Inclusion Criteria:  Moderate OSA (oAHI ≥ 5), Clinically small tonsils (Brodsky score 1+ or 2+) AND/OR Down syndrome Desiring surgical treatment. English or Spanish speaking  Exclusion Criteria:  Non-Down Syndrome neuromuscular disorder, craniofacial anomaly, genetic abnormality, subglottic or tracheal stenosis, tracheostomy dependence.