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Background: The prevalence of obstructive sleep apnea (OSA) in older people (aged over 65 years) is high. However, OSA in older populations has not received sufficient attention. This study examined the clinical phenotypic characteristics of older patients with newly diagnosed OSA. Methods: A total of 110 older patients (≥ 65 years) and 220 younger patients (< 65 years), matched by gender, body mass index (BMI), and apnea–hypopnea index (AHI), were enrolled in this retrospective study. Clinical manifestations, comorbidities, and polysomnographic results were compared between the two groups, and correlations between age ≥ 65 years and OSA comorbidities were explored. Results: Nocturia was more common in older patients with OSA, as with lower sleep efficiency, longer wake after sleep onset, increased stage N1 sleep, and decreased stage N3 sleep and average SpO2. The proportions of older OSA patients who had comorbid hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease, and ischemic stroke were significantly higher than those of younger patients. The incidence of tonsillar enlargement and pharyngeal narrowing was lower in older patients. Age ≥ 65 years was an independent risk factor for patients with OSA to have hypertension (OR: 1.89, 95% CI: 1.11–3.21), CAD (OR: 4.83, 95% CI: 2.29–10.21), and ischemic stroke (OR: 2.92, 95% CI: 1.02 to 8.38). Conclusions: The presence of OSA in older adults was associated with significant abnormalities of sleep architecture, aggravated nocturnal hypoxia and increased risks of hypertension, CAD, and stroke, which can be distinguished as a unique clinical phenotype. [ABSTRACT FROM AUTHOR]