Background: Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA) specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk.Aim: We aimed to evaluate whether OSA symptoms subtypes and HB derived from sleep recordings were associated with increased CV risk in clinical setting.Methods: Clinical data from a large multicenter cohort were linked to health administrative data to identify new-onset of CV events and death in patients with OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on 8 clinically relevant variables. HB was defined as the total area under the respiratory event-related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with a composite outcome of incident CV events or death from any cause.Results: Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]), similar to prior studies. After a median follow-up of 78 months, 592 (11.05%) of 5358 patients experienced our composite outcome. In a fully adjusted model, increasing age and HB, male gender, the presence of diabetes, hypertension and COPD were significant predictors of the composite outcome. AHI and symptom subtypes were not associated with CV risk after adjustments.Conclusion: In clinical setting, patients with OSA who demonstrate elevated OSA specific HB are at higher risk of CV event and all cause mortality. Symptom subtypes have no predictive value after adjustment for confounders.