Sleep Disorders and Comorbid Disease

Question 1:

A 32-year-old woman who works as an attorney complains that she has had difficulty in falling and staying asleep for the past 2 and one-half years. She describes “tension” in her arms, abdominal area, and legs throughout the day; the sensation wakes her from sleep at night and she must get out of bed and walk for partial relief. She denies any sensory abnormalities.

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Question 2:

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Question 3:

More than half of all patients with psychiatric disorders report disturbances of sleep and wakefulness.

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Question 4:

A 35-year-old woman comes to see you complaining of sleep problems. She exhibits the signs of obstructive sleep apnea, including restless sleep and daytime sleepiness. She is overweight although not obese (BMI 33). During a physical examination, you notice uneven skin pigmentation, fine wrinkling, and loss of skin elasticity, and erythema on her face that the patient says has lasted for more than 1 week.

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Question 5:

A 45-year-old woman consults a psychiatrist for depressive symptoms including difficulty in falling asleep, low mood, difficulty with concentration, poor appetite, and low energy along with daytime fatigue. She was diagnosed with clinical depression and prescribed an SSRI. A nightly dose of diphenhydramine also was advised to help her sleep. Several days later she returns with complaints of worsening insomnia. After further questioning, the patient reveals that for 2 years she has been experiencing intense leg discomfort that lasts most of the night. She is now diagnosed as having restless legs syndrome (RLS); the SSRI and diphenhydramine are stopped and she is prescribed low-dose dopamine agonist therapy.

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Question 6:

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Question 7:

A 55-year-old African American man presents in your office with sleep complaints. His BMI is 34 and blood pressure is 130/88 mm Hg. The patient has no complaints of difficulty in sleep initiation or maintenance, but he reports restless sleep and daytime sleepiness. You suspect obstructive sleep apnea and order blood tests, looking for high level of a particular hormone that may predict more shallow sleep in overweight, older men.

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Question 8:

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Question 9:

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Question 10:

A 35-year-old man is brought in by his wife who complains of his loud snoring, which forces the couple to sleep in separate bedrooms. You suspect that he might suffer from obstructive sleep apnea (OSA).

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ANSWER KEY:

Question 1. B. Serum ferritin level

Question 2. D. All of the above

Question 3. C. Restless legs syndrome

Question 4. A. True

Question 5. C. Coronary heart disease

Question 6. E. All of the above

Question 7. B. Total circulating testosterone

Question 8. C. An urge to move the upper or lower extremities, usually induced by rest

Question 9. A. True

Question 10. E. All of the above