Hypoglossal nerve stimulation has become an integral part of the therapy options for obstructive sleep apnea in recent years and is used more and more frequently around the world. In accordance with the increasing demand, there are now various systems available for stimulating the upper airway, but they differ from each other in several aspects. Some differences can be explained by the design and components, but also the surgical procedure that is required for implantation differs from system to system. A surgical learning curve has been described, which also depends on how many systems have been implanted by one surgeon. However, an important point for the clinical outcome seems to be the different approaches to stimulate the hypoglossal nerve. Different anatomic parts of the hypoglossal nerve are stimulated depending on the used system. Also the dependence on the breathing cycle - continuously vs. synchronized needs to be taken into account. Furthermore, unilateral or bilateral stimulation is also a distinction that must be observed. Many physicians are not familiar with these differences and the clinical outcomes, which to a certain point still remain unclear. The aim of this symposium is to point out the different approaches of the available and upcoming systems for hypoglossal nerve stimulation, discuss the existing evidence and effectiveness and point out important differences for patients and physicians.