INTRODUCTION: Obesity and the metabolic syndrome are rapidly increasing in developing countries. Whether the metabolic syndrome is independently associated with obstructive sleep apnea (OSA) is not clear. OBJECTIVE: This study investigated the association between OSA and the metabolic syndrome in obese Asian Indians. METHODS: We studied 240 obese subjects [body mass index (BMI) >25 kg/m2], 121 with OSA and 119 without OSA, matched for age, BMI, and percentage body fat (%BF). Full-montage digital polysomnography, fasting blood glucose (FBG), lipid levels, and blood pressure (BP) were done in all subjects. RESULTS: Subjects with OSA showed higher prevalence of the metabolic syndrome as compared to subjects without OSA [67.8% vs. 42.02%; chi2 = 16.08, P < 0.0001, odds ratio (OR) = 2.90, 95% confidence interval (CI)]. Prevalence of the metabolic syndrome was significantly higher in the severe OSA group as compared to the moderate OSA group (78.7% vs. 40.9%; chi2 = 11.57; P < 0.001; OR = 0.19, 95% CI). Fasting insulin levels were significantly higher in subjects with OSA as compared to subjects without OSA [median (range); 84.03(12.5-541.7) pmol/L vs. 64.4(10.4-520.8) pmol/L; P = 0.002)]. Regression analysis suggested that OSA was independently and positively associated with the metabolic syndrome, male gender, and fasting insulin levels. CONCLUSION: OSA is independently associated with the metabolic syndrome in Asian Indians in northern India.