Objective To investigate the predictive effect of lipoprotein ⁃ associated phospholipase A2 （Lp ⁃ PLA2）on patients with obstructive sleep apnea syndrome（OSAHS）with ischemic cerebrovascular disease （ICVD）. Methods The clinical data of 93 patients with OSAHS were retrospectively analyzed. According to whether they had ICVD or not，they were divided into OSAHS with ICVD group（38 cases）and OSAHS without ICVD group（55 cases）. The differences in demographic data，vascular risk factors and Lp⁃PLA2 levels were ana⁃ lyzed，and the predictive effect of Lp⁃PLA2 on ICVD in OSAHS patients was analyzed by binary Logistic regression analysis and receiver operating characteristic curve（ROC）. Results （1）Compared with the OSAHS without ICVD group，the OSAHS with ICVD group was older，with higher levels of Apnea⁃hypopnea index（AHI），oxygen desat⁃ uration index（ODI），and Lp⁃PLA2，and a higher prevalence of hypertension. The difference was statistically sig⁃ nificant（P < 0.05）.（2）Logistic regression analysis showed that the younger the age，the lower the AHI were pro⁃ tective factor for patients with OSAHS complicated with ICVD. The elevated Lp⁃PLA2 was a risk factor for patients with OSAHS complicated with ICVD.（3）The area under the ROC curve of Lp⁃PLA2 for predicting ICVD in patients with OSAHS was 0.805（95%CI：0.710 ~ 0.880，P < 0.001），and the best predictive value of Lp⁃PLA2 was 257.39 ng/mL（sensitivity 86.8%，specificity 67.3%）. Conclusion Lp⁃PLA2 is related to the occurrence of ICVD in OSAHS patients，and elevated Lp⁃PLA2 levels may have certain predictive value for OSAHS patients with ICVD.