Objective <p>This study aims to explore the characteristics and functional changes of intestinal metabolites in children with obstructive sleep apnea hypopnea syndrome (OSAHS) aged 4–6 years old through metabolomic approaches, screen potential biomarkers and analyze their correlation with clinical indicators and preliminary discuss the roles of intestinal metabolites in the occurrence and development of OSAHS.</p> Methods <p>We collected fecal samples from 40 OSAHS children and 40 healthy controls aged 4–6 years and recorded some OSAHS-related clinical indicators. Fecal specimens were used to detect all metabolites through untargeted metabolomics.</p> Results <p>This study identified a total of 1164 intestinal metabolites and screened out 254 differential metabolites. In the OSAHS group, the relative content of 96 metabolites were higher than the control group, while the relative content of 158 metabolites were lower. The receiver operating characteristic curve analysis results showed that the area under the curve of 14 differential metabolites was greater than 0.8. The area under the curve of Formononetin is the highest, at 0.9100, with sensitivity and specificity of 82.5% and 90.0%, respectively, and is positively correlated with OAHI. The differential metabolite functions mainly include the metabolism of fatty acids and other lipid substances, cellular signaling, protein and amino acid related metabolism, disease-related functions, glucose metabolism, and vitamin metabolism.</p> Conclusion <p>The intestinal metabolites and metabolic function of 4-to-6-year-old children with OSAHS altered. There was a correlation between differential metabolites and clinical indicators such as uric acid, hemoglobin, and blood sugar, which has potential diagnostic value for OSAHS screening.</p>