Objective: Although insulin resistance in obstructive sleep apnea-hypopnea syndrome (OSAHS) is known to be signaled by the triglyceride-glucose (TyG) index, its clinical significance is still unclear. The TyG index and OSAHS connection might be due to unique biases. This study aimed to explore the association between OSAHS and the TyG index using a propensity score matching (PSM) approach. Methods: Participants who completed the Polysomnography (PSG) between June 2022 and February 2024 were included. The MatchIt R package was used to minimize patient selection bias and reduce variable biases between OSAHS patients and the control group. The PSM analysis was conducted one-on-one to examine the TyG index and the OSAHS association. The predictive potency of the TyG index for OSAHS was evaluated by receiver operating characteristic curve (ROC) analysis. Results: Ultimately, the study involved 394 OSAHS patients and 185 control group individuals, with 185 pairs (OSAHS patients and controls) being effectively paired. Even though factors like age, BMI, weight, and height were taken into account, a notable disparity in the TyG index persisted between the OSAHS patients and the controls (p < 0.001). The mild and severe OSAHS groups were also shown to differ significantly (p < 0.05). Remarkably, the TyG index demonstrated proficient differentiation of OSAHS, evidenced by an AUC value of 0.628 (95% CI: 0.572-0.685, p < 0.001). Conclusion: A cross-sectional study that used PSM analysis indicated a clear connection between OSAHS and the TyG index. The TyG index can serve as an independent predictor of OSAHS, which can help to detect and diagnose OSAHS early, thus reducing the threats posed by OSAHS.