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Obstructive sleep apnea — ABIM Board MCQ

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ModeratePulmonary/Critical CareObstructive sleep apneaABIM Board

A 52-year-old man is evaluated for loud habitual snoring, witnessed apneas, morning headaches, and excessive daytime sleepiness. His BMI is 36 kg/m2, and his neck circumference is 18 inches. He has hypertension controlled with two medications. Serum bicarbonate is 25 mEq/L, and resting oxygen saturation is 96% on room air. He has no significant cardiopulmonary or neuromuscular disease, history of stroke, chronic opioid use, or severe insomnia. Which of the following is the most appropriate initial diagnostic study?

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Correct answer: B — Attended polysomnography or technically adequate home sleep apnea testing

This patient has a high probability of moderate-to-severe obstructive sleep apnea based on daytime sleepiness, loud snoring, witnessed apneas, obesity, increased neck circumference, and hypertension. Because he is an uncomplicated adult without significant cardiopulmonary disease, neuromuscular weakness, stroke, chronic opioid use, severe insomnia, or suspected hypoventilation, diagnosis may be established with either attended polysomnography or technically adequate home sleep apnea testing. Stand-alone pulse oximetry does not adequately diagnose OSA. Multiple sleep latency testing evaluates central disorders of hypersomnolence such as narcolepsy. An arterial blood gas is used when awake hypoventilation is suspected, not to diagnose OSA. Drug-induced sleep endoscopy may assist procedural planning after OSA is established but is not an initial diagnostic test.

Reference: Kapur VK, et al. American Academy of Sleep Medicine. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea, Recommendations 2-4. J Clin Sleep Med. 2017;13:479-504. https://pubmed.ncbi.nlm.nih.gov/28162150/