Deck 33: Disorders of Sleep

Question 1

Which of the following medical therapies is considered first-line treatment for obstructive sleep apnea (OSA)?

A) Continuous positive airway pressure (CPAP)
B) Surgery
C) Oxygen therapy
D) Antibiotics

Answer 1

A
Explanation: CPAP therapy was introduced for management of OSA in 1981. It has become the first-line medical therapy for OSA.

Question 2

Which of the following conditions are associated with central apnea?
1) Congestive heart failure
2) Primary central nervous system lesions
3) High-altitude hypoxemia
4) Obesity

A)1 and 4 only
B)2 and 3 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Answer 2

C

Question 3

Which of the following physical exam findings are associated with obstructive sleep apnea?
1) Large tonsils
2) Microcephaly
3) Macroglossia
4) Deviated nasal septum

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Answer 3

D

Question 4

Why should the patient with obstructive sleep apnea not use alcohol?

A) Alcohol decreases the arousal threshold.
B) Alcohol increases upper airway muscle tone.
C) Alcohol increases the arousal threshold.
D) Alcohol reduces the cardiovascular compensatory mechanisms.

Question 5

Which of the following behavioral interventions is least useful for the treatment of sleep apnea?

A) Weight loss
B) Avoidance of alcohol
C) Avoidance of sedatives
D) Avoidance of daytime naps

Question 6

What is believed to be the cause of systemic hypertension in patients with sleep apnea?

A) Hypervolemia
B) Increased sympathetic tone
C) Elevated CO₂
D) Tachycardia

Question 7

Which of the following conditions are associated with untreated obstructive sleep apnea?
1) Systemic hypotension
2) Pulmonary hypertension
3) Heart failure
4) Myocardial infarction

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 8

What are the criteria to define hypopnea?

A) 20% decrease in airflow and 4% oxygen desaturation
B) 20% decrease in airflow and 2% oxygen desaturation
C) 30% decrease in airflow and 4% oxygen desaturation
D) 30% decrease in airflow and 2% oxygen desaturation

Question 9

What value for the apnea-hypopnea index (AHI) is consistent with moderate obstructive sleep apnea?

A) 5 to 15
B) 15 to 30
C) Above 30
D) Below 5

Question 10

Which of the following are parameters used to confirm the metabolic syndrome associated with obstructive sleep apnea?
1) Low triglycerides
2) Insulin resistance
3) Hypertension
4) Impaired glucose intolerance

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 11

The definition of sleep apnea uses what criteria for defining an episode of apnea?

A) 5 sec
B) 10 sec
C) 15 sec
D) 20 sec

Question 12

Which of the following complaints is frequently seen in a patient with obstructive sleep apnea?

A) Dizziness
B) Chest pain
C) Shortness of breath with exertion
D) Excessive daytime sleepiness

Question 13

What percent of the adult population is believed to have obstructive sleep apnea?

A) Less than 1%
B) 2% to 4%
C) 5% to 10%
D) Unknown

Question 14

What term is used to describe a significant decrease in airflow during sleep but not a complete cessation of breathing?

A) Apnea
B) Minor apnea
C) Hypopnea
D) Dyspnea

Question 15

Which of the following parameters is not typically monitored with a polysomnogram?

A) SaO₂
B) Electroencephalogram (EEG)
C) Breathing effort
D) Exhaled PCO₂

Question 16

Which of the following factors has been shown to positively correlate with obstructive sleep apnea?

A) Age
B) Height
C) Obesity of the upper body
D) Blood pressure at rest

Question 17

What is the primary cause of obstructive sleep apnea?

A) Small or unstable pharyngeal airway
B) Deviated septum
C) Unstable larynx
D) Large tongue

Question 18

What is the name of the respiratory pattern where a crescendo-decrescendo pattern of hyperpnea alternates with periods of apnea?

A) Cheyne-Stokes
B) Kussmaul
C) Agonal
D) Biot's

Question 19

What is the amount of CPAP that is typically required to abolish upper airway obstruction in patients with OSA?

A) 3 to 5 cm H₂O
B) 10 to 20 cm H₂O
C) 2.5 to 7.5 cm H₂O
D) 7.5 to 12.5 cm H₂O

Question 20

Which of the following characteristics are typically associated with sleep apnea?
1) Male patient
2) Over the age of 40 years
3) Hypotensive
4) Loud snoring during sleep

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2, 3, and 4 only

Question 21

What is considered to be the major problem with the use of CPAP in patients with obstructive sleep apnea?

A) Patient compliance
B) Frequent pneumothorax
C) Cardiovascular complications
D) Expense

Question 22

Central sleep apnea occurs more often than obstructive sleep apnea.

Question 23

Available evidence has shown that bilevel pressure is associated with better patient compliance than the conventional CPAP.

Question 24

Which of the following are common side effects of positive-pressure therapy?
1) Dry nasal mucosa
2) Claustrophobia
3) Skin irritation
4) Headache

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 25

What term is used to describe CPAP units that use a computer to adjust CPAP levels as needed by the patient during sleep?

A) Min-CPAP
B) Max-CPAP
C) Retro-CPAP
D) Auto-CPAP

Question 26

When differentiating between central and obstructive sleep apnea, which of the following "channels" or parameters would reflect vastly different results during an apneic episode or event?

A) SpO₂
B) Heart rate
C) Chest wall and abdominal effort
D) Nasal airflow

Question 27

Which of the following are interventions used in the management of obstructive sleep apnea?
1) Group therapy
2) Behavioral
3) Medical
4) Surgical

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 28

In what way do BiPAP units differ from CPAP units?

A) BiPAP applies different pressure levels on inspiration and exhalation.
B) BiPAP units cost significantly more that CPAP units.
C) BiPAP operates on electricity.
D) BiPAP simulates spontaneous breathing.

Question 29

How does CPAP improve breathing in the patient with OSA?

A) Stimulation of the phrenic nerve
B) Pneumatic splinting of the upper airway
C) Stimulation of upper airway muscles
D) Repositioning of the epiglottis

Question 30

Which of the following are true about obstructive sleep apnea (OSA)?
1) It is overdiagnosed in the United States.
2) It has an equivalent prevalence to asthma in the general population.
3) It has an equivalent prevalence to diabetes in the general population.
4) The spectrum of the disease includes sleep disruption related to increased airway resistance.

A)1 and 2 only
B)2 and 3 only
C)1, 2, and 4 only
D)2, 3, and 4 only