IMPORTANCE It is important to distinguish children with different levels of severity of obstructive sleep apnea syndrome (OSAS) preoperatively using clinical parameters. This can identify children who most need polysomnography (PSG) prior to adenotonsillectomy (AT). OBJECTIVE To assess whether a combination of factors, including demographics, physical examination findings, and caregiver reports from questionnaires, can predict different levels of OSAS severity in children. DESIGN, SETTING, AND PARTICIPANTS Baseline data from 453 children from the Childhood Adenotonsillectomy (CHAT) study were analyzed. Children 5.0 to 9.9 years of age with PSG-diagnosed OSAS, who were considered candidates for AT, were included. INTERVENTIONS Polysomnography for diagnosis of OSAS. MAIN OUTCOMES AND MEASURES Linear or logistic regression models were fitted to identify which demographic, clinical, and caregiver reports were significantly associated with the apnea hypopnea index (AHI) and oxygen desaturation index (ODI). RESULTS Race (African American), obesity (body mass index z score > 2), and the Pediatric Sleep Questionnaire (PSQ) total score were associated with higher levels of AHI and ODI (P = .05). A multivariable model that included the most significant variables explained less than 3% of the variance in OSAS severity as measured by PSG outcomes. Tonsillar size and Friedman palate position were not associated with increased AHI or ODI. Models that tested for potential effect modification by race or obesity showed no evidence of interactions with any clinical measure, AHI, or ODI (P > .20 for all comparisons). CONCLUSIONS AND RELEVANCE This study of more than 450 children with OSAS identifies a number of clinical parameters that are associated with OSAS severity. However, information on demographics, physical findings, and questionnaire responses does not robustly discriminate different levels of OSAS severity. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00560859

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