100+ Free ABOHNS Sleep Medicine Practice Questions

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Question 1

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

REM

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2026 Statistics

Key Facts: ABOHNS Sleep Medicine Exam

Multi-board

Co-Sponsored Credential

ABOHNS, ABIM, ABFM, ABP, ABPN, ABA — administered by ABIM

ACGME Fellowship

Eligibility Requirement

12-month accredited Sleep Medicine fellowship after primary ABOHNS certification

AHI 15-65

Inspire HGNS AHI Range

FDA-approved upper airway stimulation for OSA

BMI < 35

Inspire HGNS BMI Cutoff

Recently expanded from less than 32 (FDA labeling)

CBT-I

First-Line Insomnia Tx

2017 AASM clinical practice guideline

ASV contraindicated

SERVE-HF Finding

Increased mortality in HFrEF (EF ≤45%) with predominant CSA

ABOHNS Sleep Medicine subcertification is a multi-board credential issued by ABOHNS to otolaryngologist-head and neck surgeons who pass the multi-board Sleep Medicine examination administered by ABIM. The exam covers the full ICSD-3 disorder spectrum plus polysomnography scoring (AASM rules), PAP titration, and surgical OSA management (UPPP, hypoglossal nerve stimulation, MMA). Eligibility requires ACGME-accredited Sleep Medicine fellowship after primary ABOHNS certification. The 2026 exam follows ABIM scheduling. Pass rates typically range 85-90%. Otolaryngology candidates should emphasize DISE, Inspire criteria (BMI less than 35, AHI 15-65, no complete concentric retropalatal collapse), Friedman staging, and pediatric OSA management.

Sample ABOHNS Sleep Medicine Practice Questions

Try these sample questions to test your ABOHNS 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 sleep stage is characterized by sleep spindles and K-complexes on EEG?

A.N1

B.N2

C.N3

D.REM

Explanation: N2 sleep is defined by the presence of sleep spindles (11-16 Hz bursts lasting at least 0.5 seconds) and K-complexes (well-delineated negative sharp waves followed by positive components). N1 shows low-amplitude mixed-frequency activity with vertex sharp waves, N3 is dominated by slow-wave (delta) activity at least 20% of the epoch, and REM features rapid eye movements with low chin EMG.

2What is the AHI threshold for diagnosing moderate obstructive sleep apnea in adults using AASM criteria?

A.AHI 5 to less than 15

B.AHI 15 to less than 30

C.AHI 30 or greater

D.AHI greater than 50

Explanation: Per AASM criteria, OSA severity in adults is graded by the apnea-hypopnea index: mild AHI 5 to less than 15, moderate AHI 15 to less than 30, and severe AHI 30 or greater. Diagnosis of OSA requires either AHI 15 or greater regardless of symptoms, or AHI 5 or greater with associated symptoms (excessive daytime sleepiness, witnessed apneas, hypertension, or other comorbidities).

3Which of the following is the FIRST-line treatment for moderate-to-severe obstructive sleep apnea in adults?

A.Hypoglossal nerve stimulation

B.Maxillomandibular advancement

C.Continuous positive airway pressure (CPAP)

D.Uvulopalatopharyngoplasty

Explanation: CPAP is the first-line treatment for moderate-to-severe OSA per AASM and AAO-HNS guidelines. It pneumatically splints the upper airway open during sleep and is the most efficacious treatment. Surgical options including UPPP, MMA, and hypoglossal nerve stimulation (Inspire) are reserved for patients who cannot tolerate or fail PAP therapy. Oral appliances are first-line for mild OSA or PAP-intolerant patients.

4What is the BMI cutoff for FDA-approved hypoglossal nerve stimulation (Inspire) therapy?

A.BMI less than 30

B.BMI less than 32

C.BMI less than 35

D.BMI less than 40

Explanation: FDA labeling and AAO-HNS guidance for Inspire hypoglossal nerve stimulation includes BMI less than 35 kg/m^2 (recently expanded from less than 32). Other criteria include AHI 15-65, age 18 or older, failure or intolerance of PAP, and absence of complete concentric retropalatal collapse on drug-induced sleep endoscopy (DISE). Pediatric Inspire was FDA-approved for Down syndrome patients age 13-18 in 2023.

5On drug-induced sleep endoscopy (DISE), which finding is a CONTRAINDICATION to hypoglossal nerve stimulation?

