Sleep Consult

Clinician: General Practitioner 62-year-old male * Type 2 Diabetes Mellitus * Hypertension * Hyperlipidaemia Medications: Metformin 500mg twice daily, Amlodipine 5mg once daily, Atorvastatin 20mg once daily Presenting Complaint Patient reports persistent loud snoring, choking/gasping episodes at night witnessed by his partner, and significant daytime sleepiness for the past 6 months. He often feels unrefreshed even after a full night's sleep and has noted a decrease in concentration at work. Social History: Alcohol intake: Occasional social drinker, 2-3 units per week. Caffeine intake: 2 cups of coffee in the morning. Exercise: Sedentary, no regular exercise. Sleep history: Go to bed: 23:00 Get out of bed: 07:00 Sleep onset: Approximately 30 minutes Awakening: Wakes up 3-4 times per night, often to use the restroom, but also with gasping sensations. Naps: Takes a 1-hour nap most afternoons due to fatigue. Epworth Sleepiness Score: 18/24 (indicating high levels of daytime sleepiness) Loud snoring, snorts, gasps, witnessed apnoeas, fatigue, daytime sleepiness, poor quality sleep. Partner sleeps in a separate room due to snoring. On examination: Heart rate: 72 bpm, Oxygen saturation: 98% on room air, Blood pressure: 138/88 mmHg Weight: 105 kg Height: 175 cm BMI: 34.3 kg/m² Oral: Mallampati score III, mild overbite, thick neck circumference (43 cm) CVS: Regular pulse, normal heart sounds, no murmurs Chest: Good air entry bilaterally, clear Assessment: Likely diagnosis of Obstructive Sleep Apnoea (OSA) given the classic symptoms of loud snoring, witnessed apnoeas, and significant daytime sleepiness, exacerbated by obesity and thick neck. Differential diagnoses include central sleep apnoea (less likely given loud snoring) and restless legs syndrome (no symptoms reported). Plan: Discussion regarding lifestyle modifications including weight loss, regular exercise, and avoiding alcohol before bed. Referral to a sleep clinic for polysomnography (sleep study) to confirm diagnosis and determine severity. Advised on nasal strips and positional therapy as temporary measures. Reviewed risks of untreated OSA including cardiovascular complications.