A 43-year old male who is 5'8 tall and weights 275 lbs, with no history of smoking or alcohol abuse, complains of trouble falling asleep, headaches, and daytime fatigue. His wife complains that his legs are kicking her while she is asleep. He most likely has:

A 43-year old male who is 5'8 tall and weights 275 lbs, with no history of smoking or alcohol abuse, complains of trouble falling asleep, headaches, and daytime fatigue. His wife complains that his legs are kicking her while she is asleep. He most likely has:

• A. Cheyne-Stokes breathing pattern
• B. PLMS
• C. Central sleep apnea
• D. Obstructive sleep apnea

Answer: (D)

Obstructive sleep apnea is most likely here because obesity in a middle‑aged man strongly increases the risk of repeated upper airway collapse during sleep. When the airway narrows or closes, breathing stops or becomes very shallow despite ongoing respiratory effort. These intermittent pauses fragment sleep, leading to daytime fatigue and morning headaches, which fit this patient’s complaints. The wife’s note about leg kicking can occur with disrupted sleep in general and doesn’t contradict obstructive sleep apnea; the presence of limb movements can coexist but doesn’t define the primary problem. The other patterns describe different mechanisms. A central sleep apnea involves a lack of respiratory effort rather than airway obstruction, and is less tied to obesity or male sex. Cheyne-Stokes breathing is a specific central pattern often seen with heart failure or certain neurologic conditions and features characteristic crescendo–decrescendo breathing with repeated central apneas. Periodic limb movements in sleep explain leg movements, but they’re a separate issue that causes disturbed sleep and daytime sleepiness rather than the hallmark obstructive pauses during sleep caused by airway collapse.

Obstructive sleep apnea is most likely here because obesity in a middle‑aged man strongly increases the risk of repeated upper airway collapse during sleep. When the airway narrows or closes, breathing stops or becomes very shallow despite ongoing respiratory effort. These intermittent pauses fragment sleep, leading to daytime fatigue and morning headaches, which fit this patient’s complaints. The wife’s note about leg kicking can occur with disrupted sleep in general and doesn’t contradict obstructive sleep apnea; the presence of limb movements can coexist but doesn’t define the primary problem.

The other patterns describe different mechanisms. A central sleep apnea involves a lack of respiratory effort rather than airway obstruction, and is less tied to obesity or male sex. Cheyne-Stokes breathing is a specific central pattern often seen with heart failure or certain neurologic conditions and features characteristic crescendo–decrescendo breathing with repeated central apneas. Periodic limb movements in sleep explain leg movements, but they’re a separate issue that causes disturbed sleep and daytime sleepiness rather than the hallmark obstructive pauses during sleep caused by airway collapse.