A.Anteroposterior retropalatal collapse

B.Lateral oropharyngeal collapse

C.Complete concentric retropalatal collapse

D.Tongue base obstruction

Explanation: Complete concentric collapse at the velopharynx (retropalatal) on DISE predicts failure of hypoglossal nerve stimulation and is an FDA-labeled contraindication. The VOTE classification (velum, oropharynx, tongue base, epiglottis) is used to grade collapse pattern. Anteroposterior collapse, tongue base obstruction, and most other patterns remain candidates for HGNS.

6Which neurotransmitter deficiency is responsible for narcolepsy type 1?

A.Serotonin

B.Dopamine

C.Hypocretin (orexin)

D.GABA

Explanation: Narcolepsy type 1 (with cataplexy) is caused by selective loss of hypocretin (orexin)-producing neurons in the lateral hypothalamus, presumed autoimmune in origin. CSF hypocretin-1 less than 110 pg/mL is diagnostic. The HLA-DQB1*06:02 allele is present in over 95% of NT1 cases. Narcolepsy type 2 (without cataplexy) typically has normal CSF hypocretin levels.

7Which finding on the multiple sleep latency test (MSLT) supports a diagnosis of narcolepsy?

A.Mean sleep latency greater than 15 minutes with 0 SOREMPs

B.Mean sleep latency 8 minutes or less with 2 or more SOREMPs

C.Mean sleep latency 5 minutes with 1 SOREMP

D.Total sleep time greater than 11 hours

Explanation: Narcolepsy diagnosis via MSLT requires mean sleep latency 8 minutes or less plus 2 or more sleep-onset REM periods (SOREMPs) across the 5 nap opportunities. A SOREMP on the preceding overnight polysomnogram can substitute for one of the daytime SOREMPs. Patients should be off REM-suppressing medications and have adequate sleep on the prior night documented by 1-2 weeks of actigraphy or sleep diary.

8Which parasomnia is characterized by acting out dreams due to loss of normal REM atonia?

A.Sleepwalking

B.Sleep terrors

C.REM sleep behavior disorder (RBD)

D.Confusional arousals

Explanation: REM sleep behavior disorder (RBD) is characterized by loss of the normal REM-related muscle atonia, allowing patients to physically enact their dreams (kicking, punching, jumping out of bed). Polysomnography shows REM sleep without atonia. RBD is strongly associated with alpha-synucleinopathies (Parkinson disease, Lewy body dementia, multiple system atrophy) and can precede neurodegenerative disease by years. Treatment includes melatonin and clonazepam.

9Which iron parameter should be checked in a patient with restless legs syndrome (RLS)?

A.Hemoglobin only

B.Serum iron

C.Serum ferritin

D.Total iron binding capacity

Explanation: Serum ferritin is the recommended initial iron study for RLS. Per AASM and IRLSSG guidelines, ferritin less than 75 ng/mL (or transferrin saturation less than 20%) warrants iron supplementation. CNS iron deficiency is implicated in RLS pathophysiology even with normal peripheral iron stores. Oral iron is first-line; IV iron (ferric carboxymaltose) is preferred when ferritin is less than 100 ng/mL or oral therapy fails.

10Which medication class is FIRST-line for chronic insomnia per the 2017 AASM clinical practice guideline?

A.Benzodiazepines

B.Cognitive behavioral therapy for insomnia (CBT-I)

C.Trazodone

D.Antihistamines

Explanation: Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia per the 2017 AASM clinical practice guideline. CBT-I components include sleep restriction, stimulus control, cognitive therapy, sleep hygiene, and relaxation techniques. Pharmacologic options (zolpidem, eszopiclone, suvorexant, ramelteon, doxepin) are second-line for short-term use. Trazodone, antihistamines, and most benzodiazepines have weak or against-recommendations.

About the ABOHNS Sleep Medicine Exam

The Sleep Medicine subspecialty certification exam is a multi-board credential co-sponsored by six ABMS member boards (ABOHNS, ABIM, ABFM, ABP, ABPN, ABA) and administered by ABIM. ABOHNS-issued certificates are awarded to otolaryngologist-head and neck surgeons who complete an ACGME-accredited Sleep Medicine fellowship and pass the multi-board Sleep Medicine exam. Content is multidisciplinary — sleep physiology, sleep-disordered breathing (OSA, CSA, OHS), insomnia, hypersomnias (narcolepsy, IH), parasomnias, RLS/PLMD, circadian rhythm disorders, pediatric sleep, polysomnography interpretation, and PAP therapy — with extra ENT-specific focus on surgical management of OSA (UPPP, hypoglossal nerve stimulation, MMA, septoplasty) and DISE.

