Association between obstructive sleep apnea and the risk of cerebrovascular disease in COPD patients

Purpose This study aimed to investigate the association between obstructive sleep apnea (OSA) and the risk of cerebrovascular disease in patients with chronic obstructive pulmonary disease (COPD), as well as to identify potential influencing factors. Methods This retrospective cohort study enrolled 1,189 patients with chronic obstructive pulmonary disease (COPD) diagnosed at the Second Affiliated Hospital of Guangdong Medical University from January 2016 to January 2020. Among these patients, 1,057 had no obstructive sleep apnea (OSA), whereas 132 were diagnosed with OSA (45 mild, 52 moderate, and 35 severe). Data were obtained from the hospital’s electronic medical record system, and patients were followed up until August 2025, or until they developed cerebrovascular disease, were lost to follow-up, or died. Univariate and multivariate logistic regression analyses were performed to evaluate the association between OSA severity and the risk of cerebrovascular disease, and sex-stratified analyses were also conducted. Results Multivariate analysis demonstrated that the severity of obstructive sleep apnea (OSA) was significantly and positively associated with the risk of cerebrovascular disease among patients with chronic obstructive pulmonary disease (COPD). The adjusted odds ratios (ORs) for cerebrovascular disease in patients with mild, moderate, and severe OSA were 2.19 (95% CI: 1.08–4.42, p = 0.029), 2.79 (95% CI: 1.47–5.28, p = 0.002), and 3.78 (95% CI: 1.62–8.81, p = 0.002), respectively. Additionally, smoking history (OR = 4.14, 95% CI: 3.07–5.58, p < 0.001), hyperlipidemia (OR = 1.83, 95% CI: 1.30–2.56, p < 0.001), and hypertension (OR = 2.92, 95% CI: 2.16–3.96, p < 0.001) were identified as independent predictors of cerebrovascular disease in COPD patients. Sex-stratified analysis revealed distinct risk profiles between male and female patients, with OSA exerting a more pronounced effect on cerebrovascular disease risk among males. Age-stratified analysis further showed that among patients aged ≥70 years, OSA had a stronger association with cerebrovascular disease risk compared with younger patients. Conclusion The severity of obstructive sleep apnea (OSA) was positively and proportionally associated with the risk of cerebrovascular disease among patients with chronic obstructive pulmonary disease (COPD). The association between OSA and cerebrovascular disease was more pronounced among male patients and individuals aged ≥70 years. Strengthened preventive and management strategies for cerebrovascular disease should be prioritized in COPD patients, especially those with concomitant OSA.