MBBS OSCE · General Medicine
OSCE — Obstructive Sleep Apnoea
Eight-minute OSCE station on Obstructive Sleep Apnoea: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Obstructive Sleep Apnoea.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Obstructive sleep apnoea (OSA) is recurrent collapse of the upper airway during sleep, causing apnoeas and hypopnoeas with oxygen desaturation and arousal. It presents with loud snoring, witnessed apnoeas (reported by a partner), excessive daytime sleepiness and unrefreshing sleep. Risk factors are obesity (large neck), male sex, middle age, alcohol/sedatives and craniofacial narrowing. Untreated, it drives systemic hypertension, atrial fibrillation, myocardial infarction, stroke, type 2 diabetes and a high risk of road-traffic accidents. Polysomnography is diagnostic, quantifying the apnoea-hypopnoea index (AHI) — mild 5-15, moderate 15-30, severe over 30 — and STOP-BANG screens for risk. M
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Severe OSA with marked daytime sleepiness — high road-traffic and occupational a |
| Safety | OSA with cardiovascular disease (hypertension, AF, heart failure, IHD) — untreat |
| Safety | Morbid obesity + daytime hypercapnia/hypoventilation — overlap syndrome (OSA + o |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.