First-line management of obstructive sleep apnea includes which of the following?

• A. Uvulopalatopharyngoplasty
• B. Weight loss and alcohol avoidance
• C. Continuous positive airway pressure
• D. Antidepressants and oxygen

Answer: (D)

Obstructive sleep apnea is best treated first with continuous positive airway pressure, which acts like an air-strong splint to keep the upper airway open during sleep. This simple mechanism directly prevents the recurrent airway collapse that causes apneas, improves oxygen levels through the night, reduces fragmentation of sleep, and usually alleviates daytime sleepiness and fatigue.

Lifestyle changes such as losing weight and avoiding alcohol or sedatives can lessen the severity and help CPAP work more comfortably, but they don’t reliably resolve the condition on their own. Surgical options like uvulopalatopharyngoplasty are typically reserved for patients who cannot tolerate CPAP or have specific anatomic issues. Oxygen therapy does not prevent airway collapse, so it’s not a first-line treatment for uncomplicated obstructive sleep apnea. Antidepressants do not address the airway obstruction itself, so they aren’t considered first-line therapy for OSA.