Questions

200 scored questions

Time Limit

Computer-based exam (~8 hours including breaks) at Pearson VUE

Passing Score

Criterion-referenced scaled passing standard set by the multi-board Sleep Medicine consortium

Exam Fee

~$2,200-$2,800 (varies by primary board; ABOHNS-issued for ENT diplomates) (American Board of Otolaryngology-Head and Neck Surgery (ABOHNS) — multi-board Sleep Medicine subcertification co-sponsored with ABIM, ABFM, ABP, ABPN, and ABA (administered by ABIM))

ABOHNS Sleep Medicine Exam Content Outline

~22%

Sleep-Disordered Breathing (OSA, CSA, OHS)

Adult OSA severity (mild AHI 5-15, moderate 15-30, severe 30+), STOP-BANG and Berlin screening, Cheyne-Stokes in HFrEF, treatment-emergent (complex) central sleep apnea, opioid-induced CSA, OHS (BMI 30+ with PaCO2 greater than 45), high-altitude periodic breathing, SERVE-HF (ASV contraindicated in HFrEF EF 45% or less).

~18%

Polysomnography Interpretation & Scoring

AASM scoring rules — N1 (vertex sharp waves), N2 (spindles, K-complexes), N3 (delta greater than 20%), REM (sawtooth, atonia). Apnea (90% airflow drop, 10s) vs hypopnea (1A: 30% drop + 3% desat or arousal; 1B: 30% + 4% desat). Pediatric scoring (2 missed breaths). HSAT vs in-lab Type I-IV studies. RERAs and RDI. Hypoventilation criteria (PaCO2 greater than 55 for 10 min).

~14%

PAP Therapy & Titration

CPAP first-line for moderate-severe OSA, lab titration starting at 4 cm H2O up to 20 cm H2O, BPAP for OHS or persistent hypoventilation, ASV (contraindicated in HFrEF), volume-assured pressure support, Medicare adherence (4+ hours on 70% of nights over 30 days), heated humidification, mask fitting, treatment-emergent central sleep apnea.

~14%

Surgical Management of OSA (ENT focus)

UPPP (Fujita 1981, ~40% success), expansion sphincter pharyngoplasty, lateral pharyngoplasty, MMA (85-90% surgical success), genioglossus advancement, tongue base reduction, lingual tonsillectomy, hyoid suspension, septoplasty + turbinate reduction (improves CPAP), tracheostomy. Friedman staging predicts UPPP outcomes (Stage I ~80% success).

~8%

Hypoglossal Nerve Stimulation & DISE

Inspire UAS criteria (BMI less than 35, AHI 15-65, age 18+, PAP failure, no complete concentric retropalatal collapse on DISE). Genio (Nyxoah) bilateral HGNS (FDA 2024). Inspire pediatric for Down syndrome 13-18 (FDA 2023). DISE with propofol TCI, VOTE classification (velum, oropharynx, tongue base, epiglottis), grading 0-2.

~10%

Hypersomnias (Narcolepsy & IH)

Narcolepsy type 1 (hypocretin deficiency, HLA-DQB1*06:02, CSF hypocretin less than 110 pg/mL), narcolepsy type 2, idiopathic hypersomnia. MSLT criteria (mean sleep latency 8 min or less + 2+ SOREMPs). Treatment: modafinil/armodafinil first-line for EDS, sodium oxybate/Xywav and pitolisant for cataplexy + EDS, solriamfetol, SNRIs/SSRIs for cataplexy. Sleep paralysis, hypnagogic hallucinations.

~6%

Insomnia

CBT-I first-line per 2017 AASM CPG. Pharmacotherapy: Z-drugs (zolpidem with FDA black-box for complex sleep behaviors and next-day impairment), DORAs (suvorexant, lemborexant, daridorexant), ramelteon, low-dose doxepin, trazodone (off-label), avoid benzodiazepines chronically. Sleep restriction therapy and stimulus control.

