Sleep-Related Breathing Disorders
Help Questions
USMLE Step 2 CK › Sleep-Related Breathing Disorders
A 63-year-old woman with heart failure (LVEF 28%) has polysomnography showing central sleep apnea with Cheyne–Stokes respiration, AHI 32/hour, and oxygen nadir 85%. She asks whether adaptive servo-ventilation (ASV) is appropriate. She is stable on medical therapy but remains symptomatic at night.
In this patient, which of the following is the most appropriate next step in managing this patient’s sleep apnea?
Avoid ASV due to reduced ejection fraction
Perform uvulopalatopharyngoplasty for airway collapse
Discontinue heart failure medications to reduce apneas
Start ASV as first-line therapy
Prescribe nightly opioids to stabilize respiration
Explanation
This question tests understanding of sleep-related breathing disorders, specifically focusing on diagnosis and management of obstructive and central sleep apnea. The concept involves recognizing the signs and symptoms of sleep apnea, interpreting sleep study results, and applying appropriate management strategies based on clinical guidelines. In this vignette, the patient presents with central apnea and Cheyne-Stokes in heart failure with low LVEF, which are indicative of central sleep apnea. Choice A is correct because it aligns with clinical guidelines for managing CSA in low EF heart failure, which involves avoiding ASV due to increased mortality risk from trials like SERVE-HF. Choice B is incorrect because it starts ASV, which is contraindicated here, a common error when not recalling specific trial outcomes. To help students: Emphasize the importance of differentiating between obstructive and central sleep apnea, understanding risk factors like heart failure, and applying evidence-based treatment plans. Encourage practice with sleep study interpretations to improve diagnostic accuracy.