OBJECTIVES: We determined the prevalence of OSA in patients with the specific components of the metabolic syndrome (hypertension, hyperlipidemia and diabetes). We also explored the incremental burden of OSA on health care utilization in patients with the specific components of the metabolic syndrome. METHODS: Data were obtained from the Maryland Medicaid database for January 2001 through June 2006. These data contain all claims records for medical inpatient, outpatient, and pharmacy services submitted to the state.We assigned beneficiaries into groups: having any one of the components of the metabolic syndrome, to a cohort called “one disease” (n=7,086). Having any two of the three components the cohort called ”two diseases” (n=6,774). Having all of the three components the cohort called ”three diseases” (n=5,925). Medical utilization data were collected from the index date through the end of the study or the last date of service, whichever occurred first. RESULTS: The likelihood of getting OSA by disease cohort- Beneficiaries with any two components of the metabolic syndrome or all three components had 2.10 and 3.24 times respectively the likelihood of developing OSA compared to those with one component alone. The average annualized medical utilization by OSA status in each cohort, adjusted for age, gender, race, obesity, CCI scores, and number of days in cohort. Beneficiaries who had the concomitant diagnosis of OSA had a significantly higher number of medical services claims than those without OSA; physician office visits accounted for the largest share of medical utilization, followed by outpatient visits and inpatient care. The pattern was observed in each cohort. In two diseases: sleep apnea- 29.6, no sleep apnea- 21.6. In three diseases: sleep apnea- 35.4, no sleep apnea- 25.8  CONCLUSIONS: The more metabolic syndrome diseases the higher risk for having OSA. The OSA burden is increasing the more metabolic syndrome components exist.