Review Question - QID 102605

This patient is presenting with morning headaches, fatigue, and obesity suggesting a diagnosis of obstructive sleep apnea which should initially be managed with weight loss.

Obstructive sleep apnea (OSA) is a common sleep disorder in which apneas and hypopneas occurs. Apneas are defined as periods when breathing is disrupted for at least 10 seconds during sleep. Hypopneas are defined as a decrease in airflow with associated decrease in oxygen saturation. The repeated awakenings result in sleep disruption and consequent daytime fatigue. This condition is more common in men and may be caused by decreased pharyngeal muscle tone, an obese neck pressing on the upper airwary, or increased tonsil size. The diagnosis can be confirmed with polysomnography and the best initial treatment is weight loss.

Incorrect Answers:
Answer 1: Alcohol avoidance in the evening would improve the quality of this patient's sleep; however, given his pattern of symptoms and obesity, OSA is a more likely etiology of his symptoms.

Answer 2: Caffeine avoidance would improve this patient's quality of sleep; however, he does not complain of trouble falling asleep and his symptom pattern is more specific for OSA.

Answer 3: CT of the head would be appropriate if there was concern for an intracranial mass which can present with a headache that is worse in the morning. However, this patient's chief complaint is daytime fatigue and a headache in the setting of obesity, making OSA a more likely diagnosis and polysomnography a better initial test if one were to be performed.

Answer 4: Screening for depression might be indicated; however, this patient only has fatigue (decreased energy) which is likely caused by OSA rather than being a part of the SIGE CAPS criteria.

Bullet Summary:
The treatment of obstructive sleep apnea is weight loss.