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Sleep disordered breathing (SDB) in the form of obstructive sleep apnea (OSA), central sleep apnea (CSA) and Cheyne Stokes respiration (CSR) are the leading cause of pulmonary arterial hypertension (PAH) and diastolic heart failure (DHF) due to repetitive oxidative stress.SDB promotes high serum fibrinogen, urine catecholamine, inflammatory cytokines, endothelin and insulin resistance.Untreated SDB with its serious cardiovascular consequences predict mortality.There is a high correlation between measurements of pulmonary artery systolic pressure (PASP) by echocardiography and right heart catheterization, with a reported sensitivity of 79% to 100% with a specificity of 60% to 98%.Treatment of the OSA with positive airway pressure (PAP) therapy could decrease but may not normalize PASP with long standing DHF.