Objective: To investigate the changes of platelet-lymphocyte ratio (PLR) in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with acute ischemic stroke and the clinical value of PLR. Methods: The case data of 155 patients with OSAHS were retrospectively analyzed. According to the presence or absence of acute ischemic stroke, patients were divided into simple OSAHS group (group A, n = 93) and OSAHS combined with acute ischemic stroke group (group B, n = 62). According to AHI, patients in group B were divided into three grades: mild, medium and severe. Clinical data of the two groups were collected and SPSS 25.0 software was used to analyze the correlation between the two groups and the efficacy of PLR in predicting acute ischemic stroke in OSAHS patients. Results: （1）There were significant differences in LYM, PLT, NEUT, NLR, PLR, TS90% and AHI between the two groups (P < 0.05). （2）PLR was positively correlated with AHI in group B (P=0.000). （3）Logistics analysis showed that PLR was an independent risk factor for acute ischemic stroke in OSAHS patients (P=0.000). （4）ROC curve analysis showed that the best cut-off value of serum PLR for predicting acute ischemic stroke in OSAHS patients was 130.79,and the area under the curve was 0.888 (95%CI=0.832-0.945). Conclusions: High serum PLR is positively correlated with AHI in OSAHS patients with acute ischemic stroke, and PLR may be an independent predictor of acute ischemic stroke in OSAHS.