Seven adult patients with a severe form of sleep apnea syndrome (mean apnea index, 47) underwent surgery for significant structural abnormalities at nose and/or throat level (septal deviation, turbinal hypertrophy, enlarged tonsils, long uvula, pharyngeal tumor). Although a subjective benefit was claimed by most patients, the polygraphic data showed no improvement or only a modest improvement in breathing pattern, oxyhemoglobin saturation, or general sleep architecture except in one patient. In this patient the evolution of the syndrome was recent (3 years) and surgical management of a parapharyngeal tumor resulted in a cure. We conclude that in adults with sleep apnea syndrome of long-standing, surgical correction of nasal or pharyngeal abnormalities should not be expected to normalize sleep and breathing. This contrasts with the known benefits achieved by the same type of surgery in children. Surgery might nevertheless be necessary in some adults to permit the application of other therapeutic means (ie, nasal continuous positive airway pressure).