Objective To investigate the surgical effects of multilevel surgery on severe obstructive sleep apnea hypopnea syndrome (OSAHS) with multiple level obstruction. Methods 54 patients with severe OSAHS received uvulopalatopharyngoplasty, hyoid myotomy with suspension, tongue volume reduction and endoscopic surgery for nasal cavities. The body mass index(BMI), apneahypopnea index (AHI), Epworth sleepy scale (ESS), lowest oxygen saturation (LSaO2), percentage of sleep time with oxyhemoglobin saturation below 90% (CT90), uvula length (UL), posterior airway space (PAS) before and after the operation were detected and compared. Results Operations were performed successfully in all 54 cases. Except BMI, other indexes got obvious changes postoperatively with statistically significant. As for the surgical complications, asphyxia occurred in one patient and got relieved with tracheotomy, submental fat liquefaction in 6 cases and got cured with symptomatic treatment, transient nasal reflux in 2 and fell away within 7 days. According to the Hangzhou criteria of OSAHS, 4 cases got cured, obvious effects occurred in 28 patients, 15 patients were effective, and the total effective rate was 87.4%.Conclusion UPPP combined with hyoid myotomy with suspension, tongue reduction and nasal endoscopic surgery is effective and safe for the treatment of severe OSAHS.