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Question 1Sleep and Sleep Disorder Fundamentals

Which sleep stage is characterized by sleep spindles and K-complexes?

  1. Stage R
  2. Stage N3
  3. Stage N1
  4. Stage N2 Correct answer.

Explanation

Stage N2 is scored when sleep spindles or K-complexes appear and the epoch does not meet criteria for N3. These thalamocortical transients signal established, stable non-REM sleep and occupy the largest share of a normal night.

Question 2Sleep and Sleep Disorder Fundamentals

Which structure serves as the master circadian pacemaker in mammals?

  1. Paraventricular nucleus
  2. Suprachiasmatic nucleus Correct answer.
  3. Raphe magnus
  4. Locus coeruleus

Explanation

The suprachiasmatic nucleus of the anterior hypothalamus generates a near-24-hour rhythm and is entrained to light through the retinohypothalamic tract. It coordinates peripheral clocks and drives the pineal melatonin rhythm.

Question 3Sleep and Sleep Disorder Fundamentals

The recommended nightly sleep duration for most healthy adults is:

  1. 4 to 5 hours
  2. 10 to 12 hours
  3. 7 to 9 hours Correct answer.
  4. 6 to 7 hours

Explanation

Consensus statements from sleep and medical societies recommend at least 7 hours per night for adults, with 7 to 9 hours typical. Habitual sleep under about 6 hours is linked to cardiometabolic, immune, and cognitive risk.

Question 4Sleep and Sleep Disorder Fundamentals

Which substance accumulates in the brain during wakefulness and generates homeostatic sleep pressure?

  1. Adenosine Correct answer.
  2. Melatonin
  3. Orexin
  4. Histamine

Explanation

Adenosine rises as ATP is consumed during wakefulness and inhibits wake-promoting neurons, producing sleep pressure that dissipates during sleep. Caffeine produces alertness by blocking adenosine receptors.

Question 5Sleep and Sleep Disorder Fundamentals

In a healthy adult, one complete sleep cycle lasts approximately:

  1. 180 minutes
  2. 30 minutes
  3. 90 minutes Correct answer.
  4. 20 minutes

Explanation

Non-REM and REM sleep alternate in cycles of roughly 90 minutes, giving four to six cycles per night. Early cycles are slow-wave rich, while later cycles contain progressively longer REM periods.

Question 6Sleep and Sleep Disorder Fundamentals

Which feature is characteristic of REM sleep in a healthy adult?

  1. Skeletal muscle atonia Correct answer.
  2. Sleep spindles
  3. Vertex sharp waves
  4. High-amplitude delta activity

Explanation

REM sleep combines low-voltage mixed-frequency EEG, rapid eye movements, and active inhibition of skeletal muscle tone. This atonia prevents the dreamer from acting out dream content.

Question 7Sleep and Sleep Disorder Fundamentals

A patient reports sleeping 6.5 hours during a night with 8 hours spent in bed. What is the sleep efficiency?

  1. 75%
  2. 92%
  3. 81% Correct answer.
  4. 65%

Explanation

Sleep efficiency is total sleep time divided by time in bed, multiplied by 100; here 6.5 divided by 8 equals 0.8125, or about 81%. Values of 85% or higher are generally considered normal in adults.

Question 8Sleep and Sleep Disorder Fundamentals

A mean sleep latency of 6 minutes on the Multiple Sleep Latency Test is:

  1. Normal
  2. Borderline
  3. Abnormal Correct answer.
  4. Equivocal

Explanation

A mean sleep latency of 8 minutes or less on the MSLT indicates pathologic daytime sleepiness. Latencies of 10 minutes or more are normal, and values between 8 and 10 minutes are considered ambiguous.

Question 9Sleep and Sleep Disorder Fundamentals

Narcolepsy type 1 results from loss of neurons that produce which neurotransmitter?

