This review highlights the complex relationship between sleep and cardiovascular disease (CVD). Recent guidelines recommend screening for obstructive sleep apnea (OSA) in patients with atrial fibrillation, emphasizing the importance of sleep quality and duration for CV health. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Conversely, CVD can also lead to sleep disturbances. The bidirectional relationship between sleep and CVD is further illustrated by the links between OSA and CVD, such as increased risk of hypertension, arrhythmias, and heart failure. Treatment of sleep disorders, particularly OSA, may play a role in preventing and treating CVD, but more data are needed to support this. The review also discusses the impact of sleep health disparities, confounding and mediating factors, and the role of OSA in CVD, including its association with metabolic syndrome and the potential benefits of CPAP therapy. Overall, the review underscores the importance of addressing sleep health in the prevention and management of CVD.This review highlights the complex relationship between sleep and cardiovascular disease (CVD). Recent guidelines recommend screening for obstructive sleep apnea (OSA) in patients with atrial fibrillation, emphasizing the importance of sleep quality and duration for CV health. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Conversely, CVD can also lead to sleep disturbances. The bidirectional relationship between sleep and CVD is further illustrated by the links between OSA and CVD, such as increased risk of hypertension, arrhythmias, and heart failure. Treatment of sleep disorders, particularly OSA, may play a role in preventing and treating CVD, but more data are needed to support this. The review also discusses the impact of sleep health disparities, confounding and mediating factors, and the role of OSA in CVD, including its association with metabolic syndrome and the potential benefits of CPAP therapy. Overall, the review underscores the importance of addressing sleep health in the prevention and management of CVD.