100+ Free ABA Sleep Medicine Practice Questions

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Question 1

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Which NREM sleep stage is characterized by slow-wave activity occupying at least 20% of the epoch?

REM

to track

2026 Statistics

Key Facts: ABA Sleep Medicine Exam

~220

Total Exam Questions

ABIM subspecialty exam format

$2,500

2026 Initial Exam Fee

ABA Sleep Medicine Exam Page

≥15

AHI for Moderate OSA

AASM severity criteria

≤8 min

MSLT MSL Cutoff

ICSD-3 narcolepsy diagnostic criteria

<110 pg/mL

CSF Hypocretin for Narcolepsy Type 1

ICSD-3

≥4h on 70%

CMS PAP Adherence Rule

CMS PAP coverage policy

Anesthesiology-trained sleep physicians sit a single multi-board Sleep Medicine exam administered by ABIM. Current format is approximately 220 multiple-choice questions delivered as 4 modules, scaled passing determined by ABIM standard-setting, with 2026 registration fees of $2,500 (retake $2,125). Content emphasizes AASM 2023 scoring, OSA/CSA management (including SERVE-HF guidance), narcolepsy diagnosis, and circadian therapeutics.

Sample ABA Sleep Medicine Practice Questions

Try these sample questions to test your ABA Sleep Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which NREM sleep stage is characterized by slow-wave activity occupying at least 20% of the epoch?

A.N1

B.N2

C.N3

D.REM

Explanation: Per AASM scoring rules, N3 (slow-wave sleep) is scored when ≥20% of an epoch contains slow-wave activity (0.5-2 Hz, ≥75 µV peak-to-peak) recorded over the frontal derivations. N3 replaces the older Stages 3 and 4 classification.

2The suprachiasmatic nucleus (SCN) synchronizes the endogenous circadian rhythm primarily through which input?

A.Auditory input from the cochlear nerve

B.Photic input via the retinohypothalamic tract

C.Olfactory input from the olfactory bulb

D.Thermal input from peripheral receptors

Explanation: The SCN in the anterior hypothalamus receives light information from intrinsically photosensitive retinal ganglion cells (ipRGCs) via the retinohypothalamic tract. This photic signal entrains the ~24.2-hour endogenous rhythm to the external light-dark cycle and modulates melatonin secretion via the pineal gland.

3According to Borbély's two-process model of sleep regulation, 'Process S' represents which component?

A.The circadian process driven by the SCN

B.Homeostatic sleep pressure accumulating with wakefulness

C.The ultradian REM/NREM alternation

D.The thermoregulatory drop associated with sleep onset

Explanation: In Borbély's two-process model, Process S is the homeostatic sleep drive that rises during wakefulness (reflected in slow-wave activity) and dissipates during sleep. Process C is the circadian alerting signal. The interaction of S and C determines sleep propensity and timing.

4How long is a typical NREM-REM sleep cycle in adults?

A.30 minutes

B.60 minutes

C.90 minutes

D.120 minutes

Explanation: A typical adult NREM-REM cycle is approximately 90 minutes (range 70-120 min). Early-night cycles are dominated by N3, while REM periods lengthen across the night so that most REM sleep occurs in the final third.

5Which EEG waveforms are the defining hallmarks of stage N2 sleep?

A.Alpha rhythm and vertex waves

B.K complexes and sleep spindles

C.Sawtooth waves and low-voltage mixed frequency activity

D.Slow waves ≥75 µV

Explanation: Stage N2 is defined by K complexes (well-delineated negative sharp wave followed by a positive component, ≥0.5 sec) and/or sleep spindles (11-16 Hz, usually 12-14 Hz, ≥0.5 sec). These are generated by thalamocortical oscillators.

6The recommended EEG derivations per the AASM 2023 scoring manual are F4-M1, C4-M1, and O2-M1. What is the purpose of using the contralateral mastoid reference (M1)?