  1. Dopamine
  2. Acetylcholine
  3. Orexin Correct answer.
  4. Serotonin

Explanation

Narcolepsy type 1 is caused by autoimmune destruction of hypothalamic neurons producing hypocretin, also called orexin. The deficiency explains cataplexy and the strong tendency toward sleep-onset REM periods.

Question 10Sleep and Sleep Disorder Fundamentals

According to AASM scoring rules, an EEG arousal is an abrupt shift in EEG frequency lasting at least:

  1. 10 seconds
  2. 3 seconds Correct answer.
  3. 1 second
  4. 5 seconds

Explanation

An arousal requires an abrupt shift of EEG frequency, including alpha, theta, or frequencies above 16 Hz but not spindles, lasting at least 3 seconds. In REM, concurrent increase in submental EMG is also required.

Question 11Sleep and Sleep Disorder Fundamentals

When no symptoms are present, obstructive sleep apnea is diagnosed when the apnea-hypopnea index reaches at least:

  1. 15 events per hour Correct answer.
  2. 10 events per hour
  3. 30 events per hour
  4. 5 events per hour

Explanation

Diagnostic criteria require an apnea-hypopnea index of 5 or more with symptoms or comorbidities, or 15 or more regardless of symptoms. An index of 30 or more defines severe disease.

Question 12Sleep and Sleep Disorder Fundamentals

Slow wave sleep in stage N3 is characterized by EEG waves in which frequency band?

  1. 16 to 30 Hz
  2. 12 to 15 Hz
  3. 8 to 13 Hz
  4. 0.5 to 2 Hz Correct answer.

Explanation

Stage N3 requires at least 20% of the epoch to contain waves of 0.5 to 2 Hz with peak-to-peak amplitude above 75 microvolts. These delta waves reflect synchronized cortical activity and are most prominent in the first third of the night.

Question 13Sleep and Sleep Disorder Fundamentals

Compared with young adults, healthy older adults typically show which change in sleep?

  1. Higher REM percentage
  2. Longer total sleep time
  3. Less slow wave sleep Correct answer.
  4. Shorter sleep onset latency

Explanation

Aging reduces slow wave sleep and increases the number of awakenings, lowering sleep efficiency. Circadian phase also advances, so older adults often become sleepy and wake earlier.

Question 14Sleep and Sleep Disorder Fundamentals

Which feature is required for the clinical diagnosis of restless legs syndrome?

  1. Periodic limb movements on PSG
  2. Daytime sleepiness
  3. Low serum ferritin
  4. Urge to move relieved by activity Correct answer.

Explanation

Restless legs syndrome is a clinical diagnosis requiring an urge to move the legs that worsens with rest and in the evening, is relieved by movement, and causes distress. Polysomnographic leg movements and iron studies support but do not establish the diagnosis.

Question 15Sleep and Sleep Disorder Fundamentals

REM sleep behavior disorder is best described as:

  1. Sleep-onset REM periods
  2. Failure of REM muscle atonia Correct answer.
  3. Excessive slow wave sleep
  4. Recurrent confusional arousals

Explanation

In REM sleep behavior disorder the normal paralysis of REM sleep fails, allowing patients to act out dreams, often violently. It is strongly associated with later development of synucleinopathies such as Parkinson disease.

Question 16Sleep and Sleep Disorder Fundamentals

Which effect does alcohol consumed near bedtime have on sleep architecture?

  1. Eliminates slow wave sleep
  2. Suppresses REM sleep Correct answer.
  3. Increases REM sleep
  4. Increases total sleep time

Explanation

Alcohol shortens sleep latency but suppresses REM sleep in the first half of the night and causes REM rebound and fragmentation later. It also relaxes upper airway muscles, worsening snoring and apnea.

Question 17Sleep and Sleep Disorder Fundamentals

In the two-process model of sleep regulation, process C refers to:

  1. Circadian sleep-wake propensity Correct answer.
  2. Homeostatic sleep debt
  3. Thermoregulatory drift
  4. Ultradian REM cycling

Explanation

Process C is the circadian component generated by the suprachiasmatic nucleus, which modulates alertness across the day independently of time awake. Process S is the homeostatic component that rises with wakefulness and falls during sleep; sleep timing reflects their interaction.

