A 45-year-old obese man reports excessive daytime sleepiness, witnessed apnoeic episodes, loud snoring, and morning headaches. His wife says he appears to stop breathing for up to 30 seconds multiple times a night. Polysomnography shows an apnoea-hypopnoea index (AHI) of 22. What is the most appropriate first-line treatment?
- A Mandibular advancement device as the primary initial therapy
- B Modafinil to reduce daytime sleepiness without treating the underlying cause
- C Continuous positive airway pressure (CPAP) ✓
- D Benzodiazepine at bedtime to improve sleep continuity
Correct answer: C. Continuous positive airway pressure (CPAP)
Explanation
Obstructive sleep apnoea with an AHI of 22 per hour is moderate severity (AHI 15–30). Continuous positive airway pressure (CPAP) is the first-line treatment, maintaining upper airway patency by delivering a continuous pneumatic splint. CPAP reduces AHI, improves daytime sleepiness, lowers cardiovascular risk, and treats morning headaches from nocturnal hypercapnia. Mandibular advancement devices are an alternative for mild-to-moderate OSA in patients who cannot tolerate CPAP. Benzodiazepines suppress respiratory drive and worsen OSA.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.