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Background Excessive daytime sleepiness (EDS) and insomnia have been associated with higher risk for cardiovascular disease (CVD) in patients with obstructive sleep apnoea (OSA). The link is not fully understood but may involve hypertension and dyslipidaemia. The aim of the study was to analyse if the EDS and insomnia phenotypes were associated with abnormal blood pressures serum lipid values in patients with OSA recruited from a European real-world cohort.Methods Patients with OSA and full lipid profile participating in the ESADA database were analysed (n=12,153). They were categorised into EDS (n=3,123), EDS+insomnia (n=2,091), insomnia (n=2,862) and non-EDS non-insomnia (n=4,077) subgroups. Non-parametric ANCOVA adjusted for age, body mass index, smoking, alcohol, study site, apnoea-hypopnoea index and time spent with saturation below 90%, followed by Dunn’s test and Bonferroni correction, was used to compare lipid values between the groups. The analyses were performed in predefined subgroups.Results The prevalence of CVD was 8.9%, 10.8%, 9.5% and 8.8% (p=0.06) whilst the prevalence of hypertension was 43.9%, 48.4%, 48.8% and 44.9% (p<0.01) in the EDS, EDS+insomnia, insomnia and non-EDS non-insomnia groups, respectively. In contrast, patients with EDS had the highest total cholesterol (5.11±1.08 vs. 5.00±1.10, 5.03±1.12, 5.04±1.10 mmol/l, EDS vs. EDS+Insomnia, Insomnia, non-EDS non-insomnia, respectively), LDL-cholesterol (3.12±0.97 vs. 3.01±0.98, 3.02±1.00, 3.09±0.98 mmol/l) and triglyceride (1.86±1.04 vs. 1.76±0.97, 1.69±0.90, 1.75±0.93 mmol/l) values and the lowest HDL-cholesterol results (1.18±0.33 vs. 1.21±0.34, 1.26±0.38, 1.20±0.34). Interestingly, patients with insomnia had the highest HDL-cholesterol values.Conclusions Whilst insomnia was associated with a higher prevalence of CVD and hypertension, EDS was related dyslipidaemia. The study highlights that phenotyping based on symptoms may be useful in detecting cardiovascular and metabolic diseases, and insomnia and daytime sleepiness may relate to different cardiometabolic pathways.