Objective To investigate the effect of high triglyceride (TG) and/or high waist circumference phenotypes on the risk of major adverse cardiovascular events (MACE) in elderly males with obstructive sleep apnea (OSA). Methods A total of 704 consecutive elderly male OSA patients were enrolled from multiple centers including the Chinses PLA General Hospital and Peking University International Hospital, etc, from January 2015 to October 2017. The patients were categorized into four groups according to triglyceride-waist-circumference phenotype, normal TG with normal WC (NTNW) group (n=173), high TG with normal WC (HTNW) group (n=95), normal TG with enlarged WC (NTGW) group (n=299), and high triglyceride-waist-circumference (HTGW) group(n=137) . SPSS 26.0 was used for data analysis. According to the data type, Kruskal-Wallis test orχ² test was used to compare the differences in demographic characteristics, clinical pathological characteristics, comorbidities, sleep parameters, and laboratory findings among the four groups. Kaplan-Miere survival analysis was used to test the cumulative survival rate among the four groups of elderly male OSA patients, and Cox regression analysis was used to analyze the occurrence of MACE of elderly male OSA patients with HTGW phenotype. Results The differences were all statistically significant among the four groups in age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), TG, low-density lipoprotein cholesterol (LDL-C), apnea hypopnea index (AHI), oxygen desaturation index (ODI), history of hyperlipidemia, and history of hypertension (P<0.05). Of the 704 patients, MACE occurred in 68 (9.7%), with the highest incidence of MACE in the HTGW group (16.1%). The cumulative survival rate was lower in the HTGW group than those in the other three groups (PLogrank=0.007). COX regression analysis showed that HTGW was associated with the occurrence of MACE in elderly male OSA patients, with a hazard ratio (HR) of 2.290 (95%CI 1.153-4.548; P=0.018). After adjusting for confounders, the findings were consistent, with an adjusted hazard ratio (aHR) of 4.433 (95%CI 1.496-13.132; P=0.007). In addition, age (HR=1.051,95%CI 1.017-1.086; P<0.01), and high systolic blood pressure level (HR=1.025,95%CI 1.012-1.038; P<0.001) were risk factors of MACE in elderly OSA patients. Conclusion Elderly male OSA patients with HTGW phenotype have a relatively higher risk of MACE.