Do you know someone with a snoring problem? Buy them a pair of running shoes—and not just so they can lose weight.
That’s the argument in an article in the current issue of the always entertaining Medical Hypotheses. The author, a doctor from Kyrgyzstan named Aibek Mirrakhimov, explains that poor fluid circulation contributes to Obstructive Sleep Apnea (really bad snoring); and he theorizes that exercise might improve blood flow in the legs and lead to a quieter night’s sleep.
All the arguments in Medical Hypotheses are, well, hypothetical. But they’re not plucked out of thin air, either, and Mirrakhimov blends scientifically established relationships with his own intuition to arrive at his theory. Regardless of whether he’s right, his argument provides a fun example of how doctors reason when confronted with an unexplained condition.
The immediate cause of Obstructive Sleep Apnea (OSA) is a narrowing of the upper airways. It’s serious because bad nocturnal breathing interferes with normal sleep rhythms, leaving people tired during the day. There are a number of risk factors for OSA. Some can’t be helped, like having a short lower jaw or a large tongue; others, like obesity, are more manageable.
It’s this last risk factor that caught Mirrakhimov’s eye. He looked at studies linking exercise and OSA, and noticed something: Even in situations where subjects weren’t getting trimmer, regular workouts still seemed to be having positive effects. This suggested that exercise mitigates OSA by some additional mechanism, beyond losing weight.
And here’s where the hypothesizing starts. Mirrakhimov knew that people with OSA also often suffer from Excessive Daytime Sleepiness. He guessed that sleepiness decreases physical activity, and he knew that decreased activity causes fluid accumulation in the legs. Mirrakhimov also knew from previous studies that when people lie down at night, the collected fluid flows up their bodies and into their necks (something known as the rostral fluid shift), constricting their airways. From there he reasoned that exercise might stop this bad cycle by stimulating the leg muscles and promoting better circulation.
Some of the links in Mirrakhimov’s chain are well-established, like the relationship between neck circumference and OSA. But his critical step—that exercise might promote better fluid circulation—is an intuition that remains to be tested. And as biologist H. Allen Orr writes in the current New York Review of Books (making a point that's surely not lost on Mirrakhimov), “a scientific education is, to a considerable extent, an exercise in taming the authority of one’s intuition.”
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