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This review provides an updated and integrated overview of OSA, spanning epidemiology, multifactorial pathophysiology, heterogeneous clinical presentation, major cardiometabolic and end\u2010organ consequences, diagnostic principles, and evolving personalized management, while also emphasizing the limitations of conventional severity classification, which is predominantly based on the apnea\u2013hypopnea index. We highlight how intermittent hypoxia\u2013reoxygenation, sleep fragmentation, sympathetic activation, intrathoracic pressure stress, endothelial dysfunction, inflammation, oxidative stress, and metabolic dysregulation interact to drive systemic injury, and why physiologically enriched metrics such as hypoxic burden, T90, event duration, sleep\u2010stage dependency, and endotypic heterogeneity may better capture biological risk than event frequency alone. Within this broader framework, fibrosis\u2010linked structural remodeling emerges as an important yet under\u2010supported dimension of OSA pathobiology. Experimental and clinical evidence suggests that OSA may contribute to remodeling of the lungs, liver, kidneys, and heart, although the strength of the evidence and the degree of causal inference vary across organs. By integrating established knowledge with this emerging fibrosis\u2010oriented perspective, this review defines key mechanistic, diagnostic, and translational priorities for future research and phenotype\u2010aware clinical stratification.<\/jats:p>","DOI":"10.1002\/mco2.70877","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:51:45Z","timestamp":1785419505000},"source":"Crossref","is-referenced-by-count":1,"title":["Obstructive Sleep Apnea: Epidemiology, Pathophysiology, Complications, Diagnosis, Management, and Emerging Fibrosis\u2010Linked Remodeling"],"prefix":"10.1002","volume":"7","author":[{"given":"Nhi Ho Thi","family":"Thuy","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences University of Sassari  Sassari Italy"},{"name":"Department of Immunology and Pathophysiology University of Medicine and Pharmacy Hue University  Hue City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u1ecb 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