Tracheostomy resulted in dramatic and sustained improvement in the symptoms of 11 patients with upper airway sleep apnea. However, seven of eight patients who had a standard tracheostomy experienced tracheal granuloma or stomal stenosis. Tracheostomy was revised in five of these eight patients using cervical skin flaps. Three of the 11 patients had a skin flap tracheostomy as the original procedure. Only two of eight patients had tracheal complications after a skin flap procedure. Postoperative problems unrelated to the procedure included recurrent purulent bronchitis in four and psychosocial difficulties in ten. Permanent tracheostomy should be limited to patients with serious cardiopulmonary complications of upper airway sleep apnea. The cervical skin flap is the preferred procedure for long-term tracheostomy in these patients.