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Obstructive sleep apnea (OSA) affects a large proportion of adults, and is as an independent risk factor for cerebrovascular and cardiovascular disease. The repetitive airway obstruction that characterizes OSA results in intermittent hypoxia, intrathoracic pressure swings, and sleep fragmentation, which in turn lead to sympathetic activation, oxidative stress, inflammation, and endothelial dysfunction. This review outlines the associations between OSA and vascular diseases and describes basic mechanisms that may be responsible for this association, in both the microand macrocirculation. It also reports on interventional studies that aim to ameliorate OSA and thereby reduce vascular disease burden.© 2016 American Physiological Society. Compr Physiol 6: 1519-1528, 2016.