A 52-year-old female presents with persistent daytime somnolence, morning headaches, and loud nocturnal snoring witnessed by her partner with brief choking episodes. Polysomnography reveals an Apnea-Hypopnea Index (AHI) of 34 events per hour. What is the first-line definitive therapy for this patient's obstructive sleep apnea (OSA)?

Answer and explanation

Correct answer: D. Continuous Positive Airway Pressure (CPAP)

  1. Step 1: An AHI >= 30 events per hour denotes severe obstructive sleep apnea (OSA).
  2. Step 2: Continuous Positive Airway Pressure (CPAP) during sleep is the gold-standard first-line treatment, acting as a pneumatic stent that prevents upper pharyngeal soft-tissue collapse.
Answer
Continuous Positive Airway Pressure (CPAP).
Why not the others: 'Mandibular advancement device' is primarily indicated for mild-to-moderate OSA or in patients completely intolerant of CPAP; 'Surgical UPPP' has unpredictable long-term success rates and is reserved for select refractory anatomical defects; 'Benzodiazepines' are strictly contraindicated as they relax pharyngeal musculature and depress respiratory drive, worsening obstructive episodes.

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