American Board of Internal Medicine (ABIM) Certification Practice Exam

Which patients should undergo in-laboratory polysomnographic diagnostic testing for obstructive sleep apnea?

1. Patients with heart failure or advanced pulmonary disease

2. Patients aging over 60

3. Patients with mild COPD

4. Patients with anxiety disorders

The correct answer is: Patients with heart failure or advanced pulmonary disease

Patients with heart failure or advanced pulmonary disease should undergo in-laboratory polysomnographic diagnostic testing for obstructive sleep apnea due to the significant implications that obstructive sleep apnea (OSA) can have on these conditions. In patients with heart failure, untreated OSA can exacerbate cardiovascular issues, leading to increased morbidity and mortality. The presence of OSA can aggravate heart function and complicate the management of heart failure by contributing to nocturnal hypoxia and increased sympathetic tone. Therefore, thorough evaluation via polysomnography is essential in this population to identify OSA, allowing for appropriate interventions. Similarly, in individuals with advanced pulmonary disease, OSA may lead to worsened outcomes due to the possible interplay between the two disorders. Detection of OSA allows for better management of respiratory complications, which could be crucial in enhancing the patient’s overall health status. While factors such as age over 60, mild COPD, or anxiety disorders may provide rationale for sleep studies, the direct, severe implications associated with untreated OSA in patients with heart failure or advanced pulmonary disease make them a priority for in-laboratory polysomnographic testing. This can significantly improve management strategies and possibly lead to better clinical outcomes in these patients.