Sleep Medicine Practice Questions

Q: What is the therapy of choice for sleep-apnea syndrome?

Non-invasive ventilation. **Explanation:** **1. Why Non-invasive Ventilation (NIV) is the Correct Choice:** The gold standard treatment for Obstructive Sleep Apnea (OSA) is **Continuous Positive Airway Pressure (CPAP)**, which is a form of non-invasive ventilation. The underlying pathophysiology of OSA is the collapse of the upper airway during sleep. CPAP acts as a **"pneumatic splint,"** providing constant positive pressure that keeps the pharyngeal airway open, preventing collapse and ensuring uninterrupted ventilation. **2. Why Other Options are Incorrect:** * **Invasive Ventilation:** This involves endotracheal intubation or tracheostomy. While a permanent tracheostomy is the most effective surgical cure for OSA (as it bypasses the obstruction), it is reserved for life-threatening cases due to its morbidity. It is not the first-line "therapy of choice." * **Oxygen Inhalation:** Oxygen may improve saturation but does not address the mechanical obstruction. In some patients, it can actually worsen hypercapnia (CO2 retention) by reducing the hypoxic respiratory drive. * **Respiratory Stimulants:** Drugs like acetazolamide or medroxyprogesterone have limited efficacy and significant side effects. They do not prevent the physical collapse of the airway, which is the primary issue in OSA. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Overnight Polysomnography (Sleep Study). * **Apnea-Hypopnea Index (AHI):** Diagnostic if AHI >5 with symptoms, or AHI >15 regardless of symptoms. * **First-line Surgery:** Uvulopalatopharyngoplasty (UPPP) is the most common surgery, but CPAP remains the primary medical therapy. * **Friedman Staging:** Used to predict the success of UPPP based on palate position, tonsil size, and BMI.

Q: What Apnea-hypopnea index (AHI) value is used for the diagnosis of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) in the absence of symptoms?

15 episodes/hr. ### Explanation The diagnosis of **Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)** is based on the **Apnea-Hypopnea Index (AHI)**, which measures the number of apnea and hypopnea events per hour of sleep recorded during polysomnography. According to the American Academy of Sleep Medicine (AASM) criteria, the diagnostic thresholds are: 1. **AHI ≥ 5 episodes/hr:** Diagnostic **ONLY IF** the patient has associated symptoms (e.g., daytime sleepiness, loud snoring, witnessed gasping) or co-morbidities (e.g., hypertension, ischemic heart disease). 2. **AHI ≥ 15 episodes/hr:** Diagnostic **regardless of the presence of symptoms**. In an asymptomatic patient, this higher threshold is required to confirm the syndrome. **Analysis of Options:** * **Option A (5 episodes/hr):** This is the minimum threshold for diagnosis, but it requires the presence of clinical symptoms. * **Option B (10 episodes/hr):** This value does not represent a standard diagnostic cutoff in current international guidelines. * **Option C (15 episodes/hr):** **Correct.** This is the definitive cutoff for diagnosing OSAHS in an asymptomatic individual. * **Option D (20 episodes/hr):** While this indicates moderate-to-severe OSAHS, it is not the minimum threshold for diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Overnight Polysomnography (Sleep Study). * **Severity Grading:** * Mild: AHI 5–15 * Moderate: AHI 15–30 * Severe: AHI > 30 * **Epworth Sleepiness Scale:** A subjective tool used to measure daytime sleepiness. * **Treatment of Choice:** Continuous Positive Airway Pressure (CPAP) is the gold standard for moderate-to-severe OSAHS. * **Surgical Procedure:** Uvulopalatopharyngoplasty (UPPP) is the most common surgical intervention.

Q: A 50-year-old male patient, a smoker with obesity and hypertension, reports loud snoring and has more than 5 episodes of apnea per hour of sleep. What is the next best management for the improvement of his symptoms?

Continuous Positive Airway Pressure (CPAP). ### Explanation **Correct Answer: B. Continuous Positive Airway Pressure (CPAP)** The patient presents with the classic triad of Obstructive Sleep Apnea (OSA): obesity, hypertension, and loud snoring. The diagnosis is confirmed by the presence of **more than 5 episodes of apnea/hypopnea per hour** (Apnea-Hypopnea Index or AHI ≥ 5). **Why CPAP is the correct answer:** CPAP is the **gold standard and first-line treatment** for OSA. It acts as a "pneumatic splint," providing constant positive pressure that keeps the pharyngeal airway open during inspiration and expiration, preventing collapse. In a patient with comorbidities like hypertension and obesity, CPAP not only improves sleep quality but also significantly reduces cardiovascular risks. **Analysis of Incorrect Options:** * **C. Weight reduction and diet control:** While essential as a long-term lifestyle modification, it is considered **adjunctive therapy**. It is rarely sufficient as a standalone treatment for symptomatic OSA and takes time to show results; immediate management requires CPAP. * **A. Uvulopalatoplasty (UPPP):** This is a surgical option reserved for patients who fail CPAP or have specific anatomical obstructions. It has lower success rates compared to CPAP and carries surgical risks. * **D. Mandibular repositioning surgery:** This (or oral appliances) is typically reserved for mild OSA or patients who are intolerant to CPAP. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Overnight Polysomnography (Sleep Study). * **AHI Grading:** Mild (5–15), Moderate (15–30), Severe (>30 episodes/hour). * **Friedman Staging:** Used to predict the success of UPPP based on palate position, tonsil size, and BMI. * **Muller’s Maneuver:** A flexible nasopharyngoscopy technique used to identify the site of airway collapse.

Q: Which of the following statements is not true regarding obstructive sleep apnea?

Spirometry is diagnostic. **Explanation:** Obstructive Sleep Apnea (OSA) is characterized by repetitive episodes of partial or complete upper airway obstruction during sleep. **Why Option D is the correct answer (False statement):** **Spirometry** is a pulmonary function test used to assess lung volumes and flow rates (primarily for COPD or Asthma); it is **not diagnostic** for OSA. The "Gold Standard" investigation for diagnosing OSA is **Polysomnography (Sleep Study)**. Polysomnography monitors multiple physiological parameters, including EEG, EOG, EMG, ECG, oxygen saturation, and airflow. An Apnea-Hypopnea Index (AHI) of >5 events per hour is typically diagnostic. **Analysis of other options:** * **Option A (True):** OSA involves repeated collapse of the pharyngeal airway, leading to **nocturnal asphyxia** (hypoxia and hypercapnia), which triggers arousal from sleep to restore airway patency. * **Option B (True):** **Alcohol** acts as a central nervous system depressant and a muscle relaxant. It reduces the tone of the genioglossus and other pharyngeal dilator muscles, significantly worsening airway collapse. * **Option C (True):** Chronic intermittent hypoxia and sympathetic nervous system activation lead to systemic inflammation and vasoconstriction. Consequently, OSA is a major independent risk factor for **systemic hypertension**, as well as pulmonary hypertension and cardiac arrhythmias. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Treatment:** CPAP (Continuous Positive Airway Pressure). * **Most common site of obstruction:** Retropalatal (Oropharynx). * **Muller’s Maneuver:** A clinical test (using flexible endoscopy) to identify the site of collapse. * **Epworth Sleepiness Scale:** Used to subjectively assess daytime somnolence. * **Surgical Procedure:** Uvulopalatopharyngoplasty (UPPP) is the most common surgery for selected cases.

Question 1

What is the therapy of choice for sleep-apnea syndrome?

Accepted Answer

Non-invasive ventilation

Answer

Invasive ventilation

Answer

Oxygen inhalation

Answer

Use of respiratory stimulants

Question 2

A 14-year-old girl, upon exposure to cold, experiences pallor of her extremities followed by pain and cyanosis. What is she prone to develop later in life?

Accepted Answer

Scleroderma

Answer

Systemic lupus erythematosus

Answer

Rheumatoid arthritis

Answer

Histiocytosis

Question 3

What Apnea-hypopnea index (AHI) value is used for the diagnosis of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) in the absence of symptoms?

Accepted Answer

15 episodes/hr

Answer

5 episodes/hr

Answer

10 episodes/hr

Answer

20 episodes/hr

Question 4

A 50-year-old male patient, a smoker with obesity and hypertension, reports loud snoring and has more than 5 episodes of apnea per hour of sleep. What is the next best management for the improvement of his symptoms?

Accepted Answer

Continuous Positive Airway Pressure (CPAP)

Answer

Uvulopalatoplasty

Answer

Weight reduction and diet control

Answer

Mandibular repositioning surgery

Question 5

Which of the following statements is not true regarding obstructive sleep apnea?

Accepted Answer

Spirometry is diagnostic

Answer

Associated with nocturnal asphyxia

Answer

Alcoholism can act as a cofactor

Answer

Patients are prone to hypertension

Sleep Medicine — MCQs

Sleep Medicine — MCQs

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