A 56-year-old woman with diabetes, hypertension, and hyperlipidemia is found to have an A1C of 11 despite her best attempts at diet and faithfully taking her metformin and glyburide. She reports severe fatigue and sleepiness in the daytime, which has limited her ability to exercise. On examination, she is obese, has a full appearing posterior pharynx, clear lungs, a normal heart examination, and trace bilateral edema. Her TSH is 2.0 m/L (normal). Before adding another oral agent or switching to insulin, what is the best next step?
AArrange for a sleep study to check the patient for obstructive sleep apnea.
BConsider prescribing a sleep aid to help her sleep better and increase her energy to exercise during the day.
CAssess for possible depression as a contributor to her fatigue.
DEducate the patient on sleep hygiene as a supportive measure to improve her overall well-being.
A 32-year-old man comes to the physician complaining of excessive sleepiness for the past several months. He reports falling asleep while dealing with customers and had a near accident when he fell asleep while driving. The patient reports that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move upon awakening. Which of the following is the most appropriate treatment for this patient?
AMelatonin
BModafinil
CClonazepam
DContinuous positive airway pressure
All of the following criteria are required for diagnosis of obesity hypoventilation syndrome except -
APaCO2 > 45 mmHg
BBMI 30 kg/m2
CHypertension
DSleep disorder breathing
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