Objective To explore the relationship between laboratory tests， infarct site， respiratory events， sleep quality， neurological function of obstructive sleep apnea（ OSA） primarily characterized by rapid eye movement（ REM） and clinical prognosis of acute cerebral infarction. Methods This study was a retrospective cohort study. From September 2023 to September 2024， 270 patients with acute cerebral infarction and underwent polysomnography（ PSG） in the Department of Neurology of the Affiliated Hospital of Yangzhou University were selected as study subjects. Patients' general information， blood routine， magnetic resonance imaging（ MRI） Epworth Sleepiness Scale（ ESS）， Pittsburgh Sleep Quality Index（ PSQI）， the National Institutes of Health Stroke Scale（ NIHSS）， Barthel Index（ BI） Rating Scale， Modified Rankin Sca（l mRs）， objective sleep data obtained from PSG， and prognostic indicators obtained from follow-up were collected. Linear regression was applied to analyze the relationship between rapid eye movement apnea hypopnea index（ REM-AHI） and clinical data， and binary Logistic regression was applied to analyze the factors influencing the REM-OSA in patients with acute cerebral infarction. Results A total of 270 patients in the entire acute cerebral infarction cohort received overnight PSG. A total of 229（ 84.8%） patients with acute cerebral infarction were diagnosed with OSA， including 37（ 16.2%） in REM-OSA group and 192（ 83.8%） in NREM-OSA group. Leukocyte and neutrophil counts were higher in REM-OSA group than those in NREM-OSA group， and the differences were statistically significant（ both P＜0.05）. The percentage of patients in REM-OSA group with acute cerebral infarction sites in the basal ganglia was higher than that in NREM-OSA group， and the difference was statistically significant （P＜ 0.05）. The ESS score was lower in EEM-OSA group than that in NREM-OSA group， the PSQI scores for time to sleep and sleep efficiency dimensions were higher in REM-OSA group than those in NREM-OSA group， and the differences were statistically significant（ all P ＜ 0.05）. The N2 duration， number of NREM apneas， NREM-AHI， AHI， oxygen desaturation index（ ODI）， arousal index， and respiratory event-related arousal index in REM-OSA group were lower than those in NREM-OSA group， and the REM-AHI in REM-OSA group was higher than that in NREM-OSA group， which were statistically significant differences（ all P＜0.05）. Binomial Logistic regression showed that mRS scores was an influencing factor of REM-OSA in acute cerebral infarction， and the difference was statistically significant（ P ＜ 0.05）. Linear regression analysis showed that body mass index and leukocytes were the influencing factors of REM-AHI in patients with acute cerebral infarction， and the difference was statistically significant（ both P＜0.05）. Conclusions Compared with NREM-OSA， patients with acute cerebral infarction complicated by REM-OSA exhibit high inflammatory markers， a great tendency for infarction to involve the basal ganglia， prominent respiratory events during REM， and poor sleep quality and neurological functional outcomes.