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ABDSM practice questions

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Question 1Patient Selection and Clinical Evaluation

Which STOP-BANG component is scored based on a measured body mass index threshold rather than self-report?

  1. Tiredness during daytime
  2. Observed apneas during sleep
  3. Age older than 50 years
  4. BMI greater than 35 kg/m² Correct answer.

Explanation

STOP-BANG assigns one point when body mass index exceeds 35 kg/m², a value derived from measured height and weight. The remaining items are symptom reports or demographic facts.

Question 2Patient Selection and Clinical Evaluation

A patient reports loud snoring, witnessed breathing pauses, and daytime sleepiness. Which initial diagnostic step is most appropriate?

  1. Prescribe an oral appliance before testing
  2. Reassure the patient and recheck in one year
  3. Recommend positional therapy alone
  4. Order a home sleep apnea test or polysomnography Correct answer.

Explanation

Symptoms suggesting obstructive sleep apnea warrant objective testing to confirm the diagnosis and grade severity before treatment selection. Therapy is chosen after, not before, diagnostic confirmation.

Question 3Patient Selection and Clinical Evaluation

Which finding on clinical interview most strongly raises suspicion for a sleep-related breathing disorder in a child?

  1. Habitual snoring with observed pauses Correct answer.
  2. Bedwetting at age four
  3. Nighttime bruxism
  4. Occasional sleep talking

Explanation

Snoring with witnessed pauses in a child is a hallmark of pediatric sleep-disordered breathing and warrants evaluation. The other findings are common and nonspecific in children.

Question 4Patient Selection and Clinical Evaluation

Which questionnaire is designed specifically to assess daytime sleepiness rather than apnea risk?

  1. Berlin Questionnaire
  2. Epworth Sleepiness Scale Correct answer.
  3. Pittsburgh Sleep Quality Index
  4. STOP-BANG

Explanation

The Epworth Sleepiness Scale quantifies propensity to doze in eight situations, giving a sleepiness score. The other instruments screen for apnea risk or sleep quality more broadly.

Question 5Patient Selection and Clinical Evaluation

Before initiating mandibular advancement therapy, which oral finding is most important to document?

  1. Tongue color
  2. Palate width
  3. Gag reflex strength
  4. Number and periodontal health of teeth Correct answer.

Explanation

Mandibular advancement requires adequate dental anchorage, so tooth count, periodontal status, and restorations must be assessed. The other findings do not determine appliance feasibility.

Question 6Patient Selection and Clinical Evaluation

A patient has a BMI of 42 kg/m² and reports morning headaches. Which condition should be considered before attributing headaches to primary headache disorder?

  1. Sleep-related hypoventilation Correct answer.
  2. Sinusitis
  3. Migraine without aura
  4. Tension headache

Explanation

Obesity with morning headaches raises concern for hypoventilation and hypercapnia during sleep, which requires blood gas or oximetry evaluation. Primary headache diagnoses should be made only after this is excluded.

Question 7Patient Selection and Clinical Evaluation

Which patient characteristic most reduces the reliability of a home sleep apnea test?

  1. Mild daytime sleepiness
  2. Severe chronic obstructive pulmonary disease Correct answer.
  3. Age of 45 years
  4. Body mass index of 27 kg/m²

Explanation

Significant cardiopulmonary disease makes home testing unreliable because oximetry and effort signals may misrepresent events and comorbidities confound interpretation. Polysomnography is preferred in such patients.

Question 8Patient Selection and Clinical Evaluation

A patient being evaluated for sleep apnea takes an opioid analgesic nightly. Which concern is most relevant to the clinical evaluation?

  1. Increased risk of restless legs
  2. Central apnea and blunted ventilatory drive Correct answer.
  3. Higher likelihood of insomnia
  4. Reduced snoring intensity only

Explanation

Opioids depress ventilatory drive and predispose to central sleep apnea and hypoventilation, so the evaluation must consider central events. Snoring reduction alone does not exclude significant disease.

