Sleep breathing disorders and cardioneurological complications: from pathophysiology to endotype-driven precision management

Sleep breathing disorders (SBDs)—including obstructive sleep apnoea, central sleep apnoea and sleep-related hypoventilation syndromes—represent a major yet under-recognised contributor to global cardiovascular and neurological morbidity. Through recurrent hypoxia, sympathetic overactivation, oxidative stress and systemic inflammation, these disorders promote hypertension, heart failure, arrhythmias, stroke and cognitive decline. Accumulating evidence also implicates SBDs in the progression of neurodegenerative diseases such as Alzheimer’s, highlighting their role as a pathophysiological bridge between cardiometabolic and neurological dysfunction. Despite this growing recognition, diagnosis and management remain suboptimal, constrained by limited screening, underuse of polysomnography and an excessive reliance on uniform therapeutic models. Recent advances underscore the need for a precision medicine framework that integrates clinical phenotyping, physiological endotyping and technological innovation. This review synthesises current evidence on the cardiovascular and neurological implications of SBDs and explores evolving strategies for personalised, endotype-driven management.