A 32-Year-Old Morbidly Obese Male Complains of Excessive Fatigue, Snoring

A 32-year-old morbidly obese male complains of excessive fatigue, snoring, and awakening in the middle of the night, which prevents restorative sleep. He is sluggish during the day due to the lack of sleep and feels like he is going to fall asleep at the wheel when driving to work. Occupation: dishwasher. Medical history includes hypertension and type 2 diabetes. Current medications include ACE inhibitor and metformin. He denies use of alcohol, tobacco, or drugs. On physical examination, the patient is afebrile, pulse 88 beats/min, respirations 20 breaths/min, blood pressure 178/95. Body mass index is 45. These are signs and symptoms of:

A) Obstructive sleep apnea
B) Primary insomnia
C) Heart failure
D) All of the above