Question 9Patient Selection and Clinical Evaluation

Which physical examination finding is most associated with difficult mask ventilation during positive airway pressure therapy?

  1. Normal thyromental distance
  2. Mallampati class IV airway Correct answer.
  3. Body mass index of 24 kg/m²
  4. Absence of neck circumference measurement

Explanation

A high Mallampati score predicts difficult mask fit and ventilation, informing mask selection and setup planning. The other options are either normal findings or omissions rather than predictors.

Question 10Patient Selection and Clinical Evaluation

A patient with treated hypertension and a neck circumference of 45 cm asks about apnea risk. Which interpretation is most accurate?

  1. Only BMI determines apnea risk
  2. Hypertension excludes apnea
  3. Neck size is unrelated to apnea
  4. Large neck circumference increases apnea risk Correct answer.

Explanation

Increased neck circumference is an established anatomic risk factor for obstructive sleep apnea because of surrounding soft tissue. It adds information beyond BMI alone.

Question 11Patient Selection and Clinical Evaluation

Which feature in a sleep history most suggests a circadian rhythm disorder rather than sleep apnea?

  1. Sleep timing shifted on weekends with normal breathing Correct answer.
  2. Witnessed apneas
  3. Morning dry mouth
  4. Loud snoring every night

Explanation

A shift in sleep timing with otherwise normal breathing points to a circadian misalignment such as delayed sleep phase. Snoring, apneas, and dry mouth point toward sleep-disordered breathing.

Question 12Patient Selection and Clinical Evaluation

A patient reports falling asleep while driving. Which action is most appropriate during evaluation?

  1. Reassure that this is normal
  2. Advise avoidance of driving until evaluated Correct answer.
  3. Increase caffeine and continue driving
  4. Delay evaluation for six months

Explanation

Sleepiness while driving is a public safety hazard and requires prompt evaluation and counseling to avoid driving until risk is addressed. Reassurance or delay is unsafe.

Question 13Patient Selection and Clinical Evaluation

Which finding on a screening questionnaire should prompt expedited referral regardless of total score?

  1. A reported motor vehicle crash from drowsiness Correct answer.
  2. Mild fatigue in the afternoon
  3. Occasional snoring
  4. Waking once nightly

Explanation

A drowsiness-related crash indicates severe consequences of sleepiness and warrants urgent evaluation even if the aggregate score is modest. The other items are common and less urgent.

Question 14Patient Selection and Clinical Evaluation

A patient with heart failure and reduced ejection fraction has Cheyne-Stokes respiration on testing. Which diagnosis best fits?

  1. Narcolepsy
  2. Obstructive sleep apnea
  3. Central sleep apnea Correct answer.
  4. Obesity hypoventilation syndrome

Explanation

Cheyne-Stokes respiration with heart failure reflects unstable ventilatory control and central apneas. Obstructive apnea would show continued effort against a closed airway.

Question 15Patient Selection and Clinical Evaluation

Which patient instruction is most important before an overnight sleep study?

  1. Keep usual sleep schedule and avoid alcohol Correct answer.
  2. Sleep less the night before
  3. Take an extra sleeping pill
  4. Exercise vigorously at bedtime

Explanation

Maintaining a typical sleep schedule and avoiding alcohol improves the representativeness of the recording. Sedatives, sleep restriction, and vigorous late exercise can distort results.

Question 16Patient Selection and Clinical Evaluation

Which comorbidity most increases perioperative risk in a patient with untreated severe sleep apnea?

  1. Occasional heartburn
  2. Difficult airway and postoperative respiratory depression Correct answer.
  3. Mild seasonal allergies
  4. Controlled hypothyroidism

Explanation

Untreated severe apnea increases risks of difficult intubation and postoperative respiratory depression from anesthetics and opioids. This drives preoperative identification and planning.

Question 17Patient Selection and Clinical Evaluation

A patient's STOP-BANG score is 3. What does this score indicate?

