Obstructive sleep apnea (OSA) is recurrent obstruction of upper airway during sleep caused by a combination of anatomical and functional factors. Among these, lack of airway neuromuscular tone during sleep is a major factor. Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, but is often poorly tolerated. Recently, we improved our understanding of upper airway muscle control during sleep, opening new horizons for sleep apnea therapeutics. This Major Symposium will review the state of the art knowledge about control of hypoglossal neurons in health and disease, as well as novel approaches to pharmacotherapy of OSA.