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Single or multi-level soft tissue surgical interventions are common options for CPAP-intolerant patients with OSA. Upper Airway Stimulation (UAS) is an alternative option using an implantable hypoglossal nerve stimulator. We compared patient outcomes between traditional sleep surgery (TSS) and UAS. Methods We selected patients who underwent TSS (including palate, oropharynx, tongue, and/or epiglottis-based procedures) for OSA and also met general UAS criteria (BMI≤35, AHI between 15-65, absence of palate concentric collapse during DISE, if available) for chart review. UAS outcomes were collected from the ADHERE international registry. For both groups, post-op AHI was collected, including full-night UAS efficacy studies. Data are presented as mean and standard deviation. Results The TSS group (n=284) and UAS group (n=541) were predominantly male and overweight. The TSS group was younger than UAS (47±12 vs 60±11 years, p&amp;lt;0.001). At baseline, both groups had severe OSA with AHI of 34±14 and 36±15 (p=0.23) and excessive daytime sleepiness with ESS of 12±5 and 12±6, (p=0.38), respectively. TSS follow-up was 169±151 days vs 392±181 days for UAS, which was significantly different. UAS had significantly larger decrease in AHI than TSS (-21/h±18 vs -16/h±16, p&amp;lt;0.0001). Both groups had a large decrease in ESS, however, the UAS group had a slightly smaller decrease, (-6±5 vs -5±5, p=0.01). Using the Sher response criteria of 50% AHI reduction and ≤ 20 events/hour, UAS had a 70% response rate vs 51% for TSS. Conclusion This study represents largest and first international, multicenter comparison of UAS to traditional surgical interventions for OSA, albeit with limitations of potential differential patient selection. While both TSS and UAS show similar improvement in symptoms, upper airway stimulation has a larger reduction of AHI with higher rates of therapy response than traditional sleep surgery Support ADHERE data assistance from Inspire Medical (Minneapolis, MN)

0637 Comparison of AHI and ESS Outcomes Between Patients with Obstructive Sleep Apnea Undergoing Sleep Surgery versus Upper Airway Stimulation