  1. Intermediate risk of moderate to severe apnea Correct answer.
  2. Need for immediate intubation
  3. Definite diagnosis of severe apnea
  4. No risk of apnea

Explanation

A score of 3 falls in the intermediate-risk range, prompting further testing rather than confirming a diagnosis. Scores do not establish severity on their own.

Question 18Patient Selection and Clinical Evaluation

Which factor most affects the choice between continuous positive airway pressure and an oral appliance for a patient with confirmed moderate apnea?

  1. Blood type
  2. Patient preference and anatomy Correct answer.
  3. Hair color
  4. Shoe size

Explanation

Device selection depends on patient preference, dental anatomy, and expected efficacy, with shared decision making. The other options are irrelevant to therapy choice.

Question 19Patient Selection and Clinical Evaluation

A patient reports nocturia and morning headaches with loud snoring. Which underlying condition best links these findings?

  1. Narcolepsy
  2. Obstructive sleep apnea Correct answer.
  3. Insomnia disorder
  4. REM sleep behavior disorder

Explanation

Nocturia and morning headaches with snoring are recognized features of obstructive sleep apnea, reflecting nocturnal pressure changes and arousals. The other conditions do not typically produce this cluster.

Question 20Patient Selection and Clinical Evaluation

Which statement about the relationship between apnea severity and symptoms is most accurate?

  1. Symptoms correlate imperfectly with severity index Correct answer.
  2. Symptoms always match severity
  3. Only symptoms determine treatment
  4. Severity index is irrelevant

Explanation

Symptom burden and apnea-hypopnea index correlate imperfectly, so both objective severity and clinical impact guide management. Neither alone fully determines care.

Question 21Patient Selection and Clinical Evaluation

A patient with a small mandible and retrognathia is evaluated for apnea. Why is this anatomy relevant?

  1. It narrows the pharyngeal airway space Correct answer.
  2. It lowers apnea risk
  3. It prevents snoring
  4. It increases nasal resistance only

Explanation

Retrognathia reduces the bony framework supporting the pharynx, narrowing the airway and raising apnea risk. It also affects oral appliance planning.

Question 22Patient Selection and Clinical Evaluation

During evaluation, a patient's bed partner describes gasping arousals but the patient denies any problem. How should this discrepancy be handled?

  1. Dismiss partner reports as unreliable
  2. Incorporate partner observations into the assessment Correct answer.
  3. Defer testing until patient complains
  4. Rely only on patient denial

Explanation

Bed partner observations of gasping and pauses are valuable because patients often underreport events during sleep. Collateral history improves diagnostic accuracy.

Question 23Patient Selection and Clinical Evaluation

Which patient is the poorest candidate for a mandibular advancement device based on oral examination?

  1. One with a full dentition and healthy gums
  2. One with mild overbite
  3. One with advanced periodontal disease and few teeth Correct answer.
  4. One with a normal jaw range of motion

Explanation

Adequate dental support and periodontal health are required for appliance retention and safety. Advanced periodontal disease and tooth loss undermine both.

Question 24Patient Selection and Clinical Evaluation

A patient with treated sleep apnea reports persistent daytime sleepiness despite good adherence. Which step is most appropriate?

  1. Stop treatment
  2. Add a stimulant immediately
  3. Reassess for other causes of sleepiness Correct answer.
  4. Increase device pressure without testing

Explanation

Residual sleepiness on effective therapy warrants evaluation for other causes such as insufficient sleep, depression, or another disorder. Adjusting therapy blindly is inappropriate.

Question 25Patient Selection and Clinical Evaluation

Which element belongs in a focused sleep history for apnea evaluation?

  1. Family history of vision loss
  2. Childhood vaccination record
  3. Usual sleep duration and timing Correct answer.
  4. Dietary fiber intake

Explanation

Sleep duration and timing contextualize symptoms and help distinguish insufficient sleep or circadian issues from apnea. The other elements are unrelated to apnea assessment.