~4%

Parasomnias

NREM disorders of arousal (sleepwalking, sleep terrors, confusional arousals — first third of night, N3). REM sleep behavior disorder (RBD) — REM sleep without atonia, alpha-synucleinopathy risk, treat with melatonin or clonazepam. Sleep-related eating disorder (zolpidem). Nightmares. Recurrent isolated sleep paralysis (SSRIs).

~2%

RLS & PLMD

RLS diagnostic criteria (urge to move, worse at rest/evening, relieved by movement). Iron studies — ferritin less than 75 ng/mL warrants supplementation. 2024 AASM guideline: alpha-2-delta ligands (gabapentin enacarbil, pregabalin) now first-line over dopamine agonists due to augmentation risk. PLMS scoring (PLMI greater than 15 abnormal in adults).

~2%

Circadian Rhythm & Pediatric Sleep

DSWPD (adolescents — morning bright light + evening melatonin 5-7 hr pre-sleep). ASWPD, non-24-hour (tasimelteon FDA-approved for blind), shift work disorder, jet lag. Pediatric OSA (oAHI greater than 1 abnormal); first-line adenotonsillectomy (CHAT trial, AAO-HNS Tonsillectomy CPG). Down syndrome OSA (Inspire FDA-approved age 13-18). Laryngomalacia (supraglottoplasty).

How to Pass the ABOHNS Sleep Medicine Exam

What You Need to Know

Passing score: Criterion-referenced scaled passing standard set by the multi-board Sleep Medicine consortium
Exam length: 200 questions
Time limit: Computer-based exam (~8 hours including breaks) at Pearson VUE
Exam fee: ~$2,200-$2,800 (varies by primary board; ABOHNS-issued for ENT diplomates)

Keys to Passing

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

ABOHNS Sleep Medicine Study Tips from Top Performers

1Memorize AASM respiratory event scoring rules cold — apnea (90% airflow drop for at least 10 seconds), hypopnea recommended (30% drop + 3% desat OR arousal) vs acceptable (30% + 4% desat), pediatric (at least 2 missed breaths). Apply rules to sample tracings and cite the 1A/1B distinction (CMS uses 1B for reimbursement)

2Master MSLT criteria for narcolepsy — mean sleep latency 8 minutes or less with 2 or more SOREMPs, with a SOREMP on the preceding overnight PSG able to substitute for one daytime SOREMP. Patients must be off REM-suppressing medications and have documented adequate sleep for 1-2 weeks (actigraphy or sleep diary)

3Know the SERVE-HF trial result by heart — ASV is CONTRAINDICATED in HFrEF (LVEF 45% or less) with predominant central sleep apnea due to increased mortality. Acceptable alternatives include optimizing HF therapy (most important), CPAP, nocturnal oxygen, and BPAP-ST

4For ENT-specific Inspire HGNS questions, memorize FDA criteria — AHI 15-65, BMI less than 35, age 18+ (or 13-18 with Down syndrome since 2023), PAP failure or intolerance, no complete concentric retropalatal collapse on DISE. The VOTE classification (velum, oropharynx, tongue base, epiglottis) graded 0-2 is required reading

5Learn the 2024 AASM RLS guideline update — alpha-2-delta ligands (gabapentin enacarbil, pregabalin) are now first-line, replacing dopamine agonists due to augmentation risk (worsening symptoms with chronic dopamine agonist use, occurring in 30-40% of patients). Always check ferritin (target greater than 75 ng/mL) and replace iron if low

Frequently Asked Questions

What is the ABOHNS Sleep Medicine subspecialty certification?

ABOHNS Sleep Medicine subcertification is one of six co-sponsored Sleep Medicine credentials issued by member boards of the American Board of Medical Specialties (ABOHNS, ABIM, ABFM, ABP, ABPN, and ABA). The single multi-board examination is administered by ABIM and is taken by candidates from all sponsoring specialties. Otolaryngologists who pass receive an ABOHNS-issued Sleep Medicine certificate. Eligibility requires completion of an ACGME-accredited Sleep Medicine fellowship after primary ABOHNS certification.

Who is eligible to take the Sleep Medicine subspecialty exam through ABOHNS?

Candidates must (1) hold current ABOHNS primary certification in Otolaryngology-Head and Neck Surgery, (2) successfully complete an ACGME-accredited Sleep Medicine fellowship (typically 12 months), (3) hold an active, unrestricted US or Canadian medical license, and (4) submit program director attestation of clinical competence. Applications are processed through ABIM (the administering board) but the resulting certificate is issued by ABOHNS for ENT-trained candidates.

