NRCME Respiratory Health and Sleep Apnea 2 — Questions and Answers
Question 1: A commercial driver reports using a CPAP machine but admits to removing it during the night. What is the most appropriate action for the medical examiner?
- Certify for 1 year if AHI was below 15 before treatment
- Request objective CPAP compliance data before certifying (Correct answer)
- Certify for 2 years since a CPAP prescription exists
- Disqualify permanently due to non-compliance
Correct answer: Request objective CPAP compliance data before certifying
Objective CPAP data (download showing ≥4 hours/night on ≥70% of nights) is required to verify therapeutic compliance before certification.
Question 2: Which Apnea-Hypopnea Index (AHI) range classifies obstructive sleep apnea as MODERATE?
- AHI 5–14 events/hour
- AHI 15–29 events/hour (Correct answer)
- AHI 30–49 events/hour
- AHI ≥50 events/hour
Correct answer: AHI 15–29 events/hour
Moderate OSA is defined as an AHI of 15–29 events per hour on polysomnography.
Question 3: A driver with well-controlled asthma on inhaled corticosteroids reports no exacerbations in the past 12 months and normal spirometry. Which certification is appropriate?
- Disqualify due to any asthma diagnosis
- Certify for 1 year with pulmonary follow-up required
- Certify for 2 years if clinically stable (Correct answer)
- Certify for 6 months pending specialist clearance
Correct answer: Certify for 2 years if clinically stable
Well-controlled asthma with normal pulmonary function and no recent exacerbations does not preclude 2-year certification.
Question 4: Which medication used to treat OSA side effects is most likely to impair a commercial driver's alertness?
- Intranasal corticosteroids
- Modafinil at therapeutic doses
- Sedating antihistamines taken at bedtime (Correct answer)
- Inhaled short-acting beta-agonists
Correct answer: Sedating antihistamines taken at bedtime
Sedating antihistamines can cause next-day drowsiness and impair driving performance even when taken at bedtime.
Question 5: During an NRCME physical exam, a driver with a BMI of 40 and neck circumference of 18 inches denies snoring or witnessed apneas. What is the best next step?
- Certify for 2 years since symptoms are denied
- Perform the Epworth Sleepiness Scale and refer for sleep study if score ≥10 (Correct answer)
- Immediately disqualify pending weight loss
- Certify for 1 year and repeat exam if symptoms develop
Correct answer: Perform the Epworth Sleepiness Scale and refer for sleep study if score ≥10
High BMI and large neck circumference are risk factors for OSA; the ESS and potential referral are warranted regardless of symptom denial.
Question 6: Which finding on spirometry would most concern a medical examiner regarding a driver's fitness for commercial vehicle operation?
- FEV1/FVC ratio of 0.82
- FVC of 95% predicted
- FEV1 of 45% predicted (Correct answer)
- Peak expiratory flow of 80% predicted
Correct answer: FEV1 of 45% predicted
An FEV1 of 45% predicted indicates severe obstruction and raises significant concern about hypoxic or hypercapnic episodes during driving.
Question 7: A driver diagnosed with central sleep apnea is treated with adaptive servo-ventilation (ASV). What additional concern must the medical examiner investigate?
- Whether ASV generates excessive noise
- Whether the driver has underlying heart failure, which is a contraindication to ASV (Correct answer)
- Whether the driver can afford ASV equipment
- Whether ASV is covered by commercial trucking insurance
Correct answer: Whether the driver has underlying heart failure, which is a contraindication to ASV
ASV is contraindicated in patients with predominant central sleep apnea and reduced ejection fraction heart failure due to increased mortality risk.
NRCME Respiratory Health and Sleep Apnea 2
A commercial driver reports using a CPAP machine but admits to removing it during the night.
What is the most appropriate action for the medical examiner?