Purpose <p>Metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are associated with an increased risk of cardiometabolic disease. The coexistence of OSAHS and metabolic disorders is common, but research on how to recognize OSAHS and how OSAHS risk exacerbates metabolic disorders is limited. This study aimed to analyze the correlations of the ZJU index and triglyceride‒glucose (TyG) index with OSAHS in MS patients and to investigate the ability to use the ZJU index and TyG-related indices to assess the presence and severity of OSAHS in MS patients.</p> Methods <p>This retrospective study included 216 MS patients with perfect polysomnographic monitoring (PSG), who were categorized into MS combined with OSAHS (<i>n</i> = 142) and MS alone (<i>n</i> = 74) groups according to the sleep monitoring results. The MS combined with OSAHS group was further categorized into mild (<i>n</i> = 55), moderate (<i>n</i> = 34), and severe (<i>n</i> = 53) groups according to the apnea hypopnea index (AHI). The general clinical data, clinical biochemical indices, AHI, mean oxygen saturation (MSaO₂), lowest oxygen saturation (LSaO₂), and longest apnea duration were collected from all the included subjects. Composite indices such as the ZJU, TyG, and TyG-BMI indices were calculated. The differences in each metabolic index among the different groups were analyzed; logistic regression analysis was used to compare the correlations between each parameter and OSAHS, and the efficacy of each parameter in identifying OSAHS in the MS population was evaluated by receiver operating characteristic (ROC) curves.</p> Results <p>The ZJU, TyG, and TyG-BMI indices were associated with OSAHS after adjusting for sex, age, history of hypertension, history of diabetes, and history of smoking (all <i>P</i> &lt; 0.05). The odds ratios for the ZJU, TyG, and TyG-BMI indices were 1.472 (1.293–1.674), 9.811 (3.916–24.582), and 1.032 (1.020–1.044), respectively. The ZJU, TyG, and TyG-BMI indices are effective predictors of the occurrence of OSAHS in MS patients, and their cutoff values could be used for early screening of OSAHS. The ZJU index was the strongest predictor of OSAHS, (area under the curve 0.829, 95% CI 0.771–0.888), with an optimal cutoff value of 38.940.</p> Conclusions <p>The ZJU, TyG, and TyG-BMI indices are novel, valid, and practical indicators for early screening of OSAHS risk in MS patients.</p>