Return to Scenario ListShow Learning Points most relevant to Phase 1:

Daytime sleepiness

Clinical Discipline(s)/Organ System(s)
Respiratory Medicine, Respiratory System, Cardiology, Cardiovascular System
Progress Test Topic(s)
A 40 year old truck driver who weighs 160kg presents after a minor road traffic crash. He ran into the car in front of him while waiting at traffic lights; he thinks he 'nodded off'. He experiences morning headaches and reports excessive daytime sleepiness. His blood pressure is 180/105 mmHg.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy and function of upper airway
   - Control of breathing; physiology of upper airway during breathing; physiology of sleep and control of breathing during sleep
   - Pathophysiology of obstructive sleep apnoea (OSA), obesity hypoventilation syndrome (OHS) and narcolepsy; control of breathing during sleep
   - Pathophysiology of resistant hypertension
   - Aspects of the chronobiology and metabolic syndrome
   - Physiology of continuous positive airways pressure (CPAP) and non-invasive ventilation
   - Effects of medicines on sleep
Clinical and Communication Skills 
   - Obtain history from patient with excess daytime sleepiness including a history from their partner
   - Assess the level of daytime sleepiness (Epworth Sleepiness Score)
   - Examine a patient with sleep disordered breathing; assessment of the upper airway
   - Differential diagnosis of daytime sleepiness
   - Investigation (including overnight oximetry) and management of patient with sleep disordered breathing
   - Role of other health professionals in investigation and management of sleep disordered breathing
   - Bariatric surgery and its indications
   - Recognition and management of restless leg syndrome
   - Other features of metabolic syndrome
   - Prognosis of obstructive sleep apnoea and obesity hypoventilation syndrome
Personal and Professional Skills 
   - Counsel patient re investigation, diagnosis and management of sleep disordered breathing and insomnia
   - Counsel patients re exercise and weight loss
   - Advise patient on 'sleep hygiene' issues
   - Provide patients with relevant treatment options for obstructive sleep apnoea and obesity hyperventilation syndrome
   - Medical aspects of fitness to drive (NZTA)
   - Appropriate management of one's own chronobiology (e.g. travel and night shifts) and minimising impact on work and self
Population Health 
   - Epidemiology and health effects of obesity
   - Epidemiology of obstructive sleep apnoea and obesity hyperventilation syndrome
   - Epidemiology of work 'accidents' and road traffic crashes
   - Cost-benefit of bariatric surgery
Conditions to be considered relating to this scenario
sleep deprivation, insomnia, obstructive sleep apnoea, obesity hypoventilation syndrome, medication-related somnolence, type II respiratory failure, jetlag and other disorders of chronobiology, gastro-oesophageal reflux disease, oropharyngeal abnormalities
Less common but 'important not to miss'
central sleep apnoea, cor pulmonale /pulmonary hypertension, left ventricular failure
narcolepsy, neuromuscular disorders, restless leg syndrome
Related Scenarios
[Headache], [Obesity], [Polycythaemia]