Pediatric Adenotonsillectomy Trial for Snoring

Inclusion Criteria: * Diagnosis of mild sleep-disordered breathing (MSDB) defined as meeting all of the following criteria: * Caregiver report of habitual snoring that occurs most of the night on at least three nights per week, and has been present for at least three months (on average occurring \> 3 nights per week or more half of sleep time) and * Centrally-scored polysomnogram (PSG) confirming an obstructive apnea index (OAI) \<1/hour and apnea-hypopnea index (AHI) ≤3/hour and no oxygen saturation (SpO2) desaturation \< 90% in conjunction with obstructive events, confirmed on PSG. * Tonsillar hypertrophy ≥2 based on a standardized scale of 0-4. * Deemed to be a candidate for AT by otolaryngologist (ENT) evaluation (i.e., no technical issues that would be a contraindication for surgery such as submucous cleft palate.) * Primary indication for AT is nocturnal obstructive symptoms (i.e., not recurrent infections or other indications). Exclusion Criteria: * Previous tonsillectomy, including partial tonsillectomy * Recurrent tonsillitis that merits prompt adenotonsillectomy (AT) per the American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines (i.e., ≥7 episodes/yr in the past year; ≥5 episodes/year over the past 2 years or ≥3 episodes/yr over the past 3 years.) * Severe obesity (body mass index (BMI) z-score ≥3). * Failure to thrive, defined as either height or weight being below the 5th percentile for age and gender. * Severe chronic health…