Correct!
4. 1 or 3

Treatment for mild obstructive sleep apnea (AHI<15 events/hour) should consider the severity of presenting symptoms and patient preferences. Therapeutic options include:

• No specific treatment except good sleep hygiene and observation for progression of symptoms;
• Sleep position training;
• Weight loss if appropriate;
• Moderate to vigorous physical exercise if appropriate;
• Nasal decongestion if appropriate;
• Avoidance of alcohol and sedating medications or substances at bedtime;
• Oral appliances;
• Positive airway pressure devices;
• Various surgical procedures;
• Avoid alcohol and sedatives;
• Myofunctional therapy (oropharyngeal exercises).

Although patients with mild OSA may not improve with CPAP, there are many exceptions (4). Weight loss of even 10% can improve the AHI (5). Moderate to vigorous exercise has been shown to independently be associated with improvement in OSA (6). Treating nasal congestion, avoidance of alcohol, and good sleep hygiene habits may also be helpful. Positional therapy is reasonable. An oral appliance is also reasonable but can be expensive. Treatment with modafinil is probably not appropriate until other therapies have failed.
Because her AHI was abnormal, her insurance company was willing to pay for CPAP and she opted for that. She was begun on nasal CPAP with variable pressure of 5-15 cm H2O. She returned for her 6-week follow-up appointment but had been switched to a full-face mask because the tech who fitted her CPAP felt she was a “mouth breather”. She had faithfully used the CPAP but neither her daytime somnolence nor her AHI had improved.

What should be done at this time? (Click on the correct answer to proceed to the fourth of six pages)

1. Overnight polysomnography
2. Switch her CPAP to a nasal mask
3. Verify her CPAP compliance with a download from her device
4. 1 and 3
5. All of the above