Of the 836 children with mild OSA, 84 parents (10%) refused ICS + OM treatment and sought alternative treatments, primarily consisting of surgical T&A (n = 72, 8.4%). Thus, 752 children began ICS + OM treatment, with 61 of these children (8.1%) discontinuing the treatment within the first 3 weeks or not adhering to the treatment as reported by parents. In the majority of these children (n = 52), parents decided to pursue T&A despite initiating the therapy but not adhering to it. However, six patients (0.7%) reported side effects that prompted them to discontinue therapy (three with headaches, one with nausea and vomiting, and two with epistaxis). Of the 691 children who presumably completed the 12-week treatment course, only 445 children (64.4%) returned for their follow-up NPSG. The changes in the sleep study between diagnosis and following ICS + OM treatment are shown in Table 2. Overall, significant improvements occurred with ICS + OM treatment in the magnitude of respiratory disturbances during sleep. More importantly, 62% of these 445 children exhibited normalization of their sleep studies (ie, they had an obstructive AHI < 1/h TST after completion of ICS + OM treatment). However, 17.1% (n = 76) showed either no improvement or worsening of their OSA. Table 3 shows the potential differences between responders who normalized breathing patterns during sleep after ICS + OM treatment and nonresponders. In general, no differences were apparent in either the sex, ethnicity, or sleep study measures between responders and nonresponders before initiation of ICS + OM treatment. However, younger children (ie, < 7 years of age) were 2.3 times more likely to normalize their sleep studies after ICS + OM treatment than obese children (95% CI, 1.43-4.13; P < .001), and nonobese children were 6.3 times more likely to normalize their sleep studies after ICS + OM treatment than obese children (BMI z-score > 1.65; 95% CI, 4.23-11.18; P < .000001). It is also worth mentioning that among the 396 patients in whom either improvements or normalization of the sleep study occurred with ICS + OM treatment, a subset of 45 patients (11.4%) opted to undergo T&A, while in 137 children (34.6%), no further treatment was prescribed (Fig 1). In the remaining 187 children (47.2%), OM was continued for 6 to 12 months as consolidation therapy or with the intent to prevent recurrence of OSA, with such recommendation being consistently provided to parents who opted to either continue therapy or not. A third NPSG was obtained in 114 of these children (61%), with complete resolution of OSA being documented in 46 children (49.1%), persistently mild OSA being present in 61 children who elected to continue OM treatment (53.5%), and unchanged or worsening of OSA severity in seven children (6.2%) prompting surgical T&A. Thus, of the original cohort with mild OSA, a total of 175 children (20.9%) underwent T&A.