TY - JOUR T1 - Just sleep apnoea? JF - Breathe JO - breathe SP - 277 LP - 282 DO - 10.1183/20734735.021710 VL - 7 IS - 3 AU - R.L. Riha Y1 - 2011/03/01 UR - http://breathe.ersjournals.com/content/7/3/277.abstract N2 - A 17-yr-old man presented to the clinic with his mother after crashing his car. He had fallen asleep at the wheel and been referred urgently by his general practitioner. He had driven for 1 h in the late afternoon without a break, prior to crashing. He denied feeling tired prior to the event and denied suicidal ideation. There was no history of substance or alcohol misuse, or of food consumption at the time, and no serious injuries were sustained as a result of the accident. On further questioning, he had been excessively sleepy since the age of 14 yrs. On several occasions, he had fallen asleep standing up, during class and during exams. He stated that he could fall asleep within seconds if not concentrating on a task. His naps lasted for a few minutes only and he always awakened refreshed. At lunchtime, he took a nap of 20 mins and again in the evening on a regular basis. Nocturnal sleep was not disrupted. He described marked hypnagogic hallucinations at least once a month, both visual and auditory but denied sleep paralysis and cataplexy. His Epworth Sleepiness Score (ESS) was 18/24 and his mother scored him at 17/24 (the ESS is a subjective questionnaire based measure of sleepiness with a maximum score of 24 [1]). He retired between 22:00 and 23:00 h every night and got out of bed at 08:30–11:00 h. However, being a student at university, he admitted to an irregular sleep–wake schedule on occasion. Specific questioning about snoring revealed that he snored minimally but that it had been a feature since childhood. No apnoeas had ever been witnessed by co-sleepers or parents. He had a dry mouth in the morning and nocturia. There was no history of parasomnias and no family history of sleep disorders. … ER -