Background: Adolescents who are obese are at high risk of developing obstructive sleep apnea (OSA). Although there is clear evidence associating OSA with metabolic dysfunction in adults, the evidence is less clear cut with adolescents. The purpose of this review was determine the association of sleep apnea with dyslipidemia, insulin resistance, cardiovascular disease risk, nonalcoholic fatty liver disease, and difficulty with weight loss in adolescents. Methods: A systematic literature review using PubMed, Scopus, CINAHL, Google Scholar, and PsycINFO was performed and articles were screened and reviewed with an a priori protocol. Results: Sixteen articles were included in qualitative synthesis and 10 were included in meta-analysis. Results from the meta-analysis indicate that OSA in adolescents is associated with greater risk of dyslipidemia, insulin resistance, and hypertension. Conclusions: Although obesity leads to increased metabolic risk, OSA appears to independently increase metabolic impairment. Adolescents with obesity should be frequently screened for OSA to determine need for treatment and reduce this metabolic burden.