Sleep disorders

Understanding Sleep Disorders: Part 2

After telling the patient you suspect he has insomnia and sleep disordered breathing, you administer a physical examination, which produces the following values:

  • Lungs—clear to auscultation
  • Cardiovascular system—regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops 
  • Neck—no carotid bruits and no masses or thyroid gland enlargement
  • Tonsil size—2 of 4
  • Macroglossia—yes
  • High arched palate—no
  • Retrognathia—yes
  • Modified Mallampati/Friedman position—3+/4
  • Nasal septal deviation—none seen overtly
  • Nasal alae—mildly incompetent, right > left
  • Neck size—17 inches

Based on these findings, he asks you how likely it is he has sleep disordered breathing. What do you tell him?

Email your responses to, and be sure to tune into next week’s podcast with Dr Joseph Diamond for the answer!




Read Case Part 1 here:
Listen to the answer to Case Part 1 here: