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ABFM Sleep Medicine study materials
ABFM Sleep Medicine study resources

ABFM Sleep Medicine practice questions

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Question 1Diagnosis and management of clinical conditions that occur during sleep

A 45-year-old man is evaluated for witnessed apneas and loud snoring. Which finding on history most strongly suggests obstructive sleep apnea rather than a central apnea mechanism?

  1. Sleepiness measured by the Epworth scale
  2. Episodes of sudden awakening with gasping
  3. Continued respiratory effort during the apneic events Correct answer.
  4. Waking with a dry mouth and morning headache

Explanation

Obstructive events are defined by ongoing ventilatory effort against a closed airway, whereas central events lack effort. Witnessed effort during pauses therefore points to an obstructive mechanism.

Question 2Diagnosis and management of clinical conditions that occur during sleep

Which nocturnal polysomnographic finding is the primary diagnostic criterion for obstructive sleep apnea severity staging?

  1. Total sleep time
  2. Number of arousals
  3. Sleep onset latency
  4. Apnea-hypopnea index Correct answer.

Explanation

The apnea-hypopnea index (events per hour of sleep) is the standard metric used to classify OSA as mild, moderate, or severe. Other parameters inform interpretation but do not define severity.

Question 3Diagnosis and management of clinical conditions that occur during sleep

A 60-year-old woman with heart failure and atrial fibrillation has frequent central apneas with Cheyne-Stokes respiration. Which mechanism best explains these events?

  1. Excessive REM-related muscle atonia
  2. Enhanced loop gain with delayed chemoreflex response Correct answer.
  3. Nocturnal gastroesophageal reflux
  4. Upper airway collapse during inspiration

Explanation

Cheyne-Stokes respiration in heart failure reflects increased ventilatory loop gain and prolonged circulation time, causing oscillating CO2 and cyclic central apneas. Airway collapse defines obstructive, not central, events.

Question 4Diagnosis and management of clinical conditions that occur during sleep

Which treatment is first-line for moderate-to-severe obstructive sleep apnea in an adherent patient?

  1. Uvulopalatopharyngoplasty
  2. Mandibular advancement device
  3. Positive airway pressure therapy Correct answer.
  4. Weight-loss pharmacotherapy

Explanation

Positive airway pressure is the standard first-line therapy for moderate-to-severe OSA because it reliably eliminates events and improves outcomes when used consistently. Surgical and oral appliance options are generally reserved for intolerance or specific anatomy.

Question 5Diagnosis and management of clinical conditions that occur during sleep

A patient with obesity and OSA reports sleeping poorly and waking frequently. Which lifestyle intervention is most strongly supported as adjunctive therapy?

  1. High-dose sedative hypnotics
  2. Alcohol at bedtime to aid sleep
  3. Weight reduction through diet and exercise Correct answer.
  4. Supine sleep positioning only

Explanation

Weight loss reduces the apnea-hypopnea index and is a cornerstone adjunctive intervention in overweight patients with OSA. Sedatives and alcohol worsen airway collapsibility.

Question 6Diagnosis and management of clinical conditions that occur during sleep

A 30-year-old reports irresistible sleep attacks, cataplexy, and hypnagogic hallucinations. Which diagnostic test is most definitive?

  1. Overnight pulse oximetry
  2. Actigraphy over 2 weeks
  3. Epworth Sleepiness Scale
  4. Multiple sleep latency test with mean sleep latency under 8 minutes and 2 or more SOREMPs Correct answer.

Explanation

Narcolepsy is confirmed by an MSLT showing short mean sleep latency with multiple sleep-onset REM periods after adequate sleep on prior polysomnography. Oximetry and questionnaires do not establish the diagnosis.

Question 7Diagnosis and management of clinical conditions that occur during sleep

Which pharmacologic agent is used for cataplexy in narcolepsy?

  1. Sodium oxybate Correct answer.
  2. Melatonin
  3. Zolpidem
  4. Modafinil

Explanation

Sodium oxybate reduces cataplexy and daytime sleepiness in narcolepsy. Modafinil treats sleepiness but has limited effect on cataplexy.

Question 8Diagnosis and management of clinical conditions that occur during sleep

A 70-year-old with Parkinson disease shouts and flails during sleep, often injuring his bed partner. Which disorder is most likely?

  1. Somnambulism
  2. Sleep terrors
  3. Obstructive sleep apnea
  4. REM sleep behavior disorder Correct answer.

Explanation

REM sleep behavior disorder involves loss of normal REM atonia with dream-enacting behaviors, and it is strongly associated with synucleinopathies such as Parkinson disease.

