Hypoglossal nerve stimulation has become an integral part of therapy options for obstructive sleep apnea in recent years. It 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 nerve are stimulated depending on the used system. Also, the dependence on the breathing cycle - continuously vs. synchronized needs to be considered. Furthermore, unilateral, or bilateral stimulation is also a distinction that must be observed. Many physicians are not familiar with these differences and its related clinical outcomes, which to a certain point 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 its effectiveness, and also point out the important differences for patients and physicians.