A 57-year-old male taxi driver presents to his physician with excessive daytime sleepiness. For the last 2 years, he has had a tendency to fall asleep whilst he is reading, watching TV or sitting quietly. On two occasions he has fallen asleep whilst driving. The first occurred at a traffic light. He was woken by the beeping of a car behind him. He also fell asleep whilst driving on a motorway and drifted into another lane before waking. He sleeps for 8 hours at night. He has woken a few times gasping for air.
His wife reports he is a loud snorer. On some occasions, he stops breathing and she has felt the need to prod him for him to resume breathing. He takes ramipril and bendroflumethiazide for hypertension. Examination On examination, his body mass index is 41 kg/m2. His blood pressure is 168/98 mmHg. His oropharynx is crowded and red. Tonsils are normal sized. Cardiopulmonary…