Question 9Diagnosis and management of clinical conditions that occur during sleep

Which medication class most commonly precipitates or worsens REM sleep behavior disorder?

  1. Proton pump inhibitors
  2. Selective serotonin reuptake inhibitors Correct answer.
  3. Statins
  4. Beta blockers

Explanation

SSRIs and other serotonergic antidepressants can induce or unmask REM sleep behavior disorder by disrupting REM atonia. The other classes are not typically implicated.

Question 10Diagnosis and management of clinical conditions that occur during sleep

A child snores, has enlarged tonsils, and shows daytime inattention. What is the most appropriate initial management for suspected pediatric OSA?

  1. Positive airway pressure therapy
  2. Adenotonsillectomy Correct answer.
  3. Weight-loss surgery
  4. Mandibular advancement device

Explanation

Adenotonsillectomy is first-line therapy for pediatric OSA with adenotonsillar hypertrophy. PAP and oral appliances are reserved for persistent or specific cases.

Question 11Diagnosis and management of clinical conditions that occur during sleep

Which finding on polysomnography confirms periodic limb movement disorder rather than restless legs syndrome?

  1. Iron deficiency
  2. Urge to move legs relieved by movement in the evening
  3. Periodic limb movements during sleep with clinical sleep disturbance Correct answer.
  4. Daytime fatigue

Explanation

PLMD is diagnosed by polysomnographically documented periodic limb movements causing sleep disturbance, whereas RLS is a clinical diagnosis based on symptoms. The two can coexist but are distinct.

Question 12Diagnosis and management of clinical conditions that occur during sleep

A patient with insomnia and chronic low back pain is started on cognitive behavioral therapy for insomnia. Which component is central to CBT-I?

  1. Sleep restriction and stimulus control Correct answer.
  2. Extended time in bed to promote sleep
  3. Use of alcohol as a sleep aid
  4. Daily daytime napping

Explanation

CBT-I combines sleep restriction, stimulus control, cognitive restructuring, and relaxation. Extending time in bed and napping typically worsen insomnia.

Question 13Diagnosis and management of clinical conditions that occur during sleep

Which is a recommended first-line pharmacologic option for chronic insomnia in adults?

  1. Alcohol
  2. Caffeine at bedtime
  3. Diphenhydramine
  4. Low-dose doxepin Correct answer.

Explanation

Low-dose doxepin is approved and recommended for sleep maintenance insomnia with a favorable safety profile. Antihistamines have tolerance and anticholinergic effects.

Question 14Diagnosis and management of clinical conditions that occur during sleep

A shift worker has difficulty sleeping during the day and excessive sleepiness at night. Which intervention is most appropriate?

  1. Timed bright-light exposure and scheduled sleep Correct answer.
  2. Increasing caffeine throughout the night
  3. Sleeping in the evening before shift
  4. Long-term benzodiazepines

Explanation

Circadian rhythm sleep-wake disorder from shift work is managed with strategically timed light exposure, scheduled sleep, and sometimes melatonin. Long-term sedatives are not first-line.

Question 15Diagnosis and management of clinical conditions that occur during sleep

Which feature distinguishes obstructive sleep apnea from central sleep apnea on polysomnography?

  1. Duration of the event
  2. Presence of respiratory effort during the event Correct answer.
  3. Associated oxygen desaturation
  4. Presence of arousals

Explanation

The presence or absence of respiratory effort during an apnea differentiates obstructive from central events. Duration, desaturation, and arousals can occur in both.

Question 16Diagnosis and management of clinical conditions that occur during sleep

A patient with treated OSA remains sleepy despite documented adherence to PAP. Which next step is most appropriate?

  1. Reassess for other causes of sleepiness such as narcolepsy or insufficient sleep Correct answer.
  2. Add a sedative hypnotic
  3. Increase PAP pressure without evaluation
  4. Discontinue PAP

Explanation

Residual sleepiness despite effective PAP warrants evaluation for other disorders, including insufficient sleep, narcolepsy, or depression. Blindly changing pressure or stopping therapy is inappropriate.

Question 17Diagnosis and management of clinical conditions that occur during sleep

Which sleep-related breathing pattern is characterized by crescendo-decrescendo ventilation with central apneas?

  1. Paradoxical breathing
  2. Biot respiration
  3. Cheyne-Stokes respiration Correct answer.
  4. Kussmaul breathing

Explanation

Cheyne-Stokes respiration shows cyclic crescendo-decrescendo tidal volumes separated by central apneas, typical of heart failure. Other patterns have different mechanisms.

