Abstract: Objective Treatment strategy including nasal operation and Huvulopalatopharyngoplasty (HUPPP) was adopted in severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients with both oropharyngeal and nasal obstruction. This study was designed to investigate the influence of operation order on outcome. Methods The diagnosis of OSAHS was confirmed; surgical effect was evaluated with polysomnography (PSG), Epworth sleep score (ESS), body mass index(BMI), and patients’ subjective symptoms. Patients were divided into group A (61 cases) and group B (57 cases) randomly. Patients in Group A underwent nasal operation (including septalectomy, radiofrequency reduction of the inferior turbinate, adenoidectomy, and functional endoscopic operation); while those in group B received HUPPP. All patients in group A and group B were separately followed up and given therapeutic effect evaluation 3 to 5 months and 6 to 8 months postoperatively. Those who failed to reach the criteria of effectiveness in group A or group B received HUPPP or nasal operation respectively. The efffective rates between the two groups after each phase of operation were compared. Results In group A, the effective rate after phase one operation was 0% (0/61) and all the patients received HUPPP operation again with an effective rate of 78.7% (48/61) one year after operation. In group B, the effective rate after HUPPP was 47.4% (27/57) but 4 cases recurred one year after operation. The other 30 cases underwent the second phase nasal operation with an effective rate of 70% (21/30) after followingup one year postoperatively. The total postoperative effective rate of group A and group B were 78.7% (48/61) and 77.2% (44/57) respectively. As for the operation order, the difference of effective rates was statistically insignificant (P>0.05). The difference of the effective rates was statistically significant between those received previous nasal operation with or without HUPPP in group A (P<0.05), and that was also statistically significant between those received previous HUPPP with or without nasal operation in group B (P<0.05). The difference of effective rates of nasal operation combined with HUPPP between group A and group B was statistically insignificant (P>0.05). The effective rate of HUPPP in group B and that of nasal operation in group A was significantly different (P<0.05). Conclusion H-UPPP is the preferred selection in treatment of severe OSAHS patients with both oropharyngeal and nasal obstruction. Additional nasal operation should be applied to those fail to respond to HUPPP. HUPPP combined with nasal operation can increase the effective rate.