ACP InternistMKSAP Quiz: Evaluation for Daytime Sleepiness

Test your knowledge on pulmonary and critical care medicine.

• Patient Information:
  • Age: 72
  • Symptoms: Daytime sleepiness, snoring, 8 hours of sleep each night, 45-minute naps on most days
  • Medical History: Atrial fibrillation, heart failure
  • Medications: Valsartan-sacubitril, metoprolol, furosemide, spironolactone, empagliflozin, apixaban
  • Physical Examination: Normal vital signs, BMI 27, low-lying soft palate, irregular cardiac rhythm, normal central venous pressure, clear lung fields, chronic venous stasis
  • Previous Test: Transthoracic echocardiogram showing left ventricular enlargement, ejection fraction of 40%

Based on the information above, which of the following tests is the most appropriate?

• Actigraphy:
  • A wrist-worn device that measures disrupted sleep patterns and sleep-wake cycles over multiple days and nights.
• Home sleep apnea testing:
  • Used in patients without comorbid cardiopulmonary disease who are likely to have obstructive sleep apnea of at least moderate severity.
• Overnight oximetry:
  • Could be reassuring in asymptomatic patients with low pretest probability.
• Polysomnography:
  • In-laboratory test considered the gold standard for diagnosing sleep apnea in mission-critical workers and patients with complicated obstructive sleep apnea or comorbid conditions.

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Did You Know?
Obstructive sleep apnea (OSA) affects an estimated 22 million Americans, with 80% of moderate to severe cases remaining undiagnosed.