Question 18Diagnosis and management of clinical conditions that occur during sleep

A pregnant woman at 32 weeks reports new loud snoring and witnessed apneas. What is the most appropriate management?

  1. Recommendation to sleep supine
  2. Reassurance that snoring is normal in pregnancy
  3. Prompt evaluation and treatment of sleep-disordered breathing Correct answer.
  4. Initiation of benzodiazepines

Explanation

New sleep-disordered breathing in pregnancy is associated with hypertensive complications and warrants prompt evaluation and treatment. Snoring is common but apneas are not normal.

Question 19Diagnosis and management of clinical conditions that occur during sleep

Which is the most common cause of excessive daytime sleepiness in the general population?

  1. Insufficient sleep Correct answer.
  2. Idiopathic hypersomnia
  3. Kleine-Levin syndrome
  4. Narcolepsy

Explanation

Chronic insufficient sleep is the leading cause of daytime sleepiness. Narcolepsy and idiopathic hypersomnia are far less common.

Question 20Diagnosis and management of clinical conditions that occur during sleep

A patient with OSA is intolerant of PAP. Which alternative is most appropriate for mild-to-moderate disease with a favorable dental evaluation?

  1. Uvulopalatopharyngoplasty
  2. Weight-loss surgery
  3. Tracheostomy
  4. Mandibular advancement device Correct answer.

Explanation

A mandibular advancement device is an appropriate alternative for mild-to-moderate OSA or PAP intolerance when the dentition is suitable. Surgery and tracheostomy are reserved for specific cases.

Question 21Diagnosis and management of clinical conditions that occur during sleep

Which finding on history most suggests restless legs syndrome?

  1. Painful cramps during exercise
  2. Numbness in a dermatomal distribution
  3. Urge to move legs that worsens in the evening and is relieved by movement Correct answer.
  4. Morning stiffness lasting hours

Explanation

RLS is characterized by an urge to move the legs, worsening at rest and in the evening, relieved by movement. Other patterns suggest different disorders.

Question 22Diagnosis and management of clinical conditions that occur during sleep

Which laboratory test should be obtained when restless legs syndrome is diagnosed?

  1. Serum cortisol
  2. Serum amylase
  3. Urine catecholamines
  4. Serum ferritin Correct answer.

Explanation

Iron deficiency is a common contributor to RLS, so ferritin should be checked and iron repletion considered if low. The other tests are unrelated.

Question 23Diagnosis and management of clinical conditions that occur during sleep

A patient with heart failure and central sleep apnea is considered for adaptive servo-ventilation. What is the key concern?

  1. Increased mortality in certain heart failure populations Correct answer.
  2. Worsening obesity
  3. Induction of narcolepsy
  4. Risk of hyperthyroidism

Explanation

Adaptive servo-ventilation has been associated with increased mortality in patients with heart failure and reduced ejection fraction, so it is not recommended in that group. Other listed effects are unrelated.

Question 24Diagnosis and management of clinical conditions that occur during sleep

Which sleep stage is most associated with parasomnias such as sleepwalking and night terrors?

  1. REM sleep
  2. Stage N2
  3. Stage N1
  4. Non-REM stage N3 Correct answer.

Explanation

Disorders of arousal such as sleepwalking and night terrors arise from deep non-REM sleep, especially N3. REM parasomnias include REM sleep behavior disorder.

Question 25Diagnosis and management of clinical conditions that occur during sleep

A patient reports acting out dreams and also has orthostatic hypotension and constipation. Which underlying process should be suspected?

  1. Myasthenia gravis
  2. A synucleinopathy such as Parkinson disease or Lewy body dementia Correct answer.
  3. Hyperthyroidism
  4. Multiple sclerosis

Explanation

REM sleep behavior disorder often precedes synucleinopathies, and autonomic features such as orthostatic hypotension and constipation support this. Other conditions do not show this association.

Question 26Diagnosis and management of clinical conditions that occur during sleep

A 45-year-old man reports loud snoring, witnessed apneas, and daytime sleepiness. Which initial diagnostic study is most appropriate when there are no major comorbid conditions?

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

Explanation

For adults with a high pretest probability of moderate-to-severe OSA and no significant cardiopulmonary or neurologic comorbidity, a home sleep apnea test is an accepted initial diagnostic pathway. In-laboratory polysomnography is reserved for those with major comorbidity, suspected other sleep disorders, or nondiagnostic home testing.

