Sleep Medicine and Airway
Sleep Medicine and Airway
This domain tests obstructive sleep apnea (OSA) diagnosis, positive airway pressure, oral appliances, upper airway surgery, and pediatric OSA. The exam focuses on severity thresholds and appropriate patient selection.
Core rules
- OSA is diagnosed by apnea-hypopnea index (AHI) or respiratory disturbance index. AHI at least 5 with symptoms or AHI at least 15 establishes OSA.
- CPAP is first-line for moderate-to-severe OSA. Mandibular advancement devices are for mild-to-moderate disease or CPAP intolerance.
- Hypoglossal nerve stimulation is considered for moderate-to-severe OSA when CPAP fails and anatomy is suitable; drug-induced sleep endoscopy helps exclude complete concentric collapse.
- Adenotonsillectomy is first-line for pediatric OSA with adenotonsillar hypertrophy.
- Central sleep apnea requires different evaluation; CPAP alone may not be appropriate.
Worked example
A 45-year-old has AHI 22, BMI 31, and cannot tolerate CPAP. Sleep endoscopy shows no complete concentric collapse. The patient is a candidate for hypoglossal nerve stimulation after counseling. The reasoning is moderate-to-severe OSA, CPAP failure, and suitable anatomy.
Traps
Do not diagnose OSA from snoring alone. Do not offer surgery before confirming severity. Do not ignore BMI and cardiovascular risk in perioperative planning. Do not assume all sleep apnea is obstructive.