OBJECTIVE: The apnea-hypopnea index (AHI) defines obstructive sleep apnea (OSA) severity but fails to describe nuances in disease burden. The modified sleep apnea severity index (mSASI) combines patient anatomy, weight, sleep study metrics, and symptoms to provide a composite OSA index ranging from 1 to 3. While prior studies have associated mSASI with quality of life and hypertension, its utility in continuous positive pressure intolerant (CPAPi) surgical patients remains unexplored. METHODS: A retrospective cohort study of surgically treated CPAPi patients who underwent upper airway stimulation (UAS), maxillomandibular advancement (MMA), or expansion sphincter pharyngoplasty (ESP) at our Tertiary Care Academic Center from 2014 to 2021. Five hundred twenty-eight patients were identified and 260 had available data to calculate mSASI pre- and postoperatively using the published method. Wilcoxon rank-sum tests were used during the analysis. RESULTS: Out of 260 patients, 167 underwent UAS (64%), 73 ESP (28%), and 20 MMA (8%). Fifty-five percent had a preoperative mSASI = 1 (average = 1.56, standard deviation = 0.68). The average overall change in mSASI postoperatively was -0.32 ( LEVEL OF EVIDENCE: 4.