9 cases with tracheotomy before uvulopalatopharyngoplasty (UPPP) were analysed. all of them suffered from severe obstructive sleep apnea syndrome (OSAS). The indications of tracheotomy included, (1) the nocturnal lowest oxygen saturation was lower than 50%; (2) apnea hyponea index (AHI) higher than 50; (3) significant cardiopulmonary problems; (4) severe hypoxia symptoms; (5) obesity, brachyneck and glossohypertrophia.