Obstructive sleep apnea (OSA) often involves multilevel airway collapse, making multilevel sleep surgery more effective than single-level procedures. Preoperative assessments like drug-induced sleep endoscopy (DISE) are crucial for identifying obstruction sites and guiding surgical strategies. Common techniques include uvulopalatopharyngoplasty (UPPP), maxillomandibular advancement (MMA), and tongue base reduction. While multilevel surgery improves the apnea–hypopnea index (AHI) and patient outcomes, it carries higher risks of postoperative bleeding and airway obstruction, particularly in patients with narrow facial skeletal structures or challenging intubation. Close monitoring and extended intubation may be necessary to manage complications. Advances, such as ultrasound-assisted transoral robotic surgery (TORS), further enhance precision and safety. This review highlights the importance of tailored surgical approaches and meticulous technique to optimize outcomes and minimize risks in OSA management.