Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children: A single-center retrospective cohort study

• Residual OSA occurred in 26.8% of children following adenotonsillectomy. • Obesity (BMI z-score >1.645) was the strongest predictor of residual disease. • Comorbid asthma was identified as an independent risk factor for surgical failure. • A nomogram based on clinical factors showed good predictive accuracy (AUC = 0.82). • High-risk groups require closer postoperative polysomnographic surveillance.