A 41-year-old man with a longstanding history of complicated, essential hypertension refractory to seven antihypertensives was noted to have CSR-CSA during sleep (Fig 1), exclusively in the supine position. His BP control was poor and showed measurements up to 280/180 mm Hg on home and office measurements and up to 200/140 mm Hg without nocturnal BP dip on 24-h ambulatory BP. The patient had an atherogenic lipid profile, was overweight (BMI = 28), smoked cigarettes, frequently drank alcohol to excess, and had a strong family history of cardiovascular disease. He had left ventricle hypertrophy with segmental contractility impairment, a history of two non-ST segment elevation myocardial infarctions, transient ischemic attack (TIA), retinopathy, and chronic kidney disease (plasma creatinine level, 150 μmol/L). The patient was free of diabetes mellitus. Several forms of secondary hypertension (renovascular, hormonal, vasculitis) as well as noncompliance with medications were excluded.