American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the December ACP Observer, copyright 2004 by the American College of Physicians.

Clinical scenario

A 43-year-old man is evaluated because he falls asleep while working at his computer during the day. He typically goes to bed at 11 p.m. and sleeps until 6 a.m. He is uncertain whether he snores, and he has no history of choking arousals. Even though he sleeps 7 hours per night during the week, he does not feel that his sleep is restful.

Instead, he says he tosses and turns throughout the night. Nearly every morning he has a headache. He drinks coffee at work to avoid falling asleep. He has not had any recent automobile accidents. He has no other medical problems, except that he admits to recent problems with sexual dysfunction. He takes no medicines and drinks alcohol only occasionally.

On physical examination, he is 175 cm (69 in) tall and weighs 81.6 kg (180 lb). His neck is 44.5 cm (17.5 in), and he has a crowed oropharynx. His blood pressure is 125/70 mm Hg. His palate is low-lying, and his uvula is elongated. Chest and heart examination reveals no abnormalities. He has no peripheral edema or clubbing.

Which of the following risk factors, considered alone, is most predictive of obstructive sleep apnea in this patient?

A. Drinking alcohol in the evening
B. Excessive daytime sleepiness
C. Nocturnal sexual dysfunction
D. Neck circumference
E. Morning headaches



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