Question 27Diagnosis and management of clinical conditions that occur during sleep

Which clinical feature most strongly suggests a diagnosis of narcolepsy type 1 rather than type 2?

  1. Sleep paralysis
  2. Hypnagogic hallucinations
  3. Cataplexy Correct answer.
  4. Fragmented nocturnal sleep

Explanation

Narcolepsy type 1 is defined by the presence of cataplexy (or documented hypocretin deficiency), reflecting loss of hypocretin-producing neurons. Sleep paralysis, hallucinations, and fragmented sleep occur in both types and do not distinguish them.

Question 28Diagnosis and management of clinical conditions that occur during sleep

A 60-year-old woman has an urge to move her legs in the evening that is relieved by walking. Which condition is most strongly associated with secondary restless legs syndrome?

  1. Hyperthyroidism
  2. Narcolepsy
  3. Obstructive sleep apnea
  4. Iron deficiency Correct answer.

Explanation

Iron deficiency, with or without anemia, is the most common and important reversible cause of secondary RLS, and ferritin should be checked in all patients. Other listed conditions are not classic secondary causes of RLS.

Question 29Diagnosis and management of clinical conditions that occur during sleep

Which statement best describes the appropriate use of melatonin for insomnia in adults?

  1. It reliably increases total sleep time in chronic insomnia
  2. It is contraindicated in older adults
  3. It has modest benefit for sleep-onset insomnia and is generally well tolerated Correct answer.
  4. It should be used as first-line therapy for all insomnia subtypes

Explanation

Melatonin has modest evidence for reducing sleep-onset latency, particularly with circadian misalignment, and has a favorable safety profile. It is not a reliable treatment for chronic insomnia maintenance and is not first-line for all patients.

Question 30Diagnosis and management of clinical conditions that occur during sleep

A 6-year-old child has recurrent episodes of screaming and confusion arising about 90 minutes after sleep onset, with no memory of the event. Which diagnosis is most likely?

  1. Sleep terrors Correct answer.
  2. REM sleep behavior disorder
  3. Nocturnal seizures
  4. Nightmare disorder

Explanation

Sleep terrors are non-REM parasomnias typically arising from slow-wave sleep in the first third of the night, with autonomic arousal and amnesia for the event. Nightmares occur in REM sleep later in the night with vivid recall.

Question 31Diagnosis and management of clinical conditions that occur during sleep

Which finding on polysomnography is required to diagnose rapid eye movement sleep behavior disorder?

  1. Reduced sleep latency on the multiple sleep latency test
  2. Periodic limb movements during wakefulness
  3. Increased chin EMG tone during REM sleep with dream enactment Correct answer.
  4. Alpha intrusion during non-REM sleep

Explanation

REM sleep behavior disorder requires REM sleep without atonia, demonstrated by elevated chin or limb EMG tone during REM, together with dream-enactment behavior. Other findings are unrelated to the diagnosis.

Question 32Diagnosis and management of clinical conditions that occur during sleep

A patient with heart failure and Cheyne-Stokes respiration has central sleep apnea. Which treatment is most appropriate?

  1. Adaptive servo-ventilation as first-line for all patients
  2. Supplemental oxygen as sole therapy
  3. Tracheostomy
  4. Optimization of heart failure therapy with consideration of positive airway pressure support Correct answer.

Explanation

Central sleep apnea in heart failure is best managed by optimizing guideline-directed heart failure therapy, with PAP considered for selected patients. Adaptive servo-ventilation is contraindicated in patients with symptomatic heart failure and reduced ejection fraction because of increased mortality.

Question 33Diagnosis and management of clinical conditions that occur during sleep

Which intervention is most effective for preventing injury in an older adult with recurrent sleepwalking?

  1. Environmental safety measures such as locking doors and removing hazards Correct answer.
  2. Scheduled awakening therapy as sole treatment
  3. Sleep restriction to reduce slow-wave sleep
  4. Nightly benzodiazepine use for all patients

Explanation

The cornerstone of managing non-REM parasomnias is injury prevention through environmental safety measures. Scheduled awakenings and medications are adjuncts for frequent or dangerous episodes, not universal first steps.

Question 34Diagnosis and management of clinical conditions that occur during sleep

A 55-year-old man with treated OSA on CPAP has a residual apnea-hypopnea index of 4 events per hour and normal adherence data. He remains sleepy. Which additional evaluation is most appropriate?

