BRPT CCSH Clinical Sleep Health

Which sleep stage is characterized by K-complexes and sleep spindles on EEG?

• AN1
• BN2
• CN3
• DREM

In the two-process model of sleep regulation, Process C refers to:

• AHomeostatic sleep pressure building during wakefulness
• BThe circadian pacemaker in the suprachiasmatic nucleus
• CREM sleep rebound after deprivation
• DAdenosine accumulation in the basal forebrain

A normal adult sleep cycle lasts approximately how long?

• A45–60 minutes
• B70–90 minutes
• C90–120 minutes
• D120–150 minutes

Melatonin is primarily secreted by which structure in response to darkness?

• AHypothalamus
• BPineal gland
• CPituitary gland
• DSuprachiasmatic nucleus

Which of the following best describes N3 sleep?

• ALow-amplitude mixed-frequency EEG with eye movements
• BDelta waves occupying ≥20% of the epoch
• CSleep spindles and K-complexes
• DMuscle atonia with sawtooth waves

In healthy older adults compared to young adults, which sleep change is expected?

• AIncreased slow-wave sleep
• BIncreased sleep efficiency
• CEarlier sleep phase (advance)
• DLonger REM latency

How much total sleep per 24 hours is recommended for a 6-month-old infant?

• A10–13 hours
• B12–15 hours
• C14–17 hours
• D16–18 hours

The Epworth Sleepiness Scale (ESS) score of 11 or higher indicates:

• ANormal daytime alertness
• BMild excessive daytime sleepiness
• CModerate-to-severe excessive daytime sleepiness
• DClinically significant insomnia

A patient scores 5 on the STOP-Bang questionnaire. This result most appropriately indicates:

• ALow risk for OSA
• BIntermediate risk for OSA
• CHigh risk for OSA
• DDefinitive diagnosis of OSA

The Insomnia Severity Index (ISI) score range indicating moderate insomnia is:

• A0–7
• B8–14
• C15–21
• D22–28

According to ICSD-3, obstructive sleep apnea in adults requires an AHI of at least:

• A≥5 events/hour with symptoms OR ≥15 events/hour
• B≥10 events/hour regardless of symptoms
• C≥15 events/hour with symptoms OR ≥20 events/hour
• D≥5 events/hour regardless of symptoms

Upper airway resistance syndrome (UARS) is best described as:

• AAHI ≥5 with oxygen desaturations
• BRespiratory effort-related arousals without apneas or hypopneas meeting AHI criteria
• CCentral apneas triggered by hypocapnia
• DDaytime sleepiness with cataplexy

Obesity hypoventilation syndrome (OHS) is defined as BMI >30 kg/m² combined with:

• AAHI >30 and oxygen saturation <88%
• BDaytime PaCO₂ >45 mmHg not explained by other causes
• CFEV1/FVC ratio <0.70
• DNocturnal SpO₂ <88% for ≥5 minutes

Complex sleep apnea syndrome (CompSAS) is characterized by:

• APersistent central apneas emerging after OSA is treated with CPAP
• BOSA coexisting with Cheyne-Stokes respiration at baseline
• CUntreated OSA with AHI >30
• DCentral apneas caused by opioid use

Narcolepsy type 1 is distinguished from type 2 primarily by:

• ASeverity of excessive daytime sleepiness
• BPresence of cataplexy and/or CSF hypocretin-1 ≤110 pg/mL
• CMultiple Sleep Latency Test mean latency <8 minutes
• DAbnormal REM sleep on overnight PSG

Idiopathic hypersomnia (IH) is best differentiated from narcolepsy type 2 by:

• AMean MSLT sleep latency >8 minutes
• BFewer than 2 sleep-onset REM periods on MSLT
• CPresence of long unrefreshing naps and sleep inertia
• DNormal nocturnal PSG

REM sleep behavior disorder (RBD) is characterized by:

• ASleepwalking with amnesia during N3 sleep
• BDream enactment behaviors with REM sleep without atonia on PSG
• CHypnagogic hallucinations at sleep onset
• DPeriodic limb movements during NREM sleep

A patient reports waking 1–2 hours after sleep onset and being unable to return to sleep for several nights per week. This pattern is most consistent with:

• ASleep-onset insomnia
• BSleep-maintenance insomnia
• CDelayed sleep-wake phase disorder
• DNocturnal seizures

Delayed sleep-wake phase disorder (DSWPD) is best managed with:

• AEvening bright light therapy and morning melatonin
• BMorning bright light therapy and low-dose evening melatonin
• CCBT-I and sleep restriction
• DHypnotic medication at conventional bedtime

Restless legs syndrome (RLS) diagnostic criteria require all of the following EXCEPT:

• AUrge to move legs often with uncomfortable sensations
• BSymptoms worsen at rest and are relieved by movement
• CSymptoms worse in the evening or night
• DPeriodic limb movements confirmed on PSG

A patient on a dopamine agonist for RLS reports that their symptoms now occur earlier in the day, at higher intensity, and in the arms. This is most consistent with:

• ARLS natural disease progression
• BAugmentation
• CPLMD development
• DIron deficiency worsening

Which of the following is the first-line pharmacologic treatment for RLS when serum ferritin is <75 ng/mL?

