A 55-year-old obese man presents with excessive daytime sleepiness, witnessed apnoeas by his wife, morning headaches, and an Epworth Sleepiness Scale score of 18/24. Polysomnography confirms moderate obstructive sleep apnoea (AHI = 22). The gold standard first-line treatment is:

• A Uvulopalatopharyngoplasty (UPPP) surgery
• B Modafinil to manage excessive daytime sleepiness
• C Continuous Positive Airway Pressure (CPAP) therapy ✓
• D Weight loss and positional therapy

Explanation

CPAP is the first-line and gold-standard treatment for moderate-to-severe obstructive sleep apnoea (AHI >15 or AHI >5 with symptoms/comorbidities), effectively splinting the upper airway and preventing apnoeic episodes. UPPP surgery has lower long-term efficacy than CPAP and is reserved for CPAP-intolerant patients with specific anatomical abnormalities. Modafinil may be added for residual daytime sleepiness despite adequate CPAP use but is not first-line. Weight loss is beneficial but insufficient as sole treatment for moderate OSA.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.