Ongoing research in obstructive sleep apnea (OSA) suggests strong associations with cardiopulmonary disorders. There is an abundance of studies describing physiological pathways in OSA that acutely impact the cardiovascular system. These mechanisms, if proven to carry over into the daytime hours, could form the basis for clinical disease. The challenge remains in disentangling these mechanistic processes from the many comorbid conditions often present in patients with OSA. Examples include male gender, obesity, and diabetes mellitus, all of which exert their own influence on the development of cardiopulmonary disease. This review discusses some of the physiological mechanisms associated with disordered breathing during sleep and explores putative cardiopulmonary disease associations.