Obstructive sleep apnea (OSA) is an independent risk factor for several cardiovascular diseases, and its characteristic intermittent hypoxic environment induces dysregulation of miRNA in cells and circulation, which promotes cellular dysfunction and metabolic disorders, and participates in the formation of atherosclerosis (As). This article reviews the potential role of miRNA in the occurrence and progression of OSA-related As, which helps to understand the molecular pathways underlying the pathogenesis of OSA-related As and provides new insights for the development of miRNA based therapies for OSA-related cardiovascular diseases.