Respiratory medicine: obstructive sleep apnoea: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: obstructive sleep apnoea

Sample item

A 50-year-old man with a BMI of 36 kg/m2 has loud snoring, witnessed apnoeas and marked daytime sleepiness, with an Epworth score of 16. Polysomnography shows an apnoea-hypopnoea index of 38 per hour. What is the most appropriate initial therapy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Nocturnal continuous positive airway pressure with weight loss

An apnoea-hypopnoea index of 30 or more per hour is severe obstructive sleep apnoea. CPAP splints the upper airway open with positive pressure, relieves sleepiness and lowers cardiovascular risk, and weight loss and avoidance of alcohol and sedatives complement it. Stimulants treat residual sleepiness only after airway obstruction is addressed.

Option by option

  • A. Nocturnal oxygen alone

    Oxygen does not prevent apnoeas and can prolong them.

  • B. A bedtime sedative-hypnotic

    Sedatives relax upper airway muscles further and worsen obstruction.

  • C. Nocturnal continuous positive airway pressure with weight loss (correct)

    Correct. CPAP is first-line for moderate to severe disease and corrects the airway collapse.

  • D. Modafinil alone

    Modafinil masks sleepiness but leaves the nocturnal obstruction and its cardiovascular effects untreated.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Nocturnal continuous positive airway pressure with weight loss. An apnoea-hypopnoea index of 30 or more per hour is severe obstructive sleep apnoea.

Why is "Nocturnal oxygen alone" not the answer?

Oxygen does not prevent apnoeas and can prolong them.

Why is "A bedtime sedative-hypnotic" not the answer?

Sedatives relax upper airway muscles further and worsen obstruction.

Why is "Modafinil alone" not the answer?

Modafinil masks sleepiness but leaves the nocturnal obstruction and its cardiovascular effects untreated.

What concept does this question test?

It tests Respiratory medicine: obstructive sleep apnoea in General Medicine. CPAP splints the upper airway open with positive pressure, relieves sleepiness and lowers cardiovascular risk, and weight loss and avoidance of alcohol and sedatives complement it. Stimulants treat residual sleepiness only after airway obstruction is addressed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: obstructive sleep apnoea?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.