A 42 year old male presents to your clinic with longstanding fatigue. He complains that for as long as he can remember, he is sleepy during the day. He has no troubles falling asleep, and does not feel physically tired. He does not have any chest pain or shortness of breath. He does not have any night sweats or unintentional weight loss. He falls asleep right away every night, and his spouse complains that he snores. He is on no medications and no past medical history of note.

On examination, his BMI is 42 and BP is 152/88. Heart sounds are normal. Breath sounds are normal.