Sleep Disorders MCQs

Psychiatry · 21 free questions with answers & explanations.

1. 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?
2. A 28-year-old man reports sudden bilateral loss of muscle tone triggered by laughter or surprise, causing him to collapse without losing consciousness. He also has excessive daytime sleepiness despite adequate night sleep and vivid dream-like images at sleep onset. PSG shows sleep-onset REM periods. What is the most likely diagnosis?
3. A 45-year-old man presents with excessive daytime sleepiness, cataplexy triggered by laughing, and hypnagogic hallucinations. Polysomnography followed by MSLT shows mean sleep latency of 6 minutes with 4 sleep-onset REM periods (SOREMPs). What is the pathophysiology of his primary diagnosis?
4. In REM Sleep Behaviour Disorder (RBD), which electrophysiological finding confirms the diagnosis on polysomnography?
5. 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:
6. A 25-year-old woman on escitalopram for depression develops bruxism and difficulty achieving orgasm. To address the sexual side effect while maintaining antidepressant efficacy, the most evidence-based pharmacological adjunct is:
7. A 40-year-old man with a 2-year history of inability to sleep despite adequate time and opportunity, associated daytime fatigue and cognitive impairment, presents for evaluation. Per DSM-5, the minimum duration required to diagnose Chronic Insomnia Disorder is:
8. A 40-year-old obese man reports excessive daytime sleepiness, loud snoring, and his wife reports witnessed apneas. Polysomnography shows an apnea-hypopnea index (AHI) of 22 events/hour. What is this threshold consistent with?
9. A 25-year-old man reports sudden episodes of muscle weakness triggered by laughter or excitement, excessive daytime sleepiness despite 8 hours of night sleep, and hypnagogic hallucinations. Sleep-onset REM periods (SOREMPs) are found on multiple sleep latency test (MSLT). What is the DIAGNOSIS and underlying neurochemical deficiency?
10. A 65-year-old man punches his wife while asleep during a dream about fighting. He has no memory of the episode. PSG shows REM sleep without atonia. He has a history of mild anosmia for 3 years. What is the MOST important implication of his diagnosis?
11. A 35-year-old man presents with sudden episodes of profound muscle weakness triggered by laughter. He also has excessive daytime sleepiness and reports dream-like hallucinations at sleep onset. Sleep study shows SOREMP (sleep onset REM period) within 15 minutes and a mean sleep latency of 6 minutes on MSLT. What is the pathophysiological basis of his condition?
12. A 55-year-old woman is started on zolpidem 10 mg for insomnia. After 3 months she complains of complex sleep-related behaviours (sleep-driving, preparing food with no recall) and next-day cognitive impairment. What is the pharmacological mechanism of these adverse effects?
13. 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:
14. Narcolepsy Type 1 (with cataplexy) is pathophysiologically characterised by loss of neurons producing which neuropeptide in the lateral hypothalamus?
15. A 60-year-old man exhibits vigorous limb movements and vocalisation during sleep, acting out dream content. His bed partner reports he punched her. He has no memory of these events. This behaviour occurs during which sleep stage and is associated with future risk of which condition?
16. A 45-year-old obese male reports loud snoring, witnessed apnoeic episodes, and non-restorative sleep with excessive daytime somnolence. He scores 16 on the Epworth Sleepiness Scale. Overnight polysomnography shows Apnoea-Hypopnoea Index (AHI) = 32 events/hour. The investigation of choice to confirm and quantify this disorder has been performed. What is the AHI threshold for SEVERE Obstructive Sleep Apnoea?
17. A 45-year-old obese man reports excessive daytime sleepiness, morning headaches, and his wife reports loud snoring with observed apnoeas. Polysomnography confirms obstructive sleep apnea (OSA). Which of the following cardiovascular consequences is MOST strongly and causally linked to untreated severe OSA?
18. A 30-year-old man has sudden episodes of bilateral leg weakness triggered by laughter, startling, or strong emotion, followed by irresistible sleep attacks. He sometimes hallucinates vivid images when falling asleep. Which neurotransmitter system deficit is central to the pathophysiology of this condition?
19. 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:
20. REM Sleep Behaviour Disorder (RBD) is characterized by loss of normal muscle atonia during REM sleep, resulting in dream enactment behavior. Its strong association with which neurodegenerative condition makes it a prodromal biomarker?
21. A 40-year-old man reports irresistible daytime sleepiness, cataplexy triggered by laughter, sleep paralysis, and hypnagogic hallucinations. PSG shows sleep-onset REM period (SOREMP) < 15 minutes on MSLT. The neurotransmitter deficiency central to the pathophysiology is: