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WorksheetsBailey's Medicine Sleep
Total questions: 30
Worksheet time: 30mins
Accurate diagnosis of obstructive sleep apnea (OSA) can best be made by:
A careful history with a complete review of systems
Bed partner history
Physical examination of the upper airway
A home sleep study or an in-lab polysomnogram
Approximately what percentage of patients with obstructive sleep apnea ( OSA) have another
coexisting sleep medicine disorder that may be contributing to their symptoms?
2%
1 0%
20%
3 3 %
6 7 %
What is the estimated prevalence o f snoring i n middle-aged men?
10%
20%
30%
50 %
In patients with obstructive sleep apnea who have a deviated nasal septum and symptomatic
nasal obstruction, nasal surgery has been shown to consistently improve all of
the following except:
Subjective sleep quality
Daytime sleepiness
Snoring
Apnea-hypopnea index (AHI)
Disease-specific and general health quality-of-life measures
In obstructive sleep apnea patients, the most effective method of assessing and following
adherence to positive pressure therapy is:
Patient self-report
Asking the bed partner
Data card monitoring software
Epworth Sleepiness scale (ESS)
Sleep diary
In patients with poor continuous positive airway pressure (CPAP) compliance and
nasal obstruction, lowering nasal resistance with surgical therapy has been shown to:
Improve CPAP compliance
Lower the apnea-hypopnea index
Lower CPAP pressure requirements
Improve CPAP compliance dan Lower CPAP pressure requirements
All of the above
A 5 6-year-old man with excessive daytime sleepiness and loud snoring is diagnosed
with severe obstructive sleep apnea (OSA) (respiratory disturbance index = 65) by
polysomnography. Best first-line treatment is:
Positional therapy
Positive airway pressure treatment
Surgical intervention
Oral appliance therapy
Which of the following is true of continuous positive airway pressure (CPAP) therapy
for pediatric patients?
It is primarily used as adjunct therapy for patients with failed adenotonsillectomy.
The delivery system in children is usually an oral mask.
Many children discontinue CPAP because it is ineffective.
Titration of the CPAP should not be performed during polysomnography.
Clinical outcomes in the assessment of obstructive sleep apnea (OSA) treatment
include:
Apnea-hypopnea index
Daytime sleepiness
Airway collapsibility
Oxygen desaturation
What is considered the gold standard for treatment of obstructive sleep apnea in
adults?
Nasal septoplasty
Positive airway pressure therapy
Uvulopalatopharyngoplasty
Tongue base reduction therapy
Medical and surgical treatments of symptomatic nasal obstruction in obstructive sleep
apnea (OSA) patients can often lead to :
Increased mask leak
Improved continuous positive airway pressure (CPAP) compliance
Resolution of the sleep apnea
Increased CP AP requirements
Reduced success with oral appliance therapy
Potential maj or complications after palatal surgery, such as nasopharyngeal stenosis
and velopharyngeal insufficiency, can be best avoided by:
Employing mucosal-sparing reconstructive modifications
Administering perioperative corticosteroids
Using cold steel instruments rather than electrocautery
Performing nasal surgery at a separate time
Advancing to a regular diet as soon as possible postoperatively
Chronic nasal obstruction and mouth breathing, compared to the normal nasal route
of breathing, are associated with:
Abnormal sleep architecture
Abnormal sleep continuity
Increased obstructive respiratory events
Maladaptive craniofacial changes in children
All of the above
Which of the following is a necessary component of hypopharyngeal airway evaluation
in obstructive sleep apnea?
Drug-induced sleep endoscopy
Magnetic resonance imaging
Lateral cephalography
Awake fiberoptic laryngopharyngoscopy
Which of the following is true regarding maxillomandibular advancement for treatment
of obstructive sleep apnea (OSA) ?
Studies have only reported short-term outcomes
Better outcomes have been reported after greater degrees of advancement
It is supported by evidence from a randomized trial
It should never be used as a primary surgical treatment for OSA
Which of the following is a tongue reduction procedure?
Genioglossus advancement
Hyoid suspension
Midline glossectomy
Epiglottoplasty
Long-term adherence patterns for continuous positive airway pressure (CPAP) use are
often best predicted and determined:
By the patient's body mass index
In the sleep laboratory during the CPAP titration
In the first week after initiating CPAP at home
After one year of persistent use
The most commonly recommended method for diagnosing obstructive sleep apnea
(OSA) in the pediatric patient is?
Physical examination
Polysomnography (PSG)
Cine MRI
Multiple sleep latency test
For most patients, the preferred and most effective oral appliance currently used in the
management of obstructive sleep apnea is a:
Mandibular repositioning appliance
Tongue-retaining device
Soft palate advancement device
Palatal expander
Prefabricated thermoplastic splint
In the population of patients with obstructive sleep apnea (OSA), what is the most
common site of obstruction?
Nasals
Retropalatal
Retrolingual
Multilevel
Which of the following most accurately describes cine MRI?
It provides a high-resolution view of the static airway.
It produces only a small amount of radiation exposure.
It is particularly helpful for multiple sites of obstruction.
It is routinely performed on children without sedation.
In the maj ority of obstructive sleep apnea patients who fail to improve after traditional
uvulopalatopharyngoplasty (UPPP) , which is the primary anatomical location of the
persistent obstruction?
Nose
Palate
Tonsils
Tongue
Epiglottis
Which of the following is the best predictor of the presence of obstructive sleep apnea
(OSA) in an adult?
An Epworth sleepiness score > 10
Neck circumference > 17 inches
A history of snoring
A history of frequent nighttime awakening
The American Academy of Pediatrics recommends postoperative admission for patients
in the "at-risk" group. Which of the following patients should be admitted overnight
postoperatively?
Children who had a previous postpartum neonatal intensive care unit stay for jaundice
Children with moderate obstructive sleep apnea on polysomnography
Children with medication-controlled asthma
Children under the age of 3 years
The mechanisms by which increased body weight plays an important role in hypopharyngeal
obstruction include:
Increase in soft tissue mass
Enlargement of lingual tonsils
Enlargement of palatine tonsils
Change in mandible position
What factors correlate with relief of obstructive sleep apnea ( OSA) after uvulopalatopharyngoplasty
(UPPP) ?
Small tonsils, small tongue
Small tonsils, large tongue
Large tonsils, large tongue
Large tonsils, small tongue
The most common cause of excessive daytime sleepiness in the United States is:
Obstructive sleep apnea
Restless leg syndrome
Insomnia
Insufficient sleep
Which type of palatal surgery is uniquely suited to address an obliquely oriented palate
with a large lateral wall component and a circumferential pattern of obstruction?
Traditional uvulopalatopharyngoplasty (UPPP)
Uvulopalatal flap modification
Expansion sphincter pharyngoplasty
Anterior palatoplasty
Transpalatal advancement
Portable or home sleep testing for the diagnosis of obstructive sleep apnea is most appropriate
for which of the following adult patients?
Patient with a recent cardiovascular accident
Patient with a history of snoring and hypertension
Patient with severe congestive heart failure
Patient with severe chronic obstructive pulmonary disease
The first-line treatment for obstructive sleep apnea {OSA) in the pediatric patient with
moderate OSA should be?
Weight loss
Continuous positive airway pressure
Adenotonsillectomy
Medical therapy
