Introduction <p>The hypertriglyceridemia-waist (HTGW) phenotype is a prevalent risk factor for cardiovascular diseases and obstructive sleep apnea (OSA). However, the impactof the HTGW phenotype on the simultaneous occurrence of OSA and cardiovascular diseases remains unexplored. This study aimed to determine whether the HTGW phenotype elevates the incidence of major adverse cardiovascular events (MACE) in patients with OSA, such as hospitalization for unstable angina and heart failure, myocardial infarction, and cardiovascular death, in patients with OSA.</p> Methods <p>A total of 1,290 patients with OSA were recruited from six hospitals for follow-up. According to the Chinese population criteria recommended by the International Diabetes Federation, the patients were divided into four groups: normal triglyceride waist circumference (NTNW) phenotype, pure high triglyceride (HTNW) phenotype, pure high waist circumference (NTGW) phenotype, and HTGW phenotype. The prognosis for MACE was evaluated using Cox proportional hazards analysis. The prognosis of MACE was evaluated using Cox proportional hazards analysis.</p> Results <p>207 (17.9%) developed an HTGW phenotype. After a median of 42 months of follow-up, 119 (10.3%) experienced MACE. Cox proportional hazards analysis revealed that patients exhibiting the HTGW phenotype had a 1.963-fold higher risk of developing MACE than patients with the NTNW phenotype (<i>P</i> = 0.012). These results remained significant after adjusting for confounders, and a 2.186-fold increased risk of MACE was found in patients with NTGW phenotype (<i>P</i> = 0.012). Subgroup analyses revealed an increased risk of MACE in OSA patients with HTGW phenotype and NTGW phenotype that were older than or equal to 70 years, male, and had moderate-to-severe OSA (all <i>P</i>-values &lt; 0.05).</p> Conclusion <p>The HTGW and NTGW phenotypes significantly increase MACE risk among elderly patients with OSA.</p>