Question 26Patient Selection and Clinical Evaluation

A 52-year-old man reports habitual snoring and witnessed apneas. His body mass index is 33 kg/m² and his Epworth Sleepiness Scale score is 12. Which initial diagnostic test is most appropriate?

  1. Overnight polysomnography Correct answer.
  2. Home sleep apnea test
  3. Overnight pulse oximetry alone
  4. Multiple sleep latency test

Explanation

Polysomnography is the reference standard for diagnosing sleep apnea and is indicated when there is a high pretest probability or significant comorbidity. Home sleep apnea testing is an alternative for selected patients without major comorbidities, but this patient's high symptom burden and obesity make polysomnography the preferred initial test. Multiple sleep latency testing assesses daytime sleepiness, not apnea. Overnight pulse oximetry alone is not diagnostic.

Question 27Patient Selection and Clinical Evaluation

Which patient-reported symptom is most specific for obstructive sleep apnea?

  1. Frequent nocturnal awakenings
  2. Witnessed apneas Correct answer.
  3. Loud habitual snoring
  4. Morning dry mouth

Explanation

Witnessed apneas are a hallmark symptom of OSA and are more specific than snoring, which is common in the general population. Nocturnal awakenings and dry mouth are nonspecific and can occur in many sleep disorders. The combination of symptoms increases diagnostic yield, but witnessed apneas carry the highest specificity among these options.

Question 28Patient Selection and Clinical Evaluation

A 45-year-old woman with a BMI of 29 kg/m² reports excessive daytime sleepiness and fatigue. She has hypertension and type 2 diabetes. Which screening tool is most appropriate to assess her risk for obstructive sleep apnea?

  1. Berlin Questionnaire Correct answer.
  2. Restless Legs Syndrome Rating Scale
  3. Epworth Sleepiness Scale
  4. Insomnia Severity Index

Explanation

The Berlin Questionnaire is a validated screening tool for OSA risk that incorporates snoring, daytime sleepiness, hypertension, and obesity. The Epworth Sleepiness Scale quantifies daytime sleepiness but does not screen for apnea risk. The Insomnia Severity Index and Restless Legs Syndrome Rating Scale assess other sleep disorders.

Question 29Patient Selection and Clinical Evaluation

Which finding on a physical examination is most strongly associated with obstructive sleep apnea?

  1. Neck circumference of 43 cm in a man
  2. Mallampati score of I
  3. Body mass index of 24 kg/m²
  4. Modified Mallampati score of III or IV Correct answer.

Explanation

A modified Mallampati score of III or IV indicates oropharyngeal crowding and is associated with increased OSA risk. A low Mallampati score, a neck circumference below the risk threshold (e.g., <43 cm in men), and a normal BMI are less associated with OSA. Neck circumference >43 cm in men is a risk factor, but 43 cm is at the threshold and less specific than a high Mallampati score.

Question 30Patient Selection and Clinical Evaluation

A patient with untreated obstructive sleep apnea is scheduled for elective surgery. Which statement about perioperative risk is most accurate?

  1. Regional anesthesia eliminates the risk of perioperative complications.
  2. Perioperative risk is not increased if the patient is opioid-naive.
  3. Untreated OSA is associated with increased risk of postoperative respiratory complications. Correct answer.
  4. The risk of perioperative complications is increased only in patients with severe OSA.

Explanation

Untreated OSA is associated with increased perioperative morbidity, including difficult intubation, postoperative respiratory depression, and cardiac events. The risk is present across severity levels but is highest in severe OSA. Opioid-naive status does not eliminate risk, and regional anesthesia does not completely eliminate the risk of respiratory complications.

Question 31Patient Selection and Clinical Evaluation

Which patient instruction is most important before an overnight polysomnography?

  1. Take a nap in the afternoon to ensure sleep during the study.
  2. Avoid all caffeine for 24 hours before the study.
  3. Wash hair and scalp thoroughly and avoid hair products. Correct answer.
  4. Fast from midnight until the study is completed.

