Circadian rhythm sleep-wake disordersDownloads

A 57-year-old man comes to the physician because of a 3-month history of fatigue, difficulty swallowing, and weight loss. He has smoked 1 pack of cigarettes daily for 30 years. He is 173 cm (5 ft 8 in) tall, and weighs 54 kg (120 lb); BMI is 18 kg/m2. Upper gastrointestinal endoscopy shows an exophytic tumor at the gastroesophageal junction. The patient is diagnosed with advanced esophageal adenocarcinoma. Palliative treatment is begun. Two months later, he complains of difficulty sleeping. His husband says that the patient does not get out of bed most days and has lost interest in seeing his friends. Mental status examination shows a blunted affect, slowed speech, and poor concentration. This patient is at increased risk of developing which of the following findings on polysomnography?

A 43-year-old man presents to a primary care clinic complaining of several months of fatigue and difficulty concentrating at work. He is tired throughout the day and often falls asleep briefly at work. He sleeps for 9 hours per night, falling asleep easily, waking up several times in the middle of the night, and then having trouble waking up in the morning. Physical exam is notable for obesity and a large neck circumference. His temperature is 98°F (36.7°C), blood pressure is 150/90 mmHg, pulse is 75/min, respirations are 22/min, and BMI is 33 kg/m^2. The rest of the physical exam is normal. Which of the following is the most likely cause of his fatigue?