  1. Immediate repeat titration polysomnography
  2. Switching to a different PAP modality
  3. Assessment for other causes of sleepiness such as insufficient sleep, depression, or a primary hypersomnia Correct answer.
  4. Discontinuing PAP therapy

Explanation

When OSA is adequately treated and adherence is documented but sleepiness persists, other causes should be evaluated, including insufficient sleep, mood disorders, medications, and primary hypersomnias. Repeating titration or changing modality is not indicated when the AHI is controlled.

Question 35Diagnosis and management of clinical conditions that occur during sleep

Which feature best distinguishes obstructive sleep apnea from central sleep apnea on polysomnography?

  1. Presence of oxygen desaturation
  2. Continued or increased respiratory effort during apneic events Correct answer.
  3. Presence of arousals
  4. Presence of snoring

Explanation

Obstructive events are characterized by continued or increased respiratory effort against an occluded airway, whereas central events show absent effort. Desaturation, arousals, and snoring can occur in both.

Question 36Diagnosis and management of clinical conditions that occur during sleep

Which agent is considered first-line pharmacotherapy for cataplexy in narcolepsy?

  1. Modafinil
  2. Melatonin
  3. Zolpidem
  4. Sodium oxybate Correct answer.

Explanation

Sodium oxybate reduces cataplexy frequency and is a first-line option, as are certain antidepressants such as venlafaxine. Modafinil treats daytime sleepiness but has little effect on cataplexy.

Question 37Diagnosis and management of clinical conditions that occur during sleep

A patient reports difficulty initiating sleep, with a bedtime that varies widely and a delayed sleep phase pattern. Which intervention is most appropriate?

  1. Daytime napping to compensate for sleep loss
  2. Evening bright light exposure
  3. Advancing bedtime by several hours at once
  4. Timed morning bright light exposure with a consistent sleep schedule Correct answer.

Explanation

Delayed sleep phase syndrome is treated with morning bright light and gradual advancement of the sleep schedule. Evening light exposure worsens phase delay.

Question 38Diagnosis and management of clinical conditions that occur during sleep

Which sleep stage is most strongly associated with arousals and autonomic instability in patients with untreated obstructive sleep apnea?

  1. Stage N2 sleep
  2. REM sleep Correct answer.
  3. Stage N1 sleep
  4. Stage N3 sleep

Explanation

REM sleep is associated with greater muscle atonia of the upper airway dilators and increased autonomic variability, making apneas and desaturations more severe and arousals more prominent. N3 sleep is associated with greater arousal threshold.

Question 39Diagnosis and management of clinical conditions that occur during sleep

A patient with insomnia is started on cognitive behavioral therapy for insomnia. Which component is central to this treatment?

  1. Extended time in bed to increase sleep opportunity
  2. Use of alcohol as a sleep aid
  3. Daytime napping to consolidate sleep
  4. Stimulus control to strengthen the association between bed and sleep Correct answer.

Explanation

Stimulus control is a core component of CBT-I, aimed at re-establishing the bed as a cue for sleep. It includes restricting time in bed and avoiding nonsleep activities in bed.

Question 40Diagnosis and management of clinical conditions that occur during sleep

Which finding on history most strongly suggests restless legs syndrome?

  1. Symptoms are worst in the morning and improve with rest
  2. Symptoms are accompanied by dream enactment
  3. Symptoms are limited to the arms
  4. Symptoms worsen in the evening and are relieved by movement Correct answer.

Explanation

The cardinal features of RLS include an urge to move the legs that worsens at rest and in the evening, with relief by movement. Morning predominance or dream enactment suggests other diagnoses.

Question 41Diagnosis and management of clinical conditions that occur during sleep

A 70-year-old with Parkinson disease has recurrent dream enactment with injury to his bed partner. Which medication class is most commonly associated with precipitating or worsening this condition?

  1. Inhaled corticosteroids
  2. Beta blockers
  3. Selective serotonin reuptake inhibitors Correct answer.
  4. Proton pump inhibitors

Explanation

SSRIs and other serotonergic antidepressants are commonly associated with REM sleep without atonia and can precipitate or worsen dream-enactment behaviors. The other classes are not typically implicated.

Question 42Diagnosis and management of clinical conditions that occur during sleep

A patient with narcolepsy has excessive daytime sleepiness despite lifestyle measures. Which medication is most appropriate for promoting wakefulness?

  1. Modafinil Correct answer.
  2. Zolpidem
  3. Melatonin
  4. Clonazepam

Explanation

Modafinil is a wake-promoting agent used for excessive daytime sleepiness in narcolepsy. Melatonin, zolpidem, and clonazepam do not promote wakefulness.