Explanation

Clean hair and scalp without oils, sprays, or gels improve electrode adhesion and signal quality during polysomnography. Caffeine avoidance is not routinely required unless specifically requested, napping is not recommended, and fasting is not necessary for polysomnography.

Question 32Patient Selection and Clinical Evaluation

A 60-year-old man with a history of hypertension and a neck circumference of 46 cm reports loud snoring and daytime sleepiness. His STOP-BANG score is 4. What is the most appropriate next step?

  1. Reassure him that his score is low risk.
  2. Prescribe a mandibular advancement device.
  3. Recommend weight loss and reassess in 6 months.
  4. Refer for a sleep study to confirm the diagnosis. Correct answer.

Explanation

A STOP-BANG score of 4 indicates high risk for moderate to severe OSA, and referral for a sleep study is warranted to confirm the diagnosis. Reassurance is inappropriate, weight loss alone is insufficient without diagnostic evaluation, and prescribing an oral appliance without a confirmed diagnosis is not standard practice.

Question 33Patient Selection and Clinical Evaluation

Which underlying condition is most likely to cause central sleep apnea?

  1. Chronic obstructive pulmonary disease
  2. Acromegaly
  3. Heart failure with reduced ejection fraction Correct answer.
  4. Hypothyroidism

Explanation

Heart failure with reduced ejection fraction is a common cause of central sleep apnea, often presenting as Cheyne-Stokes respiration. COPD, hypothyroidism, and acromegaly are associated with obstructive sleep apnea, not central sleep apnea.

Question 34Patient Selection and Clinical Evaluation

A patient reports difficulty falling asleep at night and difficulty waking up in the morning for work. On weekends, he sleeps from 2 AM to 10 AM and feels rested. Which condition is most likely?

  1. Advanced sleep phase syndrome
  2. Narcolepsy
  3. Obstructive sleep apnea
  4. Delayed sleep phase syndrome Correct answer.

Explanation

Delayed sleep phase syndrome is characterized by a delayed sleep-wake schedule that is later than desired, with normal sleep quality when allowed to follow the endogenous rhythm. Advanced sleep phase syndrome involves an earlier schedule. OSA and narcolepsy do not typically present with this weekend catch-up pattern.

Question 35Patient Selection and Clinical Evaluation

Which medication class is most likely to worsen obstructive sleep apnea?

  1. Statins
  2. Beta-blockers
  3. Benzodiazepines Correct answer.
  4. Proton pump inhibitors

Explanation

Benzodiazepines can worsen OSA by reducing upper airway muscle tone and depressing respiratory drive. Beta-blockers, proton pump inhibitors, and statins do not have this effect.

Question 36Patient Selection and Clinical Evaluation

A 35-year-old woman presents with excessive daytime sleepiness. She reports falling asleep while watching TV but not while driving. Her Epworth Sleepiness Scale score is 8. Which statement about the interpretation of her symptoms is most accurate?

  1. Her symptoms are unlikely to be due to sleep apnea because she does not fall asleep while driving.
  2. The Epworth Sleepiness Scale is a subjective measure and should be interpreted in the context of her clinical history. Correct answer.
  3. An Epworth score of 8 is always normal.
  4. She should be diagnosed with narcolepsy.

Explanation

The Epworth Sleepiness Scale is a subjective tool and should be interpreted alongside the clinical history and other findings. An score of 8 is borderline and does not rule out a sleep disorder. Falling asleep while driving is a red flag but its absence does not exclude sleep apnea, and narcolepsy cannot be diagnosed based on these symptoms alone.

Question 37Patient Selection and Clinical Evaluation

Which factor most increases the likelihood of obstructive sleep apnea in a postmenopausal woman?

  1. Regular aerobic exercise
  2. Increased waist circumference Correct answer.
  3. Use of hormone replacement therapy
  4. History of hysterectomy

Explanation

Central obesity, reflected by increased waist circumference, is a strong risk factor for OSA in postmenopausal women. Hormone replacement therapy, aerobic exercise, and hysterectomy are not established risk factors for OSA.

