Patients with acromegaly have hyperplastic and congested airway mucosa, enlarged tongue, protruding mandible, and enlarged vocal cords, which cause collapse of soft tissues in the oropharynx and upper airway obstruction during sleep, mainly causing snoring, sleep apnea hypoventilation syndrome (OSAHS) and sleep hypoxia (SH). The disease mainly manifests as snoring during nighttime sleep, disturbance of breathing and sleep rhythm, recurrent apnea and awakening, or patients feel breath-holding, morning headache, significant daytime drowsiness, memory loss, and in severe cases, psychological, intellectual and behavioral abnormalities; combined with hypertension, coronary heart disease, cardiac arrhythmia, insulin resistance and progressive body mass increase. The incidence of OSAHS and SH in the population is about 2% to 4%, and the incidence of this disease in patients with acromegaly is much higher than in the normal population, about 19% to 87.5%; about half of these patients have a difficult airway during surgical anesthesia and have difficulty with intubation, which in turn increases the risk of surgery for the patient. Recent studies in our department have shown that advanced age and obesity are independent risk factors for the development of respiratory complications in patients with acromegaly. Patients should routinely undergo sleep apnea monitoring before surgery to detect respiratory sleep disorders earlier and to guide patients to maintain a healthy weight; upper airway imaging to assist in assessing airway conditions and timely transnasal surgical treatment are effective ways to reduce perioperative risks and long-term mortality, prolong patients’ healthy lives, and improve their quality of life.