Question 18Sleep and Sleep Disorder Fundamentals

Exogenous melatonin is best described as:

  1. A circadian phase shifter Correct answer.
  2. A muscle relaxant
  3. A direct hypnotic
  4. An adenosine antagonist

Explanation

Melatonin acts on MT1 and MT2 receptors and shifts circadian phase, advancing it when taken in the evening and delaying it when taken in the morning. Its hypnotic effect is modest; its main clinical value is chronobiotic timing.

Question 19Sleep and Sleep Disorder Fundamentals

Slow eye movements with a transition from alpha to theta activity are most characteristic of which stage?

  1. Stage N1 Correct answer.
  2. Stage R
  3. Stage N2
  4. Stage N3

Explanation

Stage N1 marks the transition from wake to sleep, with attenuation of alpha rhythm, prominent theta activity, and slow rolling eye movements. Vertex sharp waves may appear late in N1.

Question 20Sleep and Sleep Disorder Fundamentals

Dim light melatonin onset is used clinically mainly to:

  1. Diagnose restless legs syndrome
  2. Estimate circadian phase Correct answer.
  3. Measure sleep apnea severity
  4. Quantify sleep efficiency

Explanation

Dim light melatonin onset is the clock time at which melatonin rises above a threshold under dim light, serving as a reliable marker of circadian phase. It helps identify delayed or advanced phase disorders and guide the timing of light and melatonin therapy.

Question 21Sleep and Sleep Disorder Fundamentals

Sleep terrors in children typically arise from which sleep stage?

  1. Stage N1
  2. Stage N2
  3. Stage N3 Correct answer.
  4. Stage R

Explanation

Sleep terrors are non-REM parasomnias that emerge from slow wave sleep, usually in the first third of the night. The child appears terrified but is not fully awake and typically has no recall of the event.

Question 22Sleep and Sleep Disorder Fundamentals

Narcolepsy is supported when the MSLT shows a mean sleep latency of 8 minutes or less plus at least how many sleep-onset REM periods?

  1. One
  2. Three
  3. Four
  4. Two Correct answer.

Explanation

The MSLT criteria for narcolepsy require a mean sleep latency of 8 minutes or less and at least two sleep-onset REM periods. A sleep-onset REM period on the preceding polysomnogram may substitute for one of the two.

Question 23Sleep and Sleep Disorder Fundamentals

The majority of daily growth hormone secretion occurs during which state?

  1. REM sleep
  2. Slow wave sleep Correct answer.
  3. Stage N1
  4. Quiet wakefulness

Explanation

Growth hormone is released in pulses, with the largest pulse coupled to the first slow wave sleep period of the night. This explains why disrupted or delayed sleep can blunt growth hormone output.

Question 24Sleep and Sleep Disorder Fundamentals

A patient who consistently falls asleep at 3 a.m. and wakes at 11 a.m. with refreshing sleep when allowed this schedule most likely has:

  1. Advanced sleep phase syndrome
  2. Insomnia disorder
  3. Delayed sleep phase syndrome Correct answer.
  4. Shift work disorder

Explanation

Delayed sleep phase syndrome involves a habitual sleep-wake timing delayed by two or more hours relative to societal norms, with normal sleep quality when the person follows their own schedule. Morning light exposure and evening melatonin are used to advance the phase.

Question 25Sleep and Sleep Disorder Fundamentals

Which intervention is the primary chronobiotic treatment for delayed sleep phase syndrome?

  1. Nighttime exercise
  2. Afternoon caffeine
  3. Evening bright light
  4. Morning bright light Correct answer.

Explanation

Bright light in the biological morning phase-advances the circadian clock, moving sleep timing earlier. Evening light would delay the clock further and should be limited in these patients.

Question 26Sleep and Sleep Disorder Fundamentals

Which pair of EEG features defines stage N2 sleep in a healthy adult?