Question 38Patient Selection and Clinical Evaluation

A patient is being evaluated for sleep apnea and has a history of stroke. Which statement about the relationship between stroke and sleep apnea is most accurate?

  1. Treating sleep apnea has no effect on stroke risk.
  2. Stroke is a risk factor for sleep apnea, and sleep apnea is a risk factor for stroke. Correct answer.
  3. Sleep apnea is a rare finding after stroke.
  4. Sleep apnea occurs only in hemorrhagic stroke.

Explanation

There is a bidirectional relationship between sleep apnea and stroke: OSA increases the risk of stroke, and stroke can worsen or precipitate sleep apnea. Sleep apnea is common after stroke, and treatment may reduce recurrence risk. It is not limited to hemorrhagic stroke.

Question 39Patient Selection and Clinical Evaluation

A 50-year-old man with a BMI of 35 kg/m² and a history of hypertension reports that his wife has observed him stop breathing during sleep. He has no other significant medical history. Which diagnostic approach is most appropriate?

  1. Empiric CPAP trial
  2. Home sleep apnea test Correct answer.
  3. Lateral cephalometry
  4. Overnight polysomnography

Explanation

For a patient with a high pretest probability of moderate to severe OSA and no significant comorbidities, a home sleep apnea test is an appropriate initial diagnostic test. Polysomnography is reserved for patients with significant comorbidities or when home testing is inconclusive. Empiric CPAP is not appropriate without a diagnosis, and cephalometry is not a diagnostic test for OSA.

Question 40Patient Selection and Clinical Evaluation

A patient with obstructive sleep apnea reports persistent daytime sleepiness despite adherence to CPAP therapy. Which action is most appropriate next?

  1. Increase the CPAP pressure empirically.
  2. Reassure the patient that sleepiness is expected.
  3. Switch to a mandibular advancement device.
  4. Evaluate for other causes of sleepiness. Correct answer.

Explanation

Persistent sleepiness despite adequate CPAP adherence warrants evaluation for other causes, such as insufficient sleep, depression, medications, or narcolepsy. Empirically increasing pressure is not recommended without evidence of inadequate treatment, switching devices may not address the underlying cause, and reassurance is inappropriate.

Question 41Sleep-Related Breathing Disorders and Diagnosis

Which apnea-hypopnea index (AHI) range defines mild obstructive sleep apnea in adults?

  1. 15 to less than 30 events per hour
  2. 5 to less than 15 events per hour Correct answer.
  3. Fewer than 5 events per hour
  4. 30 or more events per hour

Explanation

Adult OSA severity is graded by AHI: mild is 5 to <15, moderate is 15 to <30, and severe is 30 or more events per hour. An AHI below 5 falls outside the adult OSA diagnostic threshold when symptoms or comorbidities are absent.

Question 42Sleep-Related Breathing Disorders and Diagnosis

By standard AASM scoring rules, an apnea is scored when the airflow signal drops by at least what percentage from baseline for at least 10 seconds?

  1. 50 percent
  2. 30 percent
  3. 90 percent Correct answer.
  4. 70 percent

Explanation

An apnea requires a drop in the peak thermal airflow signal of at least 90 percent of baseline lasting at least 10 seconds. Lesser reductions that meet duration criteria are scored as hypopneas if associated with desaturation or arousal.

Question 43Sleep-Related Breathing Disorders and Diagnosis

Which sensor is the recommended reference for scoring hypopneas by the AASM recommended rule?

  1. Respiratory effort belts
  2. Nasal pressure transducer Correct answer.
  3. Thermal airflow sensor
  4. Pulse oximeter

Explanation

The recommended hypopnea rule uses the nasal pressure signal to detect reductions in airflow amplitude. Nasal pressure is more sensitive than thermal sensors for partial airflow limitation.

Question 44Sleep-Related Breathing Disorders and Diagnosis

A respiratory event is scored as a central apnea primarily because it lacks which feature?

