This week's free board review question...
A 54-year-old obese man presents to you with a complaint that he cannot stay awake while driving. He tells you that he lives alone and is not sure if he snores.
He falls asleep frequently after lunch and during meetings at work. When watching television at home, he reports "dozing off a lot."
He denies alcohol or illicit drug use. He sleeps in a cool, quiet room with no television and has a regular bedtime routine. He denies consuming caffeine.
Physical examination findings are normal.
Vital signs are:
- blood pressure 148/92 mm Hg,
- heart rate 89 beats/minute,
- temperature 98.6 °F (37.0° C),
- respiratory rate of 15 breaths/minute.
- body mass index of 43.2 kg/m2.
Laboratory studies are as follows:
- Hemoglobin, g/dl = 13.2 (11-14)
- Hemotocrit, % = 38 (31-42)
- PaCO2, mm Hg = 55 (35-45)
Which of the following is the most likely diagnosis?
sleep-related eating disorder
circadian rhythm disorder
obesity hypoventilation syndrome
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