  1. Vertex sharp waves and slow rolling eye movements
  2. Sawtooth waves and rapid eye movements
  3. Alpha rhythm occupying more than half of the epoch
  4. Sleep spindles and K-complexes Correct answer.

Explanation

Stage N2 is scored when the EEG shows sleep spindles, K-complexes, or both, in the absence of criteria for N3 or R. Once N2 begins, it continues until the patient transitions to another stage, wakes, or has an arousal followed by N1-like EEG.

Question 27Sleep and Sleep Disorder Fundamentals

The master circadian pacemaker that coordinates daily rhythms in humans is located in which structure?

  1. Raphe nuclei of the brainstem
  2. Pineal gland in the epithalamus
  3. Suprachiasmatic nucleus Correct answer.
  4. Locus coeruleus of the pons

Explanation

The suprachiasmatic nucleus of the anterior hypothalamus generates the endogenous circadian rhythm and receives photic input from the retina via the retinohypothalamic tract. It then entrains peripheral clocks and drives rhythms such as the evening rise in melatonin.

Question 28Sleep and Sleep Disorder Fundamentals

Approximately how long does one complete sleep cycle last in a healthy adult?

  1. 150 minutes
  2. 30 minutes
  3. 90 minutes Correct answer.
  4. 60 minutes

Explanation

Adult sleep is organized into cycles of roughly 90 minutes that progress from N1 through N2 and N3 into REM. The proportion of REM lengthens across the night while N3 shortens, so later cycles are REM-rich.

Question 29Sleep and Sleep Disorder Fundamentals

Which substance accumulates in the brain during prolonged wakefulness and increases homeostatic sleep pressure?

  1. Orexin (hypocretin)
  2. Adenosine Correct answer.
  3. Melatonin
  4. Gamma-aminobutyric acid

Explanation

Adenosine builds up in the brain with time awake and inhibits wake-promoting circuits, generating the homeostatic component of sleep drive. Its levels fall during sleep, and caffeine produces alertness by blocking adenosine receptors.

Question 30Sleep and Sleep Disorder Fundamentals

An adult has difficulty initiating and maintaining sleep at least three nights per week for five months and reports daytime fatigue and poor concentration; no other sleep, medical, or psychiatric disorder explains the symptoms. Which diagnosis fits best?

  1. Restless legs syndrome
  2. Insomnia disorder Correct answer.
  3. Delayed sleep phase syndrome
  4. Narcolepsy type 2

Explanation

Insomnia disorder requires a persistent complaint of initiating or maintaining sleep, or early awakening, occurring at least three nights per week for at least three months with associated daytime impairment. When another disorder fully accounts for the symptoms, that disorder is diagnosed instead.

Question 31Sleep and Sleep Disorder Fundamentals

Which finding qualifies as a hypopnea under the AASM recommended adult scoring rule?

  1. A 30 percent airflow reduction with a 3 percent desaturation or an arousal Correct answer.
  2. Complete cessation of airflow lasting at least ten seconds with persistent respiratory effort
  3. A 10 percent airflow reduction with a 2 percent desaturation and an arousal
  4. A 50 percent airflow reduction with a 4 percent desaturation and no arousal

Explanation

The recommended adult rule scores a hypopnea when airflow falls by at least 30 percent from baseline for at least ten seconds and is accompanied by a desaturation of at least 3 percent or an arousal. An alternative accepted rule uses a 50 percent reduction with a 4 percent desaturation.

Question 32Sleep and Sleep Disorder Fundamentals

Which item is a component of the STOP-BANG questionnaire for obstructive sleep apnea risk?

  1. Mallampati class 3 or 4
  2. Neck circumference greater than 40 cm Correct answer.
  3. Witnessed apneas recorded during polysomnography
  4. Epworth Sleepiness Scale score above 10

Explanation

STOP-BANG combines Snoring, Tiredness, Observed apnea, Pressure (hypertension), BMI, Age, Neck circumference, and Gender. A neck circumference over 40 cm is the 'N' item; the tool is a screening questionnaire and does not require sleep study data.

