Despite strong biological evidence linking obstructive sleep apnea (OSA) to cardiovascular disease, integration into cardiovascular care pathways remains inconsistent across health systems. This article synthesizes findings from a Sleep Institute comparative analysis of six major health systems, identifies three distinct models of integration — siloed, partial and condition-specific, and systematic — and considers what more integrated care could involve. A key finding: The case for integration extends beyond the direct cardiovascular effects of positive airway pressure (PAP) therapy to risk stratification, blood pressure management, and care coordination.