Elevated triglyceride-glucose index, a surrogate marker of insulin resistance, is associated with a high risk of obstructive sleep apnea.

This study aimed to investigate the association between representative Insulin resistance (IR) surrogates and obstructive sleep apnea (OSA). The study consisted of 8606 adults from the Korea National Health and Nutrition Examination Survey (KNHANES, 2019-2021), a nationwide population-based database. The STOP-Bang questionnaire was used for assessing the risk of OSA. Fasting insulin concentrations, triglyceride glucose index (TyG index), and homeostasis model assessment for insulin resistance (HOMA-IR) were used as surrogate IR markers. A multivariable logistic regression and a restricted cubic spline (RCS) model were applied to examine the association between IR and OSA risk. Multivariate logistic regression analysis revealed that only TyG index (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.56-2.62) was significantly associated with an increased risk of OSA. Results of the RCS analysis showed a positive nonlinear relationship between HOMA-IR and OSA risk (p for non-linearity < 0.001). Subgroup RCS analyses indicated that the effect of elevated TyG index on increasing risk of OSA was more pronounced in males, those aged over 60 years, and smokers. These findings suggest that the TyG index may be a more promising surrogate marker for identifying individuals at increased risk of OSA than other IR indicators. It may serve as a practical tool for OSA risk assessment, particularly in populations with elevated metabolic burden.