A 40-year-old obese man with hypertension reports excessive daytime sleepiness and his wife complains of his loud snoring and observed apneas during sleep. Overnight polysomnography shows an apnea-hypopnea index (AHI) of 35 events/hour. The MOST appropriate first-line treatment is:
- A Continuous positive airway pressure (CPAP) ✓
- B Oral modafinil 200 mg for daytime sleepiness
- C Uvulopalatopharyngoplasty (UPPP) surgery
- D Sublingual suvorexant (orexin antagonist)
Correct answer: A. Continuous positive airway pressure (CPAP)
Explanation
AHI ≥30 events/hour indicates severe obstructive sleep apnea (OSA). CPAP is the gold standard first-line treatment — it delivers positive airway pressure to splint the upper airway open, eliminating apneas and improving daytime sleepiness, cardiovascular outcomes, and quality of life. Surgery (UPPP) is reserved for CPAP-intolerant patients or anatomical cases. Modafinil treats residual sleepiness despite CPAP, not the underlying OSA. Suvorexant treats insomnia, not OSA.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.