While mild, regulated IH combined with exercise can induce beneficial cardiovascular adaptations, such as enhanced vascular function, increased maximal oxygen uptake (VO2max), and improved overall cardiovascular performance primarily through the activation of hypoxia-inducible factor 1-alpha (HIF-1α)-mediated pathways, severe or prolonged hypoxia such as that seen in obstructive sleep apnea (OSA), can contribute to pathological processes like atherosclerosis, vascular remodeling, and heart failure, all of which share tissue hypoxia as a common feature [2-4]. Here, HIF1A is linked to heart failure.