Obstructive sleep apnea (OSA) is common in older U.S. adults and the prevalence is anticipated to rise in this age group along with obesity, a prominent risk factor for OSA. Recently, OSA was determined to be highly prevalent among patients with abdominal aortic aneurysm (AAA) disease. Objectives: Examine associations between OSA risk and physical activity (PA), metabolic syndrome (MetSyn), and exercise responses to cardiopulmonary exercise testing (CPET) in elderly patients with AAA disease. Methods: Elderly patients (n=326 for Studies 1 and 2; n=114 for Study 3) newly diagnosed with small AAAs (aortic diameter "2.5 and < 5.5 cm) were recruited. Data collection for all participants included: extraction of medical history and drug information from medical records; completion of a physical examination to assess resting vital signs and anthropometrics; fasting blood draw for several biochemical analyses; completion of a cardiopulmonary exercise test (CPET); and completion of interviews and questionnaires for health history, PA, and OSA risk. Results: 57% of subjects were High-risk for OSA and 17% were classified in the highest-risk Berlin Risk Score (BRS) 3 group; these subjects reported fewer blocks walked/day, flights of stairs climbed/day, and expended fewer Calories when engaged in these activities compared to Low-risk counterparts, independent of obesity. Among those at High-risk for OSA, 45% had MetSyn. Subjects with the highest BRS also had the highest prevalence of MetSyn and values for the MetSyn component biomarkers. Exercise capacity and physiological responses at rest, during exercise, and recovery were similar between groups at High- and Low-risk for OSA. Conclusions: Reduced levels of PA among elderly AAA patients at High-risk for OSA could have unfavorable implications for cardiovascular disease (CVD) risk and all-cause and CVD mortality.  Subjects demonstrating the most clinical symptoms of OSA showed a significantly higher prevalence for MetSyn and several of the biomarkers that determine MetSyn. In clinical practice, the BRS may be useful for identifying those AAA patients at increased risk for both OSA and MetSyn. / Ph. D.