Background: Snoring and obstructive sleep apnea (OSA) are major and important health problems with increasing rate of recording and achieving more attention. The wide spread availability of polysomnography and sleep lab makes the diagnosis of OSA easier and straight forward. Hyoidothyropexy is a type of skeletal surgeries which considered a part of phase I surgery targeted to the hypopharyngeal area Objective: Evaluation of the efficacy of hyoidothyropexy in patients with moderate and severe Obstructive Sleep Apnea (OSA) Material and methods: Nineteen patients were included in the study after taking their consent.  They all underwent full history taking, and clinical examination with measurement of body mass index (BMI). Daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS). The site of obstruction was determined via the upper airway endoscopy and Mueller maneuver and sleep endoscopy. The diagnosis and severity were assessed by overnight sleep study, i.e polysomnography (PSG). Patients were divided into moderate OSA (group A - 8 patients), and severe OSA (group B - 11 patients). Post-operative revaluation after 6 months was done by ESS and PSG. Preoperative and postoperative data were compared regarding ESS, and overnight sleep study PSG findings; (AHI), (SI), average SpO₂ (%). Also demographic date and BMI were reviewed. Results:  The difference between the pre- and postoperative means of AHI, SI, ESS and average Spo₂ % was of statistically significance in both groups. The cure rate in group A and B after hyoidothyropexy was 71.4 % and 61.4% respectively, but the main postoperative AHI was < 10 in group (B). Conclusion: Hyoidothyropexy was an effective method in surgical treatment of moderate OSA with cure rate of 71.4% and significant reduction of AHI. While, in severe OSA it was better to be combined in multilevel surgery because the main AHI remained above 10 in most of the cases.