A.To reduce 60-Hz line noise

B.To provide a relatively inactive reference outside the dominant scalp electrical field

C.To capture cardiac artifact for ECG scoring

D.To allow simultaneous EOG recording

Explanation: AASM recommends referencing each scalp electrode to the contralateral mastoid (M1 or M2) because the mastoid is relatively electrically inactive and improves signal-to-noise. Backup derivations F3-M2, C3-M2, O1-M2 are used when electrodes fail.

7Per AASM 2023 rules, airflow for apnea identification is measured using which primary sensor?

A.Nasal pressure transducer

B.Oronasal thermal sensor (thermistor)

C.End-tidal CO2

D.Respiratory inductance plethysmography

Explanation: AASM specifies an oronasal thermal sensor (thermistor or thermocouple) as the recommended sensor to identify apneas, because it detects temperature change regardless of mouth vs nasal breathing. A nasal pressure transducer is the recommended sensor for hypopneas (amplitude-sensitive).

8A 52-year-old man has an apnea-hypopnea index (AHI) of 22/hour with daytime sleepiness. By AASM severity criteria, his OSA is best classified as:

A.Normal variant

B.Mild

C.Moderate

D.Severe

Explanation: AASM severity cutoffs for OSA are mild (AHI 5-14), moderate (15-29), and severe (≥30). AHI 22/hr with symptoms places this patient in the moderate category and supports initiating PAP therapy.

9Which CMS criterion defines adequate PAP adherence for continued CPAP coverage in OSA?

A.PAP use ≥2 hours per night on 50% of nights

B.PAP use ≥4 hours per night on ≥70% of nights over a 30-day period within the first 90 days

C.Any use averaging 3 hours per night

D.AHI on PAP <10 regardless of hours used

Explanation: For Medicare coverage beyond the 90-day trial, PAP adherence is defined as use ≥4 hours per night on ≥70% of nights during a consecutive 30-day period within the first 3 months, with documented clinical benefit during face-to-face reevaluation.

10A patient with heart failure and LVEF of 35% has predominantly central apneas with Cheyne-Stokes respiration on a diagnostic PSG. Which therapy is contraindicated based on the SERVE-HF trial?

A.CPAP

B.Supplemental oxygen

C.Adaptive servo-ventilation (ASV)

D.Positional therapy

Explanation: The SERVE-HF trial demonstrated increased all-cause and cardiovascular mortality with ASV in patients with symptomatic HFrEF and LVEF ≤45% and predominantly central sleep apnea. ASV is therefore contraindicated in this population; alternatives include CPAP, nocturnal oxygen, or treatment of underlying HF.

About the ABA Sleep Medicine Exam

The ABA Sleep Medicine Subspecialty exam is a multi-board certification co-sponsored by the ABA, ABIM, ABFM, ABPN, ABOHNS, and ABP and administered by ABIM. It verifies expertise in polysomnography interpretation, sleep-related breathing disorders, hypersomnia, insomnia, circadian disorders, parasomnias, and sleep movement disorders.

Questions

220 scored questions

Time Limit

About 10 hours across 4 modules

Passing Score

Scaled score set by ABIM standard-setting (criterion-referenced)

Exam Fee

$2,500 (retake $2,125) for 2026 (ABA (administered by ABIM on behalf of cosponsoring boards))

ABA Sleep Medicine Exam Content Outline

30-35%

Sleep-Related Breathing Disorders

OSA severity, PAP titration, CPAP adherence, OHS, central apnea (Cheyne-Stokes, opioid-induced, treatment-emergent), SERVE-HF guidance, pediatric OSA

15-20%

Polysomnography, HSAT & Scoring

AASM 2023 rules, EEG/EOG/chin EMG, respiratory sensors, arousal criteria, pediatric scoring, split-night studies

10-15%

Normal Sleep & Physiology

NREM/REM architecture, two-process model, SCN/melatonin, sleep-wake neurochemistry, lifespan changes

10-15%

Central Disorders of Hypersomnolence

Narcolepsy type 1/2, idiopathic hypersomnia, Kleine-Levin, MSLT/MWT interpretation, hypocretin deficiency

