A Hard Day’s Night: Test Your Knowledge of Sleep Apnea

October 6, 2014

Obstructive sleep apnea is associated with a spectrum of morbidity, from daytime sleepiness to increased risk for vascular disease. Early symptoms aren’t always obvious. Test your diagnostic skills with our OSA quiz.

 

Question 1:

A 56-year-old man with mild asthma presents in your office with complaints of sleep problems. His BMI is 38 and his blood pressure is 130/90 mm Hg. He reports restless sleep and daytime sleepiness, but has no complaints of difficulty in sleep initiation or maintenance, which raises your suspicion of potential obstructive sleep apnea (OSA). After investigation, you identify changes in his upper airway structure compared with 4 months ago.

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Question 2:

A 40-year-old man presents in your office with sleep complaints as well as visual field defects. His BMI is 36 and blood pressure is 140/90 mm Hg. He reports no difficulty in falling or staying asleep so you rule out asthma; he does wake frequently at night, however, and feels sleepiness during the day. You suspect obstructive sleep apnea (OSA) and order a sleep study. The sleep study confirms the OSA diagnosis, and you prescribe continuous positive airway pressure (CPAP) treatments.

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Question 3:

You are performing an annual visit evaluation for a 54-year-old sales manager. He has a history of hypertension and hyperlipidemia, both managed. He has no major complaints. He reports restful sleep and no daytime sleepiness. On examination his BMI is 37 and his blood pressure is 126/82 mm Hg.

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Question 4:

Three out of 4 sleep apnea patients have heart failure.

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Question 5:

Identifying and managing unrecognized obstructive sleep apnea (OSA) before surgery can improve postoperative airway function.

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Question 6:

Continuous positive airway pressure (CPAP) therapy has just been prescribed for a 40-year-old woman who experiences severe obstructive sleep apnea (OSA) syndrome by her sleep physician. She returns to your office, following a week of CPAP use, and complains that she does not like using CPAP because the mask is uncomfortable.

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Question 7:

Obstructive sleep apnea (OSA) is a risk factor for abnormal glucose metabolism.

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Question 8:

There is strong evidence for a relationship between obstructive sleep apnea (OSA) and hypertension and cardiovascular disease.

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Question 9:

Results of an annual physical examination of a 54-year-old man have led you to suspect he may have-or be at high risk for-sleep apnea syndrome. His BMI is 37 and his blood pressure is 126/82 mm Hg. He has hypertension and hyperlipidemia. He reports restful sleep and no daytime sleepiness.

The clinical characteristics that raise your suspicion are: BMI greater than 35, a history of hypertension, and male gender. These are 3 of 8 risk factors for sleep apnea identified by the STOP-BANG screening tool. The presence of 3 or more factors is sufficient to confer a high risk of the disorder.

You refer him for polysomnography and receive the following test results:

- Apnea-hypopnea index of 22
- 20 obstructive apneas
- 10 mixed apneas
- 22 central apneas
- 80 hypopneas
- Lowest oxygen saturation 82%
- 12 awakenings and 32 arousals

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Question 10:

A 57-year-old man with type 2 diabetes mellitus (T2DM) presents to your office with issues of restless sleep and daytime sleepiness. His BMI is 35 and his blood pressure is 128/87 mm Hg. With suspicion of obstructive sleep apnea, you have him undergo polysomnography, obtain an apnea–hypopnea index (AHI), and also assess his glycemic control by hemoglobin A1c (A1c) level.

Your diagnosis is obstructive sleep apnea (OSA), and you recommend the patient use a continuous positive airway pressure (CPAP) machine to help him breathe more easily during sleep.

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ANSWER KEY:

Question 1. B. Inhaled corticosteroid

Question 2. C. Open-angle glaucoma

Question 3. E. No additional conditions necessary; his risk of OSA is already elevated

Question 4. A. Transvenous phrenic nerve stimulator

Question 5. D. Auto-titrated continuous positive airway pressure (APAP) treatment

Question 6. C. Ask the patient to return to her sleep physician’s CPAP clinic

Question 7. D. All of the above

Question 8. C. Troponin

Question 9. B. Obstructive sleep apnea

Question 10. C. 7 hours