Key History and Physical Examination Findings in the Sleepy Patient

Abstract

Excessive daytime sleepiness (EDS) is defined as “the inability to stay awake and alert during the major waking episodes of the day, resulting in unintended lapses into drowsiness or sleep.” This symptom is common among the population; National Sleep Foundation (NSF) polls have suggested that more than 30 % of the surveyed population has daytime sleepiness that interferes with their quality of life. Daytime sleepiness can have significant consequences, particularly when combined with activities requiring alertness for safety, such as operating a car. Drowsy driving is an unfortunate, but common, occurrence; 52 % of polled subjects had driven while drowsy in a recent NSF poll. Patients may not use the words “daytime sleepiness” to describe the way that they feel; some will use other terminology, such as “drowsiness,” “tendency to fall asleep,” and “decreased alertness.”

Appendix. Saint Louis University Sleep Clinic Evaluation Form

Age	Race M/F	Sleepy:	Y/N	Sleep schedule:
Symptoms		Tired:	Y/N	Work days
Snoring:	Y/N	Fatigue:	Y/N	Bedtime:  _____ am/pm
Frequent snoring	Y/N	Sleepy during day with:		Time. to sleep  _____
Heard outside room	Y/N	– Sitting & Reading		Wake time:  _____am/pm
Bothering bed partner	Y/N	– Watching TV/movie		Total sleep time _____
Wake up gasping for air?	Y/N	– Driving		Alarm   Y/N
Witnessed apnea:	Y/N	– Passenger in car		Off days
Mouth breathing	Y/N	– At work/school		Bedtime:  ______ am/pm
Nasal congestion	Y/N	– Poor concentration		Wake time:  ______ am/pm
AM headaches	Y/N	– MVA’s from EDS ____ (#)		Alarm   Y/N
GERD	Y/N	– Close calls ______(#)
Sweating at night	Y/N
Supine or lateral sleep		Epworth sleepiness score ____		Arousals:  Y/N; ___x/night
		Fatigue severity score _____		Time to fall back asleep: _____
		Refreshed in am: Y/N		Cause of arousals?
		Time most tired __________		Naps:  Y/N
		Naps:  _____day/week		How often?
		_____hrs/day		How long?
				When?
PMH/PSH:		ALL:		SH:
		MEDS:		Tob: Y/N  Etoh Y/N
				Caffeine Y/N ___cups/day
				Occupation:
				Exercise:
				FH: OSA/RLS/insomnia
				Snore/narcolepsy/heart disease
				ROS:
Sleep review of systems:
RLS (creepy/crawly, twitchy)	Y/N	Act out dreams	Y/N
(better with walking)	Y/N	Sleepwalking	Y/N
(worse at night)	Y/N	Bruxism	Y/N
PLMs (kick at night)	Y/N	Hallucination	Y/N
Nightmares	Y/N	Cataplexy	Y/N
Ruminating thoughts	Y/N	Sleep paralysis	Y/N
Clock-watching	Y/N	Insomnia Meds History:

PHYSICAL EXAM:
VITALS:	BP	HR	R	Neck circ	BMI
General appearance/mental status
CN-PERRLA, pupil size,				CV-RRR w/o murmur
EOMI, visual fields full				Carotid bruits Y/N, pulse amplitude
Face sensation/strength intact				Lungs-CTA B
Hearing intact bilaterally
Palate elevates symmetrically
Tongue protrudes to midline
SCM/traps full strength
Motor-5/5 throughout, normal bulk/tone
Reflexes (R/L) biceps, triceps, brach, patellar, achilles, toes
Sensory-intact to PP/LT/vibr
Coordination/Gait:
HEENT:				Mallampati:
IMPRESSION/PLAN: