There is a strong association between abnormalities in central nervous system structure and function and increased risk for the development of hypertension.Comprehensive clinical studies and research using animal models,including brain imaging studies,have revealed effects of insula metabolites on hypertension associated with OSA.Alterations in the limbic system of the central nervous system are closely linked both to hypertension status and to myocardial changes that result from pressure overload.While therapy,including continuous positive airway pressure,have shown excellent results,new studies delineating mechanisms of action are needed.This review article summarizes current concepts regarding central nervous system connections to hypertension and cardiac pathology associated with obstructive sleep apnea(OSA).The limbic system provides one such novel mechanism for resistant hypertension and related cardiac diseases that may be amenable to treatment in the setting of OSA.