Instructions
You are a medical student on placement in the sleep clinic. Your next patient is Leonard Tregenza, 67, a retired accountant, here with his wife Maureen for the result of his sleep study. He has been shouting, punching and kicking in his sleep. The sleep physician has diagnosed REM sleep behaviour disorder.
Explain the diagnosis and your management plan to the patient and his wife
- You do not need to take a further history or examine the patient
- His wife, Maureen, is in the room and is played by a second actor
Sleep study with video, last week
REM sleep without atonia, with shouting, punching and kicking on video during REM sleep. Apnoea-hypopnoea index 3 per hour (normal under 5). No epileptiform activity.
Sleep physician's review today
Sense of smell reduced for several years. Neurological examination normal: no tremor, rigidity or slowness. Perindopril 5 mg daily, atorvastatin 20 mg daily; no antidepressants.