13th January 2024

Clinical History 

The following points can be teased out through a good history:

• Excessive daytime sleepiness: whether patients fall asleep during mundane tasks, including while driving. Indeed, patients’ first presentation may be due to a road traffic accident. This is an especially key symptom to pick up. The Epworth Sleepiness Scale is a useful screening tool for this (see Table 1)
• Partners may describe snoring, choking or gasping during sleep or witness apnoeic episodes.
• Patients may have morning headaches (frontal, bilateral, squeezing pain).
• Irritability/ mood instability
• Loss of libido
• Sleep that doesn’t refresh them
• Whether they wake to pass urine multiple times in the night (arousals are stressful, and the increase of cortisol increases urine output).
• A good drug (including recreational drugs) history can tease out chronic opioid use or benzodiazepine use.

Table 1: Epworth Sleepiness Score 0= Would never doze 1=slight chance of dozing 2=moderate chance of dozing 3= high chance of dozing.

Scores of >9 should prompt further assessment for an underlying sleep disorder