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The aim of the present work has been to verify what role the shape of the upper respiratory tract plays in both the onset of Obstructive Sleep Apnea and those cases which do not respond to treatment. Fifty patients with 1st stage chronic rhoncopathy according to the Lugaresi classification, were examined, all of whom underwent uvulopalatopharygoplasty. Of these 32 also under went tonsillectomy and 45 had followed a diet prior to surgery. At 6 months and 2 years after surgery an endoscopy was perform with a video recorder to compare the pre- and post-operative anatomic configuration of the oropharynx. Both the patients and their partners were presented a questionnaire to evaluate the degree of satisfaction with the treatment. The average follow-up was 30 months. Diet proved effective, especially in the most severe cases of obesity, with an average Body Mass Index which dropped from 30.5 to 26 after 6 months, rising to 28 after 24 months. The IAH went from 46.0 +/- 15.4 (SD) to 15 +/- 13.3 at 6 months, and rose to 27.5 +/- 14.3 (SD) at 2 years. The degree of satisfaction of both patient and partner was 88% at 6 months and dropper to 63% after 2 years. Videoendoscopy using a flexible lens was performed to evaluate the diameter of the positive results with surgery while it was the anterior-posterior axis in 70% of those who had negative results. In this study, after surgery, the larger URT diameter was latero-lateral in 62% of the patients while preoperatively it was so in just 10%. The use of tonsillectomy associated with UPP proved necessary to modify the shape of the URT.