Question 33Sleep and Sleep Disorder Fundamentals

A 40-year-old woman repeatedly awakens at night, walks to the kitchen, and eats large amounts of food that she does not recall the next morning. These episodes are best classified as which phenomenon?

  1. Sleep-related hallucinations
  2. Dream enactment from REM sleep behavior disorder
  3. Nocturnal eating related to binge-eating disorder
  4. Sleep-related eating as a disorder of arousal Correct answer.

Explanation

Sleep-related eating disorder is a partial arousal from NREM sleep in which patients eat, often with amnesia for the event. Because the behavior arises from non-REM sleep, it is grouped with the disorders of arousal rather than with eating disorders or REM parasomnias.

Question 34Sleep and Sleep Disorder Fundamentals

A patient drinks two cups of coffee at 4 p.m. and again has trouble falling asleep at 11 p.m. Which property of caffeine best explains this?

  1. A half-life near 5 hours leaves active drug at bedtime Correct answer.
  2. Complete renal clearance of the dose within 90 minutes
  3. Direct agonism at adenosine receptors increases sleep drive
  4. Suppression of melatonin synthesis lasting about 20 minutes

Explanation

Caffeine is eliminated with an average half-life of about five hours, so a substantial fraction of an afternoon dose remains in the body at bedtime. It promotes wakefulness by antagonizing adenosine receptors rather than by acting on melatonin.

Question 35Sleep and Sleep Disorder Fundamentals

Sleep restriction therapy for chronic insomnia typically begins by:

  1. Limiting time in bed to near the patient's average total sleep time Correct answer.
  2. Extending the time allowed in bed to at least nine hours to reduce performance anxiety
  3. Moving bedtime two hours earlier each night until sleep onset becomes immediate
  4. Adding a daily afternoon nap of at least 60 minutes

Explanation

Sleep restriction therapy compresses time in bed to approximate the patient's measured average total sleep time, which increases homeostatic sleep drive and consolidates sleep. Time in bed is then titrated upward as sleep efficiency improves, generally targeting 85 to 90 percent.

Question 36Sleep and Sleep Disorder Fundamentals

A patient reports waking from sleep and being unable to move or speak for up to a minute while fully aware of the surroundings. Which phenomenon is this?

  1. Cataplexy
  2. Confusional arousal
  3. Sleep paralysis Correct answer.
  4. Nocturnal seizure

Explanation

Sleep paralysis is a REM-related phenomenon in which muscle atonia persists briefly after awakening while consciousness is already restored. Episodes are often triggered by supine sleep and sleep deprivation and can occur in otherwise healthy people as well as in narcolepsy.

Question 37Sleep and Sleep Disorder Fundamentals

Which breathing pattern is characteristic of Cheyne-Stokes respiration during sleep?

  1. Rapid irregular breathing without apneic pauses
  2. Repetitive obstructive apneas terminated by arousals
  3. Waxing and waning tidal volume with central apneas Correct answer.
  4. Sustained hypoventilation with a chronically elevated baseline carbon dioxide

Explanation

Cheyne-Stokes respiration is a central sleep apnea pattern with a crescendo-decrescendo change in tidal volume separated by central apneas or hypopneas. It reflects unstable ventilatory control, classically in heart failure and after stroke.

Question 38Sleep and Sleep Disorder Fundamentals

A patient reports sleeping only about three hours each night, but two weeks of actigraphy shows a mean total sleep time of seven hours. Which condition best fits this discrepancy?

  1. Psychophysiological insomnia
  2. Idiopathic hypersomnia
  3. Paradoxical insomnia Correct answer.
  4. Advanced sleep phase syndrome

Explanation

Paradoxical insomnia, also called sleep state misperception, is characterized by a large discrepancy between subjective sleep reports and objective measures that show near-normal sleep. The complaint is genuine even though recorded sleep duration is not severely reduced.

