The first line treatment for obstructive sleep apnea (OSA) in children is adenotonsillectomy (T&A). Persistent OSA occurs in 30% of otherwise healthy children after T&A. In children who are obese, or have craniofacial, genetic or neuromuscular disorders, persistent OSA after T&A is as high as 70%. Thus, otolaryngologists are increasingly managing this challenging patient population. Despite this, there are no guidelines regarding the optimal management of children with persistent OSA after T&A. The role of observation; drug induced sleep endoscopy (DISE); cine MRI; allergy evaluation; CPAP; and turbinate, palatal and tongue base surgeries will be discussed.Learning Objectives: 1. Examine the challenges (and solutions) for managing children with persistent OSA after T&A. 2. Assess the modalities for evaluation and treatment of children with persistent OSA. 3. Propose an algorithm for the management of children with persistent OSA using case-based learning.Faculty: Stacey Ishman, MD, MPH(Research funding: National Institute of Health; American Society of Pediatric Otolaryngology; Inspire medical; Leadership Role: International Surgical Sleep Society; American Society of Pediatric Otolaryngology; ABOTO; Consulting Fees: Medtronic; Genus Lifesciences), Ron Mitchell, MD(Nothing to Disclose).