Crosstalk mechanisms, clinical correlations and therapeutic implications linking OSA with HFpEF progression

Obstructive sleep apnea (OSA) is closely associated with and represents a potential biological contributor to the onset and progression of heart failure with preserved ejection fraction (HFpEF). Although abundant studies have clarified the associations of OSA with cardiovascular diseases including hypertension, coronary artery disease, arrhythmia and heart failure with reduced ejection fraction (HFrEF), the exact pathophysiological mechanisms underlying OSA-related HFpEF remain poorly elucidated, and relevant systematic reviews are still scarce. This review summarizes the pathophysiological links and clinical correlations between OSA and HFpEF. Beyond classical mechanisms such as intrathoracic pressure swings and sympathetic overactivation, we highlight the pivotal roles of systemic inflammation, obesity, vascular injury and metabolic dysfunction in disease progression. We further elaborate how these interactive pathological pathways shape a clinically identifiable OSA–HFpEF phenotype, and summarize phenotype-based diagnostic strategies. Moreover, we discuss therapeutic implications for targeted management for patients with isolated OSA and comorbid OSA-HFpEF. Finally, we outline existing limitations and future research perspectives in the mechanistic exploration, diagnosis and management of OSA-HFpEF comorbidity.