Persons with sleep apnea have a 30% higher risk of heart attack or death than those unaffected. In severe and prolonged cases, increased in pulmonary pressures are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure known as cor pulmonale. Diastolic function of the heart also becomes affected. Elevated arterial pressure (i.e., hypertension) can be a consequence of OSA syndrome. When hypertension is caused by OSA, it is distinctive in that, unlike most cases (so-called essential hypertension), the readings do not drop significantly when the individual is sleeping (non-dipper) or even increase (inverted dipper).Without treatment, the sleep deprivation and lack of oxygen caused by sleep apnea increases health risks such as cardiovascular disease, aortic disease (e.g. aortic aneurysm), high blood pressure, stroke, diabetes, clinical depression, weight gain, obesity, and even death. OSA is associated with cognitive impairment, including deficits in inductive and deductive reasoning, attention, vigilance, learning, executive functions, and episodic and working memory. OSA is associated with increased risk for developing mild cognitive impairment and dementia, and has been associated with neuroanatomical changes (reductions in volumes of the hippocampus, and gray matter volume of the frontal and parietal lobes) which can however be at least in part reversed with CPAP treatment. Epidemiology
Until the 1990s, little was known regarding the frequency of OSA.
African histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. duboisii, or Histoplama duboisii (Hcd). : 316  Disease has been most often reported in Uganda, Nigeria, Zaire (Democratic Republic of the Congo) and Senegal, as Hcd is exclusive to Africa. In human disease it manifests differently than histoplasmosis (caused by Histoplasma capsulatum, or Hcc), most often involving the skin and bones and rarely involving the lungs. Also unlike Hcc, Hcd has been reported to rarely present in those with HIV, likely due to underreporting. However, this along with the differences in Hcc and Hcd have been disputed.The favored locations of African histoplasmosis are "osteoarticular, ganglionic and pulmonary". Genitourinary skin damage is rare, occurring in only 4-11% patients and typically as a secondary skin invasion in those with disseminated infection.It presents as "localized with isolated skin, bone, or lymph node infections or disseminated with multiple cutaneous lesions present all over the body, subcutaneous abscesses, enlarged lymph nodes, liver and spleen, and visceral organ enlargement" Cutaneous manifestations can be isolated or present with nodules, papules, or ulcers. They may present with subcutaneous swelling, cold abscesses progressing to spontaneous fistulization, or ulcers that may bud. If left alone, lesions may turn into a large ulcer. See also
Histoplasmosis

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== Further reading ==