Question 39Sleep and Sleep Disorder Fundamentals

On the Multiple Sleep Latency Test, a sleep-onset REM period is defined as REM sleep beginning within how many minutes of sleep onset?

  1. 15 minutes Correct answer.
  2. 20 minutes
  3. 30 minutes
  4. 5 minutes

Explanation

A sleep-onset REM period is scored when REM sleep appears within 15 minutes of the first epoch of sleep during a nap opportunity. Two or more sleep-onset REM periods across the five naps support a diagnosis of narcolepsy when other criteria are met.

Question 40Sleep and Sleep Disorder Fundamentals

A 5-year-old's polysomnogram shows cessation of airflow for 8 seconds with continued thoracoabdominal effort and a 4 percent oxygen desaturation. How should the event be scored?

  1. As an obstructive apnea, because two breaths suffice in children Correct answer.
  2. As a normal variant, because the desaturation was under 5 percent
  3. As a central apnea, because respiratory effort continued through the event
  4. As a hypopnea, because the event lasted less than ten seconds

Explanation

Pediatric scoring rules define an apnea by duration of at least two missed breaths rather than ten seconds, so a brief event in a child may still be an apnea. Continued effort with airflow cessation indicates obstruction, and a 4 percent desaturation is not required but supports the score.

Question 41Patient Assessment and Sleep Health History

Which set of variables is most appropriate to record in a prospective sleep diary?

  1. Limb movement index, REM latency, and sleep efficiency
  2. Serum melatonin, cortisol, and core body temperature
  3. Bedtime, rise time, naps, and estimated sleep latency Correct answer.
  4. Apnea-hypopnea index, oxygen nadir, and arousal count

Explanation

A sleep diary is a prospective self-report that captures bedtimes, rise times, sleep latency, awakenings, naps, and daytime sleepiness. It reveals night-to-night variability and habitual timing that a single-night laboratory study cannot show. Physiologic measures such as AHI, oximetry, and limb movements come from sleep testing, not a diary.

Question 42Patient Assessment and Sleep Health History

The Epworth Sleepiness Scale asks the patient to rate which of the following?

  1. Frequency of snoring and witnessed breathing pauses
  2. Chance of dozing in eight common sedentary situations Correct answer.
  3. Time required to fall asleep on a typical night at home
  4. Sleep quality over the previous four weeks

Explanation

The Epworth Sleepiness Scale asks the respondent to rate the likelihood of dozing in eight sedentary situations, such as sitting and reading or riding as a passenger. Scores range from 0 to 24, and a total above 10 suggests excessive daytime sleepiness. It measures trait sleepiness rather than sleep quality, snoring, or sleep latency.

Question 43Patient Assessment and Sleep Health History

Which item is a component of the STOP-BANG questionnaire?

  1. Sleep efficiency calculated from a two-week sleep diary
  2. Treated hypertension, recorded as a yes-or-no item Correct answer.
  3. Daytime sleep latency measured during a multiple sleep latency test
  4. Oxygen saturation nadir obtained from overnight oximetry

Explanation

STOP-BANG stands for Snoring, Tiredness, Observed apnea, Pressure (treated hypertension), BMI, Age, Neck circumference, and Gender. Treated hypertension is the P item, and each positive item adds one point. Sleep latency, sleep efficiency, and oximetry are not components of this screening tool.

Question 44Patient Assessment and Sleep Health History

The Insomnia Severity Index is designed primarily to quantify which domain?

  1. Objective sleep architecture on polysomnography
  2. Risk of moderate-to-severe obstructive sleep apnea
  3. Daytime alertness during a maintenance of wakefulness test
  4. Patient-perceived insomnia severity and daytime impact Correct answer.

Explanation

The Insomnia Severity Index is a seven-item self-report measure of perceived insomnia severity, including difficulty falling and staying asleep, early awakening, satisfaction with sleep, daytime impairment, worry, and distress. It is not a diagnostic test for sleep apnea or a measure of objective sleep architecture.

