, OSA triggers intermittent hypoxia, sympathetic activation, oxidative stress, and systemic inflammation, factors that contribute directly to conditions such as hypertension, insulin resistance, and cardiovascular strain. The chapter also addresses how these processes vary across patient phenotypes and influence clinical outcomes.

In terms of treatment, the role of continuous positive airway pressure (CPAP) is reviewed in detail. While CPAP reduces symptoms and improves quality of life, its effects on long-term cardiometabolic outcomes are modest and depend heavily on adherence. Evidence suggests that CPAP alone is insufficient to modify overall risk. Instead, a multimodal approach, including weight loss, pharmacological treatment, and structured rehabilitation—is required to effectively manage both OSA and its associated comorbidities.

To conclude, the chapter underscores the need for personalised and integrated treatment strategies that go beyond symptom control. Long-term management should combine ventilatory support, lifestyle interventions, and coordinated follow-up to address the full burden of cardiometabolic risk in OSA.

Keywords:

cardiovascular, continuous positive airway pressure (CPAP), metabolic, mortality, personalised medicine, sleep apnoea