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Introduction: Obstructive sleep apnea (OSA) is associated with the progression of abdominal and thoracic aortic aneurysms. However, the role of OSA in the overall outcome of intracranial aneurysms (IAs) has not yet been established. We have investigated the role of OSA in the progression and outcome of intracranial aneurysms.Methods: Radiological and clinical data of 283 patients (from 2010 through 2015) were retrospectively reviewed. Significant differences between the OSA and non-OSA groups were determined by a chi-square test. Logistic regression analysis was performed to identify the predictors of unfavorable outcome.Results: Among the 283 patients with IAs, 45 (16%) patients were positively screened for OSA, a proportion that was significantly higher than the prevalence of OSA in the general population (4%), p=0.008. Number of patients with hypertension (p=0.018), BMI ≥ 30 (p<0.0001), hyperlipidemia (p=0.034), diabetes mellitus (DM, p=0.005), chronic heart disease (CHD, p=0.024), cerebrovascular accident (CVA, p=0.03) was significantly higher in the OSA group compared to the non-OSA group. Similarly, the number of wide neck aneurysms (p=0.00001) and poor Hunt and Hess grade 4-5 (p=0.01) was significantly higher in the OSA group compared to the non-OSA group. In addition, the number of ruptured aneurysms (p=0.03) and vasospasms (p=0.02) was significantly higher in the OSA group. The number of the patients with poor modified Rankin scale (mRS) scores (3-6) was significantly higher in the OSA group (p=0.03). Both in univariate (p=0.01) and multivariate (p=0.04) regression analysis, OSA was identified as an individual predictor of unfavorable outcome. In addition, hypertension, smoking, CHD and CVA were revealed as positive predictors of poor outcome of IAs.Conclusions: The complications of IAs such as rupture and vasospasms are influenced by presence of OSA. Overall outcome (mRS) of IAs is also affected by the concurrence of OSA. Therefore, coexistence of OSA in patients with IAs affects progression as well as outcome of IAs. Lastly, OSA serves as an individual risk factor for poor outcome in these patients.