Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. He does not have problems with nasal congestion. Medical history is otherwise negative and he takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 138/86 mm Hg, pulse rate is 72/min, and respiration rate is 12/min; BMI is 32. A low-lying soft palate and patent nasal airways are noted. The cardiopulmonary examination is unremarkable, and the neurologic examination is normal.
Which of the following is the most appropriate next step in management to address this patient’s continued drowsiness?
A. Prescribe eszopiclone
B. Prescribe modafinil
C. Review data from the patient’s continuous positive airway pressure device
D. Switch to a bilevel positive airway pressure device
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