A 43-year-old man comes to the physician with persistent fatigue, morning headaches, and daytime sleepiness. The patient's wife confirms that he snores loudly at night and occasionally stops breathing. He has no known medical problems and does not use tobacco, alcohol, or illicit drugs.
His blood pressure is 138/88 mm Hg and pulse is 78/min. BMI is 33 kg/m². Physical examination is unremarkable.
Which of the following conditions is the patient at highest risk for developing?

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11ec193a_98eb_5619_853d_8ff1376c4e59_MD0002_00 This patient's presentation of persistent fatigue, morning headaches, daytime sleepiness, and snoring with apneic spells is consistent with obstructive sleep apnea (OSA). Patients with OSA are at increased risk of cardiovascular complications and all-cause mortality compared to patients without this condition. There is a higher prevalence of atrial fibrillation, bradyarrhythmias (atrioventricular block, sinus pause, and asystole), and ventricular arrhythmias (nonsustained ventricular tachycardia, complex ventricular ectopy). obstructive sleep apnea Polysomnography ("sleep study") is the preferred modality for diagnosis of OSA and will document recurrent apnea and hypopnea during sleep. Treatment with continuous positive airway pressure (CPAP) has been shown to improve blood pressure control, decrease frequency of cardiac arrhythmias, and reduce mortality. (Choice A) Risk factors associated with an increased risk of abdominal aortic aneurysm include male gender with advancing age, history of smoking, hypertension, and systemic atherosclerosis. (Choice C) Cigarette smoking is the most important risk factor associated with development of emphysema. (Choice D) The major risk factors associated with esophageal squamous cell carcinoma include cigarette smoking and alcohol use, while risk factors for esophageal adenocarcinoma include obesity, cigarette smoking, gastroesophageal reflux disease, and Barrett's esophagus. (Choice E) Hypertrophic cardiomyopathy is an autosomal dominant genetic disorder caused by mutations in one of several genes that encode the myocardial contractile proteins of the cardiac sarcomere. Educational objective: Obstructive sleep apnea is associated with an increased risk of cardiovascular morbidity, including cardiac arrhythmias. Treatment with continuous positive airway pressure helps to improve symptoms and cardiovascular complications. __________ References: Arterial oxygen desaturation during sleep and atrial fibrillation. (http://www.ncbi.nlm.nih.gov/pubmed/17105888) Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. (http://www.ncbi.nlm.nih.gov/pubmed/16424443)

A 43-Year-Old Man Comes to the Physician with Persistent Fatigue