Question 45Patient Assessment and Sleep Health History

Which medication history detail is most important when evaluating a patient with suspected insomnia?

  1. Family history of hypertension and diabetes mellitus
  2. Timing and dose of stimulants, steroids, and sedating agents Correct answer.
  3. Number of prior surgical procedures requiring general anesthesia
  4. Use of topical antibiotics within the past twelve months

Explanation

Many medications can alter sleep or wakefulness: stimulants and steroids may cause insomnia, while sedatives, opioids, and some antidepressants can increase daytime sleepiness or worsen breathing. Recording the timing and dose helps distinguish medication effects from primary sleep disorders. Topical antibiotics, family hypertension history, and prior surgeries are less directly relevant to insomnia timing.

Question 46Patient Assessment and Sleep Health History

A patient reports difficulty staying asleep. Which history question best clarifies a potential substance contributor?

  1. How many hours per week do you spend exercising outdoors in daylight?
  2. Have you ever been tested for iron deficiency or thyroid disease?
  3. Do you eat breakfast at approximately the same time each morning?
  4. When do you consume caffeine and alcohol relative to bedtime? Correct answer.

Explanation

Caffeine has a long half-life and can impair sleep onset and continuity when consumed in the afternoon or evening. Alcohol may shorten sleep latency but typically fragments sleep later in the night and can worsen snoring. Asking about timing relative to bedtime clarifies whether the substance is contributing before other causes are pursued.

Question 47Patient Assessment and Sleep Health History

When taking a sleep history from a parent of a school-aged child, which question best screens for sleep-disordered breathing?

  1. Does the child snore or pause breathing during sleep? Correct answer.
  2. How many minutes does the child nap after school each weekday?
  3. What time does the child usually finish homework on weeknights?
  4. Does the child prefer a nightlight or a completely dark bedroom?

Explanation

Snoring, mouth breathing, and witnessed pauses in breathing are key screening symptoms for pediatric obstructive sleep apnea. Children may also present with restless sleep, enuresis, or daytime behavior problems. Nightlight preference, after-school naps, and homework timing do not directly screen for sleep-disordered breathing.

Question 48Patient Assessment and Sleep Health History

Which patient is the most appropriate candidate for a home sleep apnea test rather than in-laboratory polysomnography?

  1. A stable adult with high pretest probability of moderate-to-severe OSA Correct answer.
  2. A child with suspected obstructive sleep apnea and enlarged tonsils
  3. A patient with severe heart failure and nightly Cheyne-Stokes breathing
  4. A patient with suspected narcolepsy and cataplexy

Explanation

Home sleep apnea testing is appropriate for stable adults with a high pretest probability of moderate-to-severe obstructive sleep apnea and no major cardiopulmonary or neurologic comorbidity. It is not appropriate when central sleep apnea, hypoventilation, narcolepsy, or pediatric OSA is suspected. Those situations require attended polysomnography or specialized testing.

Question 49Patient Assessment and Sleep Health History

During a sleep history, a patient reports “I fall asleep fine but wake at 3 a.m. and cannot return to sleep.” Which term best describes this pattern?

  1. Sleep-onset insomnia
  2. Advanced sleep-wake phase disorder
  3. Sleep-maintenance insomnia Correct answer.
  4. Sleep state misperception

Explanation

Waking during the night and having difficulty returning to sleep is sleep-maintenance insomnia. Sleep-onset insomnia refers to difficulty falling asleep at the beginning of the night. Advanced sleep-wake phase disorder shifts sleep earlier but does not by itself explain frequent middle-of-the-night awakenings.

Question 50Patient Assessment and Sleep Health History

The Pittsburgh Sleep Quality Index produces a global score that reflects which time frame?

  1. The previous year
  2. The previous seven days
  3. The previous month Correct answer.
  4. The previous three months

Explanation

The Pittsburgh Sleep Quality Index asks about sleep over the preceding month and yields a global score plus component scores. A global score above 5 is often used to indicate poor sleep quality. It is not a one-week, three-month, or one-year recall instrument.