A 45-year-old obese man with excessive daytime somnolence undergoes overnight polysomnography. The test shows an Apnea-Hypopnea Index (AHI) of 35 events/hour with oxygen desaturation nadir of 78%. The first-line treatment is:

• A Modafinil to reduce daytime sleepiness
• B Mandibular advancement device
• C Continuous Positive Airway Pressure (CPAP) ✓
• D Uvulopalatopharyngoplasty (UPPP)

Explanation

An AHI ≥ 30 with severe oxygen desaturation classifies this as severe obstructive sleep apnoea (OSA). Continuous Positive Airway Pressure (CPAP) is the gold-standard first-line treatment for moderate-to-severe OSA, reducing AHI, improving oxygenation, and resolving daytime somnolence. Mandibular advancement devices are acceptable for mild-moderate OSA or CPAP intolerance. UPPP is reserved for selected surgical candidates who fail CPAP. Modafinil may be an adjunct for residual somnolence despite adequate CPAP but does not address the underlying airway obstruction.

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

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Written and medically reviewed by the StethoPrep medical team.