American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of sleep testing is appropriate for patients with high pretest probability of obstructive sleep apnea but no significant comorbidities?

1. In-laboratory polysomnographic testing

2. Home-based sleep testing

3. Clinical evaluation only

4. Nursing observation

The correct answer is: Home-based sleep testing

For patients with a high pretest probability of obstructive sleep apnea (OSA) but no significant comorbidities, home-based sleep testing is particularly appropriate. This method is effective for diagnosing OSA as it allows for convenient monitoring of key physiological parameters associated with the condition, such as airflow, respiratory effort, and oxygen saturation, while the patient sleeps in their own home environment. Home-based sleep testing has advantages such as increased accessibility and comfort for the patient, fewer logistical hurdles than in-laboratory testing, and it can often be done at a lower cost. This approach can provide a reliable diagnosis without the necessity of an overnight stay in a sleep laboratory, making it beneficial for patients who fit the specified criteria: high suspicion of OSA but without complexities due to comorbid conditions that might require more extensive evaluation. In contrast, the other testing options may not align well with the patient's profile. In-laboratory polysomnographic testing is more comprehensive and typically recommended for patients with significant comorbidities or those presenting with atypical symptoms. Clinical evaluation alone might not provide the necessary diagnostic insights without some form of objective testing. Nursing observation does not sufficiently capture the needed physiological data for diagnosing OSA. Therefore, home-based sleep testing emerges as