We evaluated the surgical results of a one tempo multilevel surgical approach of the upper airway to treat patients with obstructive sleep apnea syndrome (OSAS) in a prospective case series. Twenty-two patients with OSAS and obstruction at both palatinal and tongue base level, as assessed by sleep endoscopy, underwent UPPP, RFTB, HS with or without GA in one operative session. The mean apnea hypopnea index (AHI) decreased from 48.7 (range 17.4-100.9) to 28.8 (P < 0.0001). The success rate (AHI <20 and >50% reduction in AHI) was 45%, the response rate (reduction in AHI of 20-50%) was 27%. The overall response rate was 72%. The success rates of patients with an AHI <55 and >55 were 56 and 0%, respectively. The overall response rate of patients with an AHI <55 was 78% and >55 was 50%. Improvement of desaturation index was significant from 31.9 to 17.6 (P < 0.0001). Visual analogue scales for snoring and hypersomnolence and the Epworth Sleepiness Scores showed significant improvements too (all P < 0.0001). There was no difference in objective and subjective outcomes between the group with and without GA. This study demonstrates that one stage multilevel surgery, in which genioglossus advancement is not of additional value, is a valuable addition to the therapeutic armentarium and can be considered a viable alternative, objective as well as subjective, to NCPAP or as primary treatment in well selected patients with moderate to severe OSAS with an AHI <55.