Background Acromegaly is a rare, chronic, and progressive disorder characterized by excessive secretion of growth hormone (GH) after the closure of the epiphyseal plates. The disease has an estimated annual incidence of 5 cases per 1,100,000 individuals. Sleep apnea/hypopnea syndrome (OSAHS) affects up to 80% of individuals with acromegaly and is recognized as an independent risk factor for the development of cardiovascular disease. This study aims to estimate the prevalence of SAHS and its associated factors in patients with acromegaly in Colombia. Methods This observational, retrospective cohort study utilized the National Registry of Patients with Acromegaly (RAPACO) data. The study evaluated patients who had undergone baseline polysomnography as a criterion for inclusion. Results A total of 163 patients were included in the study, of whom 89 (54.6%) were diagnosed with OSAHS. Women accounted for 99 (60.7%) of the cohort, aged 34.4 to 63.54 years. Patients with OSAHS exhibited a higher BMI and a longer disease duration. Additionally, they demonstrated elevated levels of IGF-1 (936.2 ± 447.2) and baseline GH (20.0 ± 20.4), both of which were statistically significant (p = 0.006 and p = 0.027, respectively). Severe apnea was the most prevalent form of the condition, and microadenoma was the predominant tumor type. Multivariate analysis identified disease duration and IGF-1 levels as the primary variables associated with OSAHS. Conclusion OSAHS is a prevalent comorbidity in patients with acromegaly, with hormonal factors playing a critical role in its pathogenesis. Consistent with previous studies, our findings demonstrate that elevated IGF-1 and GH levels are associated with greater OSAHS severity. Routine polysomnography (PSG) is recommended following the diagnosis of acromegaly. If OSAHS is confirmed, appropriate treatment should be initiated, and follow-up PSG should be performed during acromegaly management.