  1. Respiratory effort during the event Correct answer.
  2. Associated oxygen desaturation
  3. Duration of at least 10 seconds
  4. An arousal at event termination

Explanation

Central apnea is defined by absent respiratory effort throughout the event, distinguishing it from obstructive apnea. Desaturation, arousal, and duration are not the defining discriminator between central and obstructive events.

Question 45Sleep-Related Breathing Disorders and Diagnosis

Which finding on a diagnostic polysomnogram is most characteristic of obstructive sleep apnea?

  1. Absent effort with absent airflow
  2. Periodic breathing with crescendo-decrescendo effort
  3. Cheyne-Stokes respiration pattern
  4. Paradoxical thoracoabdominal motion during airflow limitation Correct answer.

Explanation

Obstructive events show continued or increasing respiratory effort against an occluded airway, often with paradoxical thoracoabdominal motion. Central events instead show absent effort, and periodic or Cheyne-Stokes patterns suggest central mechanisms.

Question 46Sleep-Related Breathing Disorders and Diagnosis

The oxygen desaturation index (ODI) is best defined as which measure?

  1. Lowest oxygen saturation recorded during sleep
  2. Number of desaturations of at least 3 percent per hour of sleep Correct answer.
  3. Percentage of sleep time below 90 percent saturation
  4. Mean oxygen saturation across the study

Explanation

The ODI counts desaturation events meeting a specified threshold (commonly 3 or 4 percent) per hour of recording or sleep. It is an oximetry-derived surrogate for respiratory event frequency.

Question 47Sleep-Related Breathing Disorders and Diagnosis

Which instrument is most commonly used to screen for OSA risk in a dental or primary care setting before referral?

  1. Pittsburgh Sleep Quality Index
  2. STOP-BANG questionnaire Correct answer.
  3. Mallampati classification
  4. Epworth Sleepiness Scale

Explanation

STOP-BANG combines symptoms and clinical features to stratify OSA risk and is widely used for triage to sleep testing. The Epworth scale quantifies daytime sleepiness but does not itself estimate apnea probability.

Question 48Sleep-Related Breathing Disorders and Diagnosis

In adults, polysomnography is generally indicated when which combination is present?

  1. Clinical suspicion of OSA plus significant comorbidity or safety risk Correct answer.
  2. Self-reported insomnia without snoring
  3. Loud snoring alone without other symptoms
  4. A single witnessed apnea with no daytime symptoms

Explanation

Testing is indicated when there is clinical suspicion of OSA with significant comorbidity (such as hypertension or cardiovascular disease) or occupational safety risk. Isolated snoring or insomnia without suspicion of sleep-disordered breathing does not warrant polysomnography.

Question 49Sleep-Related Breathing Disorders and Diagnosis

A patient's home sleep apnea test shows an AHI of 6 events per hour with a 3 percent desaturation criterion, but the recording has 3 hours of usable data. How should this result be interpreted?

  1. Diagnostic of moderate OSA
  2. Equivocal and requiring repeat testing regardless of quality
  3. Inadequate study because of insufficient recording time Correct answer.
  4. Diagnostic of mild OSA with no further testing

Explanation

A home sleep apnea test requires a minimum of 4 hours of usable recording to be considered adequate. With only 3 hours, the study is technically inadequate and should be repeated or followed by in-lab testing.

Question 50Sleep-Related Breathing Disorders and Diagnosis

A patient has an AHI of 18 per hour with 12 percent of total sleep time spent below 90 percent oxygen saturation. How is severity best characterized?

  1. Normal study because AHI is under 30
  2. Severe OSA based on oxygen burden
  3. Moderate OSA with significant hypoxemia Correct answer.
  4. Mild OSA with significant hypoxemia

Explanation

An AHI of 15 to <30 defines moderate OSA, and substantial time below 90 percent indicates meaningful hypoxemic burden. Severity is classified by AHI, with oxygen metrics adding prognostic information.