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  #1  
Old 09-27-2014
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Pancreas Question of the weekend.

A 40 yr old man's wife is disturbed by his snoring so much so that they ask him to sleep on the sofa in the Hall. The patients BMI is 34. He is diabetic, smokes and drinks alcohol often. What is the reason for such a symptom?

a. Insulin resistance
b. Relaxation of a muscle
c. Upper airway obstruction
d. His addictive habits
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  #2  
Old 09-27-2014
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C
OSA obstructive sleep apnea! BMI 34. = severe obesity.
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  #3  
Old 09-27-2014
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Dr. ann can you be more precise and explain
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  #4  
Old 09-27-2014
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So i think pt got obstructive sleep apnea in which pt tries to do respiratory effort against airway obstruction.
Normally when we sleep our muscle tone is decreased so if the patient is obese he might not have too much soft tissues around his throat, palate. And due to increase neck circumference more likely to obstruct his airway during sleep as all muscle are relaxed.
So when the muscle tone around soft tissues like in throat, tongue, palate decreases then tongue may drop backward down and can obstruct the airway leads to apnea. It occurs many time during the sleep, high snoring is characteristic, associated with diabetes, obesity, systemic and pulmonary hypertension.
Oxygen can't go in and even carbondioxide accumulates!
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Old 09-27-2014
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There is the answer in your description "All muscles are relaxed". Obstruction can occur due to any other reason. Precisely the relaxation of muscles of the tongue is a major contributor to the Obstruction. Genioglossus forms the majority of the tongue. Geniohyoideus is also considered as the reason for Obstruction. So two muscles (Genio) glossus and hyoideus are responsible.

Quote:
Originally Posted by Dr.ann View Post
So i think pt got obstructive sleep apnea in which pt tries to do respiratory effort against airway obstruction.
Normally when we sleep our muscle tone is decreased so if the patient is obese he might not have too much soft tissues around his throat, palate. And due to increase neck circumference more likely to obstruct his airway during sleep as all muscle are relaxed.
So when the muscle tone around soft tissues like in throat, tongue, palate decreases then tongue may drop backward down and can obstruct the airway leads to apnea. It occurs many time during the sleep, high snoring is characteristic, associated with diabetes, obesity, systemic and pulmonary hypertension.
Oxygen can't go in and even carbondioxide accumulates!
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  #6  
Old 09-27-2014
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C hopefully.
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  #7  
Old 09-28-2014
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I would choose c too!
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  #8  
Old 09-28-2014
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Quote:
Originally Posted by Panmedic View Post
There is the answer in your description "All muscles are relaxed". Obstruction can occur due to any other reason. Precisely the relaxation of muscles of the tongue is a major contributor to the Obstruction. Genioglossus forms the majority of the tongue. Geniohyoideus is also considered as the reason for Obstruction. So two muscles (Genio) glossus and hyoideus are responsible.
I was going for C! Are u saying answer is B?
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Old 09-28-2014
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Originally Posted by nsesereso View Post
I was going for C! Are u saying answer is B?
I have the same doubt. What I think they're trying to say is, that normally also the muscles in floor of mouth relax during sleep, but don't cause obstruction. But, couple this with the excess fat in an obese person, it gives you airway obstruction.

Then again, the question remains - B or C.
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  #10  
Old 09-28-2014
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Default My answer

It could be both B and C (If "collapse" can be used interchangeably with "obstruction" )


There is collapse of upper respiratory in obese while sleeping as compared to normal, coz their airway lumen is narrower when awake too. But the point about obstruction and tongue muscle relaxation is also true.

I think Ill go with B

Thanks.
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  #11  
Old 09-29-2014
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the answer is B.

Yes you are right DrNewB
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  #12  
Old 10-04-2014
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Quote:
Originally Posted by nsesereso View Post
I was going for C! Are u saying answer is B?
Yes the answer is "B". That is the reason why we call the genioglossus muscle as the "safety muscle".

Don't worry during REM sleep the genie is there for your safety as a mnemonic for nesseresso.
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