The study followed 1,189 COPD patients hospitalized between 2016 and 2020, of whom 1,057 did not have OSA and 132 had diagnosed OSA (45 mild, 52 moderate, 35 severe). Patients were followed until August 2025 or until the onset of cerebrovascular disease, loss to follow-up, or death. OSA severity was significantly and directly associated with a higher risk of cerebrovascular disease in patients with COPD in multivariate analysis. The adjusted odds ratio (OR) was 2.19 (95% CI 1.08–4.42; p = 0.029) for mild OSA, 2.79 (95% CI 1.47–5.28; p = 0.078) for moderate OSA, and 3.78 (95% CI 1.62–8.81; p = 0.078) for severe OSA. 0.002). History of smoking (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 2.18–3.92; p < 0.001) emerged as independent predictors of cerebrovascular disease. 0.001). Analysis by gender showed that the effect of OSA on the risk of cerebrovascular disease is more pronounced in men than in women. Age-stratified analysis found a stronger association between OSA and cerebrovascular disease in patients aged ≥70 years compared with younger patients. The study concludes that in patients with COPD, especially with concomitant OSA, it is necessary to prioritize more intensive preventive and therapeutic procedures aimed at cerebrovascular diseases.