OSA + AAFP PA - Medical Learning Institute Inc

PAFP – CONNECT4 Spring Conference

Hershey Lodge, Hershey, PA

Saturday, April 6, 2024 | 10:30 AM – 11:30 AM

Gain expert insights on the weighty impact of obstructive sleep apnea – from underdiagnosis and complex comorbidities, to decreased quality of life and ballooning healthcare cost. Walk away with up to 2.5 AAFP Prescribed credits and actionable strategies you can put to practice to help your patients sleep better and breathe easier.

This series consists of four individual activities; 3 on-demand activities linked below and 1 live in-person workshop which will be at PAFP’s Spring Connect4 meeting in Hershey on April 6, 2024 at 10:30 AM – 11:30 AM. Plan to participate in as many as you can before April 6 in Hershey to maximize your CME credit.

Please click the buttons below to access the enduring activities and fill out the below form to pre-register for the workshop.

Enduring 1

Enduring 2

Enduring 3

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1. What percent of adults with OSA go undiagnosed, despite receiving adequate access to health care? *

a. 20-30%
b. 40-50%
c. 60-70%
d. 80-90%

2. What percent of people with OSA are also people with obesity? *

a. 25%
b. 50%
c. 70%
d. 90%

3. Betsy is a 48-year-old patient presenting to your clinic for an annual visit. She has a BMI of 36 and a history of hypertension, diabetes, and reports symptoms of insomnia. She also reports that her partner says that she gasps in her sleep. Which additional clinical factors would you assess if using the STOP-Bang questionnaire to gather a sleep history from Betsy *

a. Resting heart rate
b. Neck circumference
c. Waist circumference
d. Smoking history

4. A female with hypertension presents to your clinic endorsing symptoms of depression, headache, and fatigue. She does not report any experiences with insomnia symptoms or sleepiness. Based on her report, which of the following phenotypes of OSA might she have?

a. Disturbed sleeping
b. Typical OSA
c. Minimally symptomatic
d. Daytime sleepiness

5. Andre is a male with obesity who comes for his annual physical at your clinic. Through previously diagnosed with OSA, his symptoms have not resolved with CPAP device treatment or with lifestyle modification of diet and exercise. Furthermore, he reports discomfort with CPAP use and would like to avoid devices. Andre is interested in exploring other treatment modalities for OSA. To facilitate shared decision making, which of the following points would you provide around additional treatment options in OSA?

a. CPAP (continuous positive airway pressure) device effectiveness is maximized with short term, intermittent use
b. Pharmacological interventions indicated for OSA treatment are often suitable choices for patients who wish to address both OSA and obesity concerns and who have not seen OSA symptom improvement with other lifestyle modifications
c. Use of a MAD would be a good choice following Andre's lack of tolerance of the CPAP
d. Bariatric surgery may be a suitable choice for Andre, given its ease of compliance

6. Lin, who has overweight, presents at your clinic with complaints of daytime fatigue and loud snoring. Lin has not been diagnosed or treated for OSA, but you identify her as at-risk after evaluation with the STOP-BANG questionnaire. Lin relies on her children for transportation and is underinsured. Lin also expresses anxiety around spending time in clinic settings. Which of the following steps are you likely to recommend to Lin?

a. In-lab sleep study
b. CPAP
c. Surgical intervention
d. At-home sleep test

7. Miranda is a patient who is using CPAP to manage her moderate OSA (AHI=18). Miranda has found her CPAP device to be uncomfortable due to a feeling of claustrophobia and inability to tolerate the mask, despite trying multiple masks and pressure settings, and despite spending 2 sessions with the PAP therapist in PAP clinic. A change to BiPAP has not helped. Her PAP machine is interrogated and reveals an average use of less than 1 hour per night over the prior month, with a residual AHI of 15. She is dissatisfied with its results. Miranda presents today with BMI of 37 (increase over her past visit of 34). Which of the following factors in Miranda’s case is TRUE?

a. Miranda’s experience suggests that a multidisciplinary approach to OSA treatment should be considered
b. While the best treatment option for Miranda is still CPAP or BiPAP, Miranda would benefit from consideration of weight management utilizing the expertise of dieticians and bariatric specialists
c. Miranda may be an appropriate candidate for oral appliance therapy utilizing the expertise of a specialized dentist
d. All of the above

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