Purpose <p>Upper airway stimulation by means of unilateral hypoglossal nerve stimulation is an alternative therapy for patients with obstructive sleep apnea and continuous positive airway pressure intolerance or failure. Optimal device settings are essential for effective treatment of obstructive sleep apnea with this therapy. Some patients experience therapy failure, despite standard titration methods. We perform a drug induced sleep endoscopy with upper airway stimulation in these patients. This study provides an overview of this procedure and our patient outcomes.</p> Methods <p>Retrospective chart review of patients implanted with an upper airway stimulation device between 2015 and 2022.</p> Results <p>The drug-induced sleep endoscopy with upper airway stimulation therapy is performed in 29 non-responders of therapy. In seven patients, a change in device settings was sufficient to prevent an upper airway collapse during the drug-induced sleep endoscopy, while additional therapy was recommended for the remaining. Eventually, six patients were fitted with a change in device settings and fourteen patients were treated with additional therapy, being oral appliance therapy, barbed wire pharyngoplasty or alternative upper airway surgery. At follow-up, the apnea–hypopnea index declined significantly from 41.6 ± 15.0 to 23.2 ± 9.9 events/hour and resulted in eight additional responders to therapy.</p> Conclusion <p>The drug-induced sleep endoscopy might be a valuable addition in the clinical pathway of upper airway stimulation therapy. It provides a better evaluation of the stimulation process and offers the opportunity for alterations in settings or targeted additional therapy.</p>