What topics are tested on the Sleep Medicine examination?

The exam covers the full International Classification of Sleep Disorders, Third Edition (ICSD-3) spectrum: sleep-disordered breathing (OSA, central sleep apnea, obesity hypoventilation syndrome), insomnia, hypersomnias (narcolepsy types 1 and 2, idiopathic hypersomnia), parasomnias (NREM disorders of arousal, REM sleep behavior disorder), restless legs syndrome and periodic limb movement disorder, circadian rhythm sleep-wake disorders, sleep-related movement disorders, and pediatric sleep medicine. Polysomnography interpretation (AASM scoring rules), PAP therapy titration, and pharmacology are heavily tested. ENT candidates should emphasize surgical management of OSA, DISE, and Inspire/HGNS criteria.

How is the multi-board Sleep Medicine exam structured?

The Sleep Medicine certification exam is a single full-day computer-based examination administered at Pearson Professional Centers. It contains approximately 200 multiple-choice questions over multiple test sessions with breaks. The blueprint is shared across all six co-sponsoring boards (ABOHNS, ABIM, ABFM, ABP, ABPN, ABA). Performance is reported as pass/fail with diagnostic feedback by content area. Pass rates typically range 85-90% across all candidates.

What ENT-specific topics should ABOHNS candidates emphasize?

ABOHNS candidates should master the surgical management of OSA: UPPP (Fujita 1981, ~40% success), expansion sphincter pharyngoplasty, lateral pharyngoplasty, maxillomandibular advancement (MMA, ~85-90% surgical success), genioglossus advancement, tongue base reduction, lingual tonsillectomy, hyoid suspension, septoplasty/turbinate reduction (improves CPAP), and tracheostomy. Hypoglossal nerve stimulation (Inspire) selection criteria — BMI less than 35, AHI 15-65, age 18+, PAP intolerance, no complete concentric retropalatal collapse on DISE — are high yield. Friedman staging predicts UPPP outcomes (Stage I ~80% success). Pediatric OSA and adenotonsillectomy (CHAT trial, AAO-HNS Tonsillectomy CPG) are also emphasized.

What are the highest-yield non-surgical topics on the exam?

AASM scoring rules (apnea greater than 90% airflow drop for 10 sec; hypopnea 1A — 30% drop with 3% desat OR arousal; pediatric — at least 2 missed breaths). MSLT diagnostic criteria for narcolepsy (mean sleep latency 8 min or less plus 2+ SOREMPs). CSF hypocretin less than 110 pg/mL for narcolepsy type 1. Stop-Bang for OSA screening. SERVE-HF (ASV contraindicated in HFrEF EF 45% or less). 2024 AASM RLS guideline (alpha-2-delta ligands now first-line). 2017 AASM insomnia CPG (CBT-I first-line). Pediatric OSA oAHI greater than 1 abnormal. CHAT trial for adenotonsillectomy in pediatric OSA. Treatment-emergent central sleep apnea (~5-15% of CPAP starts).

How should I study for the Sleep Medicine board exam?

Use a 6-12 month structured plan during fellowship. Foundation: AASM Manual for the Scoring of Sleep and Associated Events (current version) — memorize EEG features by stage and respiratory event definitions. Master the AASM clinical practice guidelines (insomnia 2017, OSA in adults 2019, pediatric OSA, RLS 2024, oral appliance 2015). Learn ICSD-3 diagnostic criteria for all disorders. Take the AASM Self-Assessment in Sleep Medicine (SASM) and complete board-style MCQs. Practice scoring epochs from sample PSG tracings. Take at least one full-length timed practice exam. Review SERVE-HF, CHAT, CANPAP, and other landmark trials.

What is the recertification (continuing certification) requirement for ABOHNS Sleep Medicine?

Sleep Medicine certificates are time-limited (10 years). ABOHNS diplomates must participate in ABOHNS Continuing Certification (CC), including annual fee, professional standing, lifelong learning and self-assessment activities, and a periodic assessment of cognitive expertise (formerly called MOC Part 3). The Knowledge Self-Assessment Pathway (KSAP) is an alternative to the traditional 10-year recertification examination, with annual case-based questions and ongoing performance feedback.