Background: Obesity, a chronic disease affecting both life quality and expectancy, is one of the most important health issues of the developing world. The aim of this study was to examine the incidence of difficult airway, risk factors, and related perioperative complications in patients undergoing bariatric surgery. Methods: The medical records of 96 patients, aged 18-65 years, undergoing bariatric surgery were evaluated retrospectively. Results: Difficult airway incidence was 12.5%. The presence of obstructive sleep apnea syndrome and high Mallampati scores were the predictors of difficult airway. Body mass index was not found to be an independent risk factor of difficult airway. Insulin resistance was significantly high in patients with difficult mask ventilation. Conclusion: Bariatric anesthesiologists should consider the existence of insulin resistance in morbidly obese patients with obstructive sleep apnea syndrome for perioperative respiratory complications. Further studies are needed to find out if insulin resistance is an independent predictor of difficult airway.