Hyzer JM, Milczuk HA, Macarthur CJ, et al. - Children with Down syndrome or obesity commonly experience persistent obstructive sleep apnea after adenotonsillectomy. Researchers here examined differences, if any, in the patterns of collapse during drug-induced sleep endoscopy in children with obesity or children with Down syndrome (DS) compared with children without obesity and DS among surgically naive children with obstructive sleep apnea. Findings from this prospective cohort study of 317 surgically naive children with obstructive sleep apnea revealed proportionally greater tonsillar obstruction in children with obesity or DS relative to children without obesity or DS. In addition, children with DS showed worse arytenoid obstruction. Arytenoid obstruction might have contributed to the higher rate of failure of adenotonsillectomy in children with DS. They emphasize considering routine drug-induced sleep endoscopy in surgically naive children with DS to help inform the surgical plan.