• APramipexole
• BGabapentin enacarbil
• CIron supplementation
• DRopinirole

The FMCSA requires commercial motor vehicle drivers with moderate-to-severe OSA to demonstrate CPAP adherence before:

• ACompleting a 30-day trial period
• BReturning to safety-sensitive driving duties
• CObtaining a commercial driver's license renewal
• DReceiving a diagnosis from a sleep specialist

Cognitive behavioral therapy for insomnia (CBT-I) typically includes all of the following components EXCEPT:

• ASleep restriction therapy
• BStimulus control
• CRelaxation techniques
• DPrescription sleep medication titration

Sleep restriction therapy in CBT-I works primarily by:

• AReducing time in bed to match actual sleep time, building homeostatic drive
• BEliminating all naps and caffeine
• CProviding a fixed 8-hour sleep opportunity each night
• DConditioning wakefulness through stimulus control

A patient using CPAP reports awakening with a dry mouth each morning. The most likely cause and initial intervention is:

• APressure too high; reduce CPAP pressure
• BMouth breathing causing air leak; add chinstrap or switch to full-face mask
• CHumidifier setting too low; increase humidity level
• DMask seal failure; replace mask

BiPAP therapy delivers two separate pressures. These are referred to as:

• AIPAP and EPAP
• BCPAP and APAP
• CHigh-span and low-span
• DInspiratory support and PEEP

Adaptive servo-ventilation (ASV) is contraindicated in patients with:

• ATreatment-emergent central sleep apnea
• BCheyne-Stokes respiration and ejection fraction <45%
• COHS requiring bilevel support
• DREM-related OSA

The CPAP ramp feature is designed to:

• AAutomatically adjust pressure based on detected apneas
• BStart at a lower pressure and gradually increase to prescribed pressure at sleep onset
• CMaintain constant pressure throughout the night
• DProvide bilevel pressure during exhalation

A patient with OSA prefers a nasal pillow mask but reports persistent air leaks. The most appropriate first step is to:

• ASwitch immediately to a full-face mask
• BVerify mask fit and reposition nasal pillows for proper seal
• CIncrease CPAP pressure to overcome the leak
• DDiscontinue CPAP and trial an oral appliance

Mandibular advancement devices (MADs) are most effective for:

• ASevere OSA (AHI >30) in obese patients
• BMild-to-moderate OSA in non-obese patients who cannot tolerate CPAP
• CCentral sleep apnea
• DObesity hypoventilation syndrome

A patient using a mandibular advancement device reports morning jaw pain and tooth soreness. The most appropriate recommendation is:

• ADiscontinue MAD therapy immediately
• BRefer back to the dental sleep specialist for adjustment and morning jaw exercises
• CSwitch to a tongue-retaining device
• DStart NSAIDs indefinitely

Hypoglossal nerve stimulation (Inspire) is indicated for patients who meet all of the following EXCEPT:

• AAHI 15–100 with <25% central/mixed apneas
• BFailure or intolerance of CPAP
• CBMI ≤40 kg/m²
• DPresence of concentric palatal collapse on DISE

Positional therapy is most appropriate for:

• APatients with AHI ≥30 in all positions
• BPatients whose AHI is ≥2× higher in the supine position compared to non-supine
• CAny patient who cannot tolerate CPAP
• DPatients with central sleep apnea

Modafinil is used as a wakefulness-promoting agent in narcolepsy. Its primary mechanism of action is:

• ADopamine reuptake inhibition and norepinephrine release
• BInhibition of dopamine reuptake with weaker effects than amphetamines
• CDirect hypocretin receptor agonism
• DSelective serotonin-norepinephrine reuptake inhibition

Sodium oxybate (Xyrem) is approved for narcolepsy symptoms including:

• AExcessive daytime sleepiness only
• BCataplexy only
• CBoth excessive daytime sleepiness and cataplexy
• DSleep paralysis and hallucinations only

Pitolisant is a narcolepsy medication that works by:

• ABlocking histamine H3 receptors to increase histamine release
• BStimulating dopamine receptors in the ventral tegmental area
• CInhibiting orexin receptor type 2
• DEnhancing GABA-A receptor activity