Obstructive sleep apnea syndrome OSAS is defined as the symptomatic repetitive obstruction of the upper airway during sleep and has been estimated to affect 1-6% of the general pediatric population. Untreated OSAS in children has been associated with childhood hypertension, autonomic dysfunction, attention deficit/hyperactivity disorder, neurobehavioral impairment, and poor quality of life. These sequelae contribute to a 226% increase in health care utilization among children with OSAS compared to controls, primarily in the form of increased hospitalizations, emergency department visits, and medication use. Adenotonsillar hypertrophy is considered the most common risk factor for OSAS in children, therefore unlike in adult OSAS, adenotonsillectomy (AT) is the recommended first line treatment. In large part due to the increasing awareness and diagnosis of pediatric OSAS, the incidence of AT increased dramatically from 1980 to 2005. With more than 500,000 procedures performed per year, AT is now the second-most common procedure performed in children in the US, and 77% of these have OSAS as the primary indication.