Objectives: To characterize obstructive sleep apnea (OSA) and its severity in a referred pediatric population undergoing polysomnography (PSG) evaluation at an aerodigestive (AD) clinic. Study design: A total of 234 AD children at a single institution were retrospectively reviewed. Demographic characteristics, symptoms, and respiratory indices were collected. Patients’ medical complexity scores (MCS), a comorbidity burden metric on a scale of 0-7, were calculated based on institution-specific criteria. Kruskal-Wallis rank sum and Fisher’s exact tests compared sociodemographic and clinical characteristics by OSA severity. Logistic multivariable regression models identified factors associated with a moderate/severe OSA diagnosis. Results: Among 234 AD patients, 86 had PSG studies (mean 1.86 studies/patient). The median age at first study was 2 years; 53% were male, 27% Non-Hispanic White, and 49% Hispanic. OSA was diagnosed in 92% of those who completed a PSG, and the OSA severity were mild in 45.3%, moderate in 26.7%, and severe in 19.8%. Median MCS was 4 with no significant differences between OSA severity groups. Female gender (OR 2.51), age >9 years (OR 3.22), and genetic/syndromic diagnoses (OR 2.44) were significantly associated with moderate/severe OSA. Multimodal treatments with pharmacologic therapy, noninvasive support, and surgical interventions were the most effective in mitigating disease progression compared to single-modality approaches (p<0.001). Conclusions: OSA is highly prevalent in pediatric AD patients, with increased likelihood of moderate/severe disease in females, older children, and those with genetic/syndromic diagnoses. We report no association between OSA severity and higher medical complexity. Consequently, OSA screening should be considered in all pediatric AD patients.