Step 2

Pulmonary 1

A 45-year-old overweight man with no medical history is referred to you for evaluation of obstructive sleep apnea (OSA). He complains of loud snoring, excessive daytime fatigue & sleepiness. Physical exam is unremarkable except for a BMI of 29 and a crowded oropharynx. His primary care physician ordered a home sleep study that demonstrated mild OSA, with an apnea-hypopnea index (AHI) of 12 events per hour. Treatment with nasal continuous positive airway pressure (CPAP) was initiated, but the patient could not tolerate CPAP despite multiple mask changes, CPAP device adjustments and educational interventions. The patient wants to pursue treatment but cannot tolerate having a mask on his face. In fact, he finds CPAP more disruptive to his sleep.

What is the next appropriate recommendation?

  • A) Evaluation by sleep dentistry for mandibular advancement device
  • B) Continuing CPAP with the addition of a sleeping aid such as zolpidem
  • C) Referral to otolaryngology for hypoglossal nerve stimulator evaluation
  • D) Stop treatment since the AHI is less than 15 and is considered mild
  • E) Try a new modern “sleep hack” that has gained recent popularity called “mouth taping”


Dr. Raj Dasgupta


Dr. Raj Dasgupta