PURPOSE: Obstructive sleep apnea (OSA) is a known risk factor for coronary artery disease (CAD), but its phenotypic variations and their impact on cardiovascular risk remain unclear. Recent studies suggest that a high periodic limb movement index (PLMI) and a high arousal index OSA phenotype may contribute to cardiovascular disease. This study aims to assess the association between this phenotype and CAD in patients undergoing preprocedural screening for coronary artery bypass grafting (CABG). METHODS: This case-comparison study analyzed a prospective adult patient group undergoing polysomnography before CABG, compared to an age- and gender-matched retrospective group undergoing polysomnography for employment screening. Sleep parameters, including PLMI, arousal index, apnea-hypopnea index (AHI), and sleep onset latency, were assessed. Statistical analysis, including chi-square tests, Fisher's exact test, and multivariable logistic regression, was conducted to evaluate associations between sleep disturbances and CAD. RESULTS: CAD patients had significant differences in the amount of abnormal PLMI, arousal index, and AHI values compared to the non-CAD group (p = 0.0002, p = 0.002, and p = 0.015, respectively). Multivariable regression identified high PLMI and arousal index as the strongest associations of CAD. CONCLUSION: A high PLMI/high arousal index OSA phenotype may increase cardiovascular risk. Identifying high-risk OSA phenotypes could improve early CAD screening and intervention strategies. Further research is needed to explore underlying mechanisms.