Sleep Medicine

A 32-year-old medical resident reports excessive daytime sleepiness during morning rounds. She typically gets to bed after midnight and must be at the hospital by 6 AM; she denies snoring, witnessed apneas, or leg discomfort. Epworth Sleepiness Scale score is 16. Which of the following is the MOST likely cause of her sleepiness?

A 64-year-old man with hypertension and NYHA class II heart failure (LVEF 35%) has loud snoring, witnessed apneas, and an Epworth Sleepiness Scale score of 18. His physician suspects moderate-to-severe obstructive sleep apnea. Which is the most appropriate diagnostic test?

A 48-year-old woman with excessive daytime sleepiness has an apnea–hypopnea index of 12 per hour on polysomnography. She tried CPAP for 3 weeks but stopped due to severe claustrophobia. She has healthy teeth and no temporomandibular joint disease. Which is the most appropriate next therapy?

A 68-year-old man with heart failure with reduced ejection fraction (LVEF 30%), on guideline-directed medical therapy, has polysomnography showing an AHI of 28 per hour composed predominantly of central apneas in a crescendo–decrescendo pattern consistent with Cheyne–Stokes breathing. He remains symptomatic despite optimized heart failure therapy. Which therapy should be AVOIDED in this patient?

A 45-year-old woman with BMI 42 kg/m² reports morning headaches, unrefreshing sleep, and daytime sleepiness. Awake arterial blood gas shows Pco2 of 52 mm Hg. Polysomnography shows an AHI of 38 per hour. She is otherwise stable as an ambulatory outpatient. According to the American Thoracic Society, which is the recommended first-line positive airway pressure modality?