Question 43Diagnosis and management of clinical conditions that occur during sleep

A patient with severe OSA is intolerant of CPAP despite multiple interface trials. Which alternative therapy is most appropriate for a patient with a favorable airway anatomy and mild-to-moderate disease?

  1. Mandibular advancement device Correct answer.
  2. Positional therapy for all patients
  3. Weight loss alone
  4. Uvulopalatopharyngoplasty as first-line

Explanation

A mandibular advancement device is a reasonable alternative for patients with mild-to-moderate OSA who cannot tolerate PAP, particularly with favorable anatomy. Surgery and weight loss are adjuncts, not universal first-line alternatives.

Question 44Diagnosis and management of clinical conditions that occur during sleep

A 32-year-old pregnant woman at 30 weeks reports new loud snoring and witnessed apneas. Which management is most appropriate?

  1. Recommendation of supine sleep positioning
  2. Prompt evaluation for sleep-disordered breathing with treatment if confirmed Correct answer.
  3. Reassurance that snoring is normal in pregnancy
  4. Delay evaluation until after delivery

Explanation

New snoring and witnessed apneas in pregnancy warrant prompt evaluation because sleep-disordered breathing is associated with adverse maternal and fetal outcomes. Treatment, often with PAP, should be initiated if OSA is confirmed.

Question 45Diagnosis and management of clinical conditions that occur during sleep

Which finding on polysomnography is most characteristic of periodic limb movement disorder?

  1. Movements associated with dream enactment
  2. Limb movements occurring only during wakefulness
  3. Movements occurring exclusively in REM sleep
  4. Repetitive limb movements at intervals of about 20 to 40 seconds during sleep Correct answer.

Explanation

Periodic limb movement disorder is characterized by stereotyped, repetitive limb movements at intervals of roughly 20 to 40 seconds during sleep, often with arousals. Movements during wakefulness or dream enactment suggest other conditions.

Question 46Diagnosis and management of clinical conditions that occur during sleep

A patient with treated OSA reports persistent daytime sleepiness despite good adherence. Which test is most useful to objectively quantify sleepiness?

  1. Epworth Sleepiness Scale
  2. Overnight pulse oximetry
  3. Actigraphy
  4. Multiple sleep latency test Correct answer.

Explanation

The multiple sleep latency test provides an objective measure of sleep propensity and can help evaluate residual sleepiness or suspected narcolepsy. The Epworth scale is subjective, and oximetry and actigraphy do not quantify sleepiness.

Question 47Diagnosis and management of clinical conditions that occur during sleep

Which condition is most commonly associated with excessive daytime sleepiness in the general population?

  1. Insufficient sleep Correct answer.
  2. Idiopathic hypersomnia
  3. Kleine-Levin syndrome
  4. Narcolepsy

Explanation

Chronic insufficient sleep is the most common cause of excessive daytime sleepiness in the general population. Narcolepsy and idiopathic hypersomnia are rare causes.

Question 48Diagnosis and management of clinical conditions that occur during sleep

A patient with OSA has a predominantly supine apnea-hypopnea index. Which non-PAP intervention is most appropriate?

  1. Tracheostomy
  2. Mandibular advancement device
  3. Weight loss surgery
  4. Positional therapy to avoid supine sleep Correct answer.

Explanation

Positional therapy is appropriate for patients whose OSA occurs predominantly in the supine position. Other interventions are considered for broader disease or when positional therapy fails.

Question 49Diagnosis and management of clinical conditions that occur during sleep

Which statement about the relationship between sleep and seizures is most accurate?

  1. Seizures occur only during REM sleep
  2. Antiepileptic drugs have no effect on sleep architecture
  3. Nocturnal seizures are always psychogenic
  4. Sleep deprivation can lower the seizure threshold and provoke seizures Correct answer.

Explanation

Sleep deprivation is a well-recognized trigger that lowers the seizure threshold. Seizures can occur in any sleep stage, and some antiepileptic drugs alter sleep architecture.

Question 50Diagnosis and management of clinical conditions that occur during sleep

A patient with insomnia and depression is started on cognitive behavioral therapy for insomnia. Which outcome is most likely?

  1. Worsening of depressive symptoms
  2. Improvement in both sleep and depressive symptoms Correct answer.
  3. No effect on either sleep or mood
  4. Immediate resolution of depression

Explanation

CBT-I can improve both insomnia and depressive symptoms, and it is recommended as an adjunct in patients with comorbid depression. It does not replace treatment for depression.