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Primary spontaneous pneumothorax — SCE Respiratory MCQ

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HardPleural DiseasePrimary spontaneous pneumothoraxSCE Respiratory

Respiratory polygraphy shows mild obstructive sleep apnoea almost entirely while supine, with a normal non-supine event rate. The patient is not excessively sleepy and prefers a non-CPAP option. Which treatment is most specifically matched to this phenotype?

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Correct answer: D — Supine-avoidance positional therapy during sleep

A positional modifier can be considered for mild or moderate positional OSAHS when other treatments are unsuitable or declined. It directly targets the posture in which this patient’s obstruction occurs. CPAP would treat OSA but is not the preferred non-CPAP choice here; a mandibular advancement splint is an alternative for selected OSA generally but is less specifically matched to an almost exclusively supine phenotype, and surgery is not justified without an appropriate anatomical target.

Reference: NICE NG202 recommendations for obstructive sleep apnoea (Published 20 August 2021): https://www.nice.org.uk/guidance/ng202/chapter/1-Obstructive-sleep-apnoeahypopnoea-syndrome; NICE NG202 rationale for sleep-disordered breathing recommendations (Published 20 August 2021): https://www.nice.org.uk/guidance/ng202/chapter/Rationale-and-impact