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Sleepy Since Adolescence

Case Editor - Judd Flesch

Reviewed By Sleep and Respiratory Neurobiology Assembly

Submitted by

James A. Rowley, MD

Associate Professor of Medicine

Wayne State University School of Medicine

Detroit, MI

Submit your comments to the author(s).

History

A 28-year-old woman presents for evaluation of excessive daytime sleepiness since she was a teenager. Her Epworth Sleepiness Score is 22/24. She complains of falling asleep at traffic lights, and she has had five to six near-miss accidents. She admits to three naps per day, two in the afternoon and one in the evening. Sleep-related symptoms include choking sensation at night, morning headaches, and vivid dreams at sleep onset. Her sleep habits include going to bed around 12 AM with a latency to sleep within 5 minutes, and getting out of bed at 7 AM. She arrives at work by 9 AM and is generally home by 9 PM.

Past medical history is significant only for hyperlipidemia. She is not presently taking any medications. Social history is significant for having three children (ages 6 years, 2 years, and 6 months) and drinking one to two cups of coffee per day. She does not admit to drinking alcohol, and she does not smoke. There is no significant family history.

Physical Exam

Height 62 inches; weight 211 pounds; BMI 39 kg/m2. Oral examination demonstrates Mallampati class 3 airway with 3+ tonsils. Remainder of examination is normal.

Lab

PSG     Total sleep time:  474 minutes; Time in bed: 479 minutes; Sleep efficiency: 99%    

Latency to sleep onset: 1 minute; Latency to REM sleep 58.5 minutes 

            %Stage 1: 8.3, %Stage 2: 72.3, %Slow wave 3.4, %REM 16.0

            AHI 7.5/hr (NREM AHI 10.3/hr; REM AHI 6.9/hr; supine AHI 7.5/hr; non-supine AHI 7.0/hr)             %TST spent with SaO2<90%: 0%

            PLMI 0.0/hr

A representative 2 minute fragment from REM sleep is shown.

MSLT  4 naps performed

            Mean latency 1.1 minutes with 2 REM-onset naps

Figures


Question 1

In the representative trace shown, which of the following respiratory events is illustrated?

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