Volume 1, Issue 2


Can a Man’s Shirt (collar) size serve as an indicator for an underlying sleep disorder?

August 2, 2010


The importance of chronic sleep insufficiency is under-recognized as a public health problem, despite being associated with numerous physical and mental health problems, injury, loss of productivity, and mortality1.  An estimated 50-70 million persons in the United States have chronic sleep and wakefulness disorders. Most sleep disorders are marked by difficulty falling or staying asleep, daytime sleepiness, sleep-disordered breathing, or abnormal movements, behaviors, or sensations during sleep2. Men are at greater risk for certain types of sleep disorders. Studies have indicated  that obesity and male gender are the main risk factors for the development of obstructive sleep apnea (OSA); however, some epidemiological data has shown that neck circumference (NC) > or = 43 cm (17in)  is a better predictor of obstructive event frequency than body mass index (BMI) 3.

 Studies have shown that increased neck circumference irrespective of obesity can provide clues regarding a patient’s cardiovascular health, risk for diabetes, hypertension control, and likelihood of having sleep apnea4. Hoffstein et al concluded that patients with sleep apnea have fatter necks than equally obese non-apneic snorers, and that the neck circumference could be a significant determinant of apnea and snoring5.  The study also showed that non-apneic versus apneic obese patients had similar abdominal waist circumferences but differed in neck circumference.  Furthermore, studies have shown that non-obese patients with increased neck circumference can have obstructive sleep apnea placing them at risk for developing chronic conditions6.

 Measuring neck circumference may indeed surpass abdominal circumference as a predictor for obstructive sleep apnea. However, few physicians have the time or resources to measure their patient’s neck circumference during an office visit. In addition, physicians generally do not have the time to inquire about a patient’s sleep habits and frequency of snoring or apnea spells.  To circumvent some of these time-consuming measurements, simply asking a man’s shirt size may hold the key in understanding sleep disorders, cardiovascular, