Sleep Apnea

Question 1

Causes daytime sleepiness and impaired daily function.

Answer 1

OSA

Question 2

Diagnosis requires the patient to have (1) either symptoms of nocturnal breathing disturbances (snoring, snorting, gasping, or breathing pauses during sleep) or daytime sleepiness or fatigue that occurs despite sufficient opportunity to sleep and is unexplained by other medical problems; and (2) five or more episodes of obstructive apnea or hypopnea per hour of sleep (the apnea-hypopnea index [AHI], calculated as the number of episodes divided by the number of hours of sleep) documented during a sleep study.

Question 3

OSA also may be diagnosed in the absence of symptoms if the AHI is ____ episodes/h.

Answer 3

≥15

Question 4

OSA may be most severe during ____, when neuromuscular output to the skeletal muscles is particularly low, and in the supine position due to gravitational forces.

Answer 4

rapid eye movement (REM) sleep

Question 5

Which of the following factors is MOST responsible for the occurrence of obstructive sleep apnea (OSA)?

A. Collapse of the pharyngeal airway due to reduced neuromuscular output during sleep
B. Increased activation of the pharyngeal dilator muscles during sleep
C. Presence of fixed bone or cartilage in the pharyngeal airway
D. Increased sensitivity to oxygen levels during sleep

Answer 5

A

Question 6

Which site is the MOST COMMON location of airway collapse in obstructive sleep apnea?

A. Tongue base
B. Epiglottis
C. Lateral pharyngeal walls
D. Soft palate

Answer 6

D

Question 7

Which site is the MOST COMMON location of airway collapse in obstructive sleep apnea?

A. Tongue base
B. Epiglottis
C. Lateral pharyngeal walls
D. Soft palate

Answer 7

D

Question 8

Which of the following statements regarding pharyngeal muscle activity during sleep is CORRECT?

A. Pharyngeal muscle activity increases during non-REM sleep.
B. Pharyngeal muscle activity is consistently high during all stages of sleep.
C. Pharyngeal muscle activity decreases significantly during REM sleep.
D. Pharyngeal muscle activity is controlled by oxygen levels rather than CO₂ levels.

Answer 8

C

Question 9

The major risk factors for OSA are ___

Answer 9

obesity, male sex, and older age

Question 10

Approximately 40–60% of cases of OSA are attributable to ____

Answer 10

excess weight.

Question 11

_____ are at a fourfold or greater risk for OSA than their normal-weight counterparts.

Answer 11

Obese individuals

Question 12

Factors that predispose men to OSA include ___pattern of obesity (resulting in upper-airway and abdominal fat deposition) and relatively ___ pharyngeal length, which increases collapsibility.

Answer 12

android

greater

Question 13

Which of the following changes in body weight is MOST likely to worsen obstructive sleep apnea (OSA)?

A. A 5% weight loss
B. A 10% weight gain
C. Stable weight
D. Fluctuations within 2% of body weight

Answer 13

B

Question 14

Which anatomical feature MOST commonly contributes to increased OSA risk in non-obese patients?

A. Retrognathia
B. Increased lung volume
C. Wide pharyngeal airway
D. Increased nasal resistance

Answer 14

A

Question 15

What is the MOST likely reason men have a higher prevalence of OSA compared to premenopausal women?

A. Longer pharyngeal length and android fat distribution
B. Higher lung volumes and chest wall compliance
C. Higher estrogen and progesterone levels
D. Greater lower-body fat distribution

Answer 15

A

Question 16

Which of the following BEST describes the influence of family history on OSA risk?

A. No association with familial history
B. First-degree relatives have a twofold higher risk of developing OSA
C. Genetic factors increase the risk only in obese individuals
D. Risk is limited to middle-aged adults with a family history of OSA

Answer 16

B

Question 17

What is the primary reason for the decline in OSA prevalence in children after age 8?

A. Decreased craniofacial abnormalities
B. Regression of lymphoid tissue
C. Increased physical activity
D. Reduced sensitivity to CO₂ levels

Answer 17

B

Question 18

The most common daytime symptom is ______, identified by a history of difficulty maintaining alertness or involuntary periods of dozing.

Answer 18

excessive daytime sleepiness

Question 19

The gold standard for diagnosis of OSA is an ____

Answer 19

overnight polysomnogram (PSG).

Question 19

The key physiologic information collected during a sleep study for OSA assessment includes measurement of ____

Answer 19

breathing (changes in airflow, respiratory excursion)

oxygenation (hemoglobin oxygen saturation)

body position

cardiac rhythm.

Question 19

____ is the standard medical therapy with the highest level of evidence for efficacy.

Answer 19

CPAP

Question 19

____ is often caused by an increased sensitivity to Pco 2 , which leads to an unstable breathing pattern that manifests as hyperventilation alternating with apnea.

Answer 19

CSA

Question 20

Crescendo-decrescendo breathing with alternating hyperventilation and apnea.

Answer 20

Cheyne-Stokes Breathing (CSB):

Question 21

CSA is an independent risk factor for the development of both ___and ____

Answer 21

heart failure
atrial fibrillation,

Question 22

CSA may be an early marker of ____

Answer 22

subclinical myocardial dysfunction

Question 23

Which of the following treatments is CONTRAINDICATED in a patient with central sleep apnea (CSA) and heart failure with reduced ejection fraction?

A. Adaptive servoventilation (ASV)
B. Supplemental oxygen
C. Optimization of heart failure therapy
D. Discontinuation of opioid medications

Answer 23

A

Question 24

Other risk factors for CSA include _____ medications (which appear to have a dose-dependent effect on CSA

Answer 24

opioid

Question 25

In which of the following scenarios is supplemental oxygen MOST likely to reduce central apneas?

A. In patients with treatment-emergent central sleep apnea (complex sleep apnea)
B. In patients with chronic obstructive pulmonary disease (COPD)
C. In patients with opioid-induced respiratory depression
D. In patients with high-altitude CSA and hypoxemia

Answer 25

D