The study evaluates the utility of the NoSAS score in screening for cerebrovascular disease risk in patients with obstructive sleep apnea (OSA). A retrospective cohort study included 1348 patients from sleep centers (2016–2019), without previous cerebrovascular disease, with 5-year follow-up through records and telephone calls. Participants were divided into a high-risk group (NoSAS ≥8, n=690) and a low-risk group (<8). In the high-risk group, the 5-year incidence of cerebrovascular diseases was 9.71%. In the adjusted logistic model, the high-risk group had a 1.8-fold higher risk (OR: 1.85, 95% CI: 1.01–3.38; p=0.045) compared to the low-risk group. There was a significant association in the stratification of ESS ≤9. NoSAS score serves as an independent predictor, especially in sleep-deprived OSA.