Objective: Investigating potential predictors of aortic dissection development in high-risk hypertensive patients with obstructive sleep apnea syndrome (OSAS). Methods: Hypertensive patients with aortic dissection, admitted to hospital between January 2010 and July 2020, was diagnosed with OSAS by overnight sleep study with polysomnography (PSG). Results: Male was liable to aortic dissection compared to female in both groups（84.7% and 86% respectively）.There were actually significant differences with regard to neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV) / platelet count (PLT) ratio and D-dimer that we concerned about and were of great value in aortic dissection as previously reported. As multivariable regression analysis revealed, NLR (odds rate [OR], 2.258, 95% confidence interval [CI], 1.464-3.482, P<0.05), MPV/PLT (OR, 2.743, 95%CI, 1.713-4.392, P<0.05) and apnea and hypopnea index (AHI) (OR, 1.746,95% CI, 1.225-1.320, P<0.05) were all independent risk factors for aortic dissection. receiver operating characteristic curves analysis of NLR, MPV/PLT, AHI and combination of indicators for aortic dissection revealed combination of NLR, MPV/PLT ratio and AHI is of outstanding predictive value with sensitivity of 0.904 and specificity of 0.847. At the thresholds of 4.41 for NLR and 5.14 for MPV/PLT and 35.95 for AHI, 87.5% of all studied patients were expected to be correctly diagnosed with regard to aortic dissection. Conclusion: Inflammation, platelet alteration is crucial for initiation and progression of aortic dissection. Combined detection of NLR, MPV/PLT ratio and AHI could assist sleep physicians to identify silent or potential aortic dissection in patient comorbidity OSAS and hypertension.