To the Editor The MIST+ randomized clinical trial conveyed a clear and practice-relevant message: for children with obstructive sleep-disordered breathing, a time-limited conservative pathway starting with intranasal saline combined with follow-up led to symptom resolution in a substantial proportion of children; however, adding intranasal mometasone after the saline run-in did not show additional incremental benefit. This finding supports a low-risk, scalable initial strategy.