Objective To explore the prevalence of obstructive sleep apnea (OSA) in elderly patients with hiatal hernia (HH) complicated with gastroesophageal reflux disease (GERD), and determine the effect of anti-reflux surgery (laparoscopic hiatal hernia repair combined with fundoplication) on OSA in these elderly patients. Methods A total of 83 elderly patients diagnosed with HH complicated with GERD in our hospital from January 2021 to June 2022 were recruited, 6 cases were excluded, and then the 77 cases were divided into OSA group (n=45) and non-OSA group(n=32) according to the results of polysomnography (PSG). The changes in body mass index (BMI), apnea hypopnea index (AHI), oxygen desaturation index (ODI), longest apnea time (LAT), lowest oxygen saturation (LSaO₂), Epworth sleepiness score (ESS), and results of gastroesophageal reflux disease questionnaire (GERD-Q), and serum levels of interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were compared before and after surgery. SPSS statistics 25.0 was used for data analysis. Based on data type, comparison between groups was performed using student′s t test, Chi-square test or Fisher exact probability test. Pearson correlation analysis was used to evaluate the relationship of preoperative inflammatory indicators with sleep parameters, and the difference between inflammatory indicators and sleep parameters in OSA group before and after surgery. Results AHI, ODI, LAT, ESS score and serum levels of IL-8 and TNF-α were significantly higher, and LSaO₂ was obviously lower in the OSA group than the non-OSA group (P<0.05). In the OSA group, the serum TNF-α level was positively correlated with AHI, ODI and LAT, and negatively with LSaO₂ (r=0.647,0.579,0.477, -0.312; P<0.05); the serum IL-8 level was positively correlated with AHI and ODI, and negatively with LSaO₂ (r=0.422,0.501, -0.330; P<0.05). Compared with pre-operation, the OSA group had notably decreased AHI, ODI, LAT, ESS score, GERD-Q, and serum IL-8 and TNF-α levels, and increased LSaO₂ after operation (P<0.05). In the OSA group, the change of serum TNF-α level before and after surgery was positively correlated with the changes of AHI, ODI and LAT (r=0.329,0.408,0.529; P<0.05), and the difference of serum IL-8 level before and after surgery was positively correlated with the changes of AHI, ODI and LAT, and negatively with the change of LSaO₂ (r=0.343,0.371,0.350, -0.330; P<0.05). Conclusion For the elderly with HH complicated with GERD, the presence of OSA is quite common. The male patients have similar proportion as the female, and mainly mild to moderate OSA in severity. Laparoscopic hiatal hernia repair combined with fundoplication alleviates the symptoms of OSA, attenuates the severity, and reduce inflammation in the patients.