| Show 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) Respiratory |
Description
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 3Applied 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
- 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
- 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
- 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
- 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
Common
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
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
central sleep apnoea, cor pulmonale /pulmonary hypertension, left ventricular failure
Uncommon
narcolepsy, neuromuscular disorders, restless leg syndrome
narcolepsy, neuromuscular disorders, restless leg syndrome
