A 55-year-old female with a history of type 2 diabetes and obesity presents with excessive daytime sleepiness and snoring. She also complains of nocturnal chest pain. What might be the issue and what are the next steps?
This patient's symptoms are suggestive of Obstructive Sleep Apnea (OSA), which is common in individuals with obesity and type 2 diabetes. The nocturnal chest pain could be related to nighttime acid reflux, which can be aggravated by OSA, or less likely, it could indicate nocturnal angina. The next steps would be a formal sleep study to confirm the diagnosis. If OSA is confirmed, initial treatment options typically include lifestyle changes, weight loss, CPAP therapy, and management of her diabetes.