Objective: To assess the effect of concurrent uvulopalatopharyngoplasty (UPPP) and hypopharyngeal procedures in obstructive sleep apnea (OSA) patients with diffuse airway narrowing. Study design and setting: Forty-eight patients were treated surgically by a single surgeon in private practice over 2 years. Symptoms, Epworth score, and polysomnographic outcome were assessed preoperatively and postoperatively. The Friedman staging system was applied. UPPP with genioglossus advancement, hyoid suspension, or radiofrequency treatment was carried out. Results: In 37 patients with complete data, the average apnea-hypopnea index (AHI) was reduced from 46.5 ± 24.8 to 14.9 ± 16.8. The Epworth score was reduced from 12.1 ± 4.9 to 6.7 ± 3.7. Most patients reported improved sleep quality, alertness, memory, concentration, and mood. Conclusion: Successful outcome, defined by symptom and AHI reduction, was achieved with multilevel surgery for most patients with advanced Friedman stages 2 and 3. Significance: Multilevel surgery seems effective in treating severe OSA patients with diffuse airway narrowing. EBM rating: C-4.