This systematic review and meta-analysis evaluated the association between the triglyceride-glucose (TyG) index and obstructive sleep apnea (OSA). Ten studies involving 16,726 participants were included. The results showed that patients with OSA had significantly higher TyG indices compared to healthy controls (SMD 0.856, 95% CI 0.579 to 1.132, P<0.001). The TyG index demonstrated a diagnostic ability for OSA with a pooled area under the curve (AUC) of 0.681 (95% CI 0.627 to 0.735). No significant difference was found between different severities of OSA. The TyG index was identified as a potential predictor of adverse outcomes in OSA patients. The study concluded that the TyG index is an easy-to-measure marker of insulin resistance (IR) for assessing OSA, both in diagnosis and prognosis. It supports its implementation in clinical practice to aid in decision-making and patient stratification. The TyG index is a reliable and valuable marker for assessing IR, comparable to other IR markers like HOMA-IR. It is also more accessible and cost-effective than invasive methods. The study highlights the importance of measuring IR in OSA patients for risk prediction and therapeutic monitoring. The TyG index and its modified versions, such as TyG-WC and TyG-BMI, may serve as valuable biomarkers for diagnosing OSA and predicting its complications. The study also identified limitations, including the small number of studies and the lack of data on sensitivity and specificity. Future research should focus on confirming these findings and comparing the TyG index in different severities of OSA.This systematic review and meta-analysis evaluated the association between the triglyceride-glucose (TyG) index and obstructive sleep apnea (OSA). Ten studies involving 16,726 participants were included. The results showed that patients with OSA had significantly higher TyG indices compared to healthy controls (SMD 0.856, 95% CI 0.579 to 1.132, P<0.001). The TyG index demonstrated a diagnostic ability for OSA with a pooled area under the curve (AUC) of 0.681 (95% CI 0.627 to 0.735). No significant difference was found between different severities of OSA. The TyG index was identified as a potential predictor of adverse outcomes in OSA patients. The study concluded that the TyG index is an easy-to-measure marker of insulin resistance (IR) for assessing OSA, both in diagnosis and prognosis. It supports its implementation in clinical practice to aid in decision-making and patient stratification. The TyG index is a reliable and valuable marker for assessing IR, comparable to other IR markers like HOMA-IR. It is also more accessible and cost-effective than invasive methods. The study highlights the importance of measuring IR in OSA patients for risk prediction and therapeutic monitoring. The TyG index and its modified versions, such as TyG-WC and TyG-BMI, may serve as valuable biomarkers for diagnosing OSA and predicting its complications. The study also identified limitations, including the small number of studies and the lack of data on sensitivity and specificity. Future research should focus on confirming these findings and comparing the TyG index in different severities of OSA.