10-15%

Insomnia

Chronic insomnia, CBT-I (stimulus control, sleep restriction), DORAs, doxepin, ramelteon, Z-drug black-box warning

10-15%

Parasomnias & Movement Disorders

RBD (melatonin/clonazepam, synuclein prodrome), NREM parasomnias, RLS (alpha-2-delta first-line, iron target), PLMS

5-10%

Circadian Rhythm Sleep-Wake Disorders

DSPD, ASPD, shift work, jet lag, non-24 in blind (tasimelteon), light therapy, DLMO

How to Pass the ABA Sleep Medicine Exam

What You Need to Know

Passing score: Scaled score set by ABIM standard-setting (criterion-referenced)
Exam length: 220 questions
Time limit: About 10 hours across 4 modules
Exam fee: $2,500 (retake $2,125) for 2026

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABA Sleep Medicine Study Tips from Top Performers

1Memorize AASM 2023 respiratory event thresholds exactly: apnea ≥90% airflow drop for ≥10s, hypopnea ≥30% drop + 3% desat or arousal (1A) vs 4% (1B)

2Drill MSLT criteria until instant: ≤8 min mean sleep latency plus ≥2 SOREMPs supports narcolepsy; sleep-onset REM on preceding PSG counts as one SOREMP

3Lock in SERVE-HF: ASV contraindicated in symptomatic HFrEF with LVEF ≤45%; preserved EF allows ASV for treatment-emergent CSA

4For RLS pharmacology, remember the 2020-2024 shift: alpha-2-delta ligands now first-line over dopamine agonists; target ferritin >100 ng/mL

5Practice timed modules in 4 blocks of 60 questions to simulate ABIM's delivery pattern and build endurance for the ~10-hour day

Frequently Asked Questions

Is ABA Sleep Medicine a separate exam from ABIM Sleep Medicine?

No. The Sleep Medicine subspecialty exam is a single, multi-board exam co-sponsored by ABA, ABIM, ABFM, ABPN, ABOHNS, and ABP and administered by ABIM. ABA candidates register through the ABA portal but sit the same content-equivalent exam.

Who is eligible to sit the ABA Sleep Medicine exam?

Candidates must be ABA-certified in anesthesiology and have completed a 12-month ACGME-accredited Sleep Medicine fellowship. Primary specialty certification must be active and in good standing.

How much does the 2026 ABA Sleep Medicine exam cost?

The 2026 fee is $2,500 for the initial exam and $2,125 for a retake, registered through the ABA portal. Registration for the November 10, 2026 exam is open December 1, 2025 through June 15, 2026.

How many questions are on the Sleep Medicine exam?

ABIM-administered subspecialty exams typically deliver approximately 220 multiple-choice questions across 4 modules of 60 questions with break time between modules.

What scoring manual should I study for polysomnography questions?

Use the AASM Manual for the Scoring of Sleep and Associated Events (2023 rules), especially respiratory event thresholds, arousal criteria, staging (N1/N2/N3/REM), and pediatric rules.

How is ABA Sleep Medicine certification maintained?

You can choose a traditional 10-year recertification exam or the Longitudinal Knowledge Assessment (LKA), which delivers about 600 questions over 5 years and requires engagement with at least 500. ABA does not run MOCA Minute for sleep content because the exam is administered by ABIM.

Should I use in-lab PSG or home sleep apnea testing for suspected OSA?

AASM recommends HSAT for uncomplicated adults with a high pretest probability of moderate-to-severe OSA. Use in-lab PSG for children, significant cardiopulmonary disease, suspected non-OSA sleep disorders, neuromuscular disease, or inconclusive HSAT results.

Is adaptive servo-ventilation safe in heart failure with central sleep apnea?

ASV is contraindicated in symptomatic heart failure with reduced ejection fraction (LVEF ≤45%) because of increased mortality in SERVE-HF. In preserved ejection fraction (LVEF >45%), ASV remains a valid option for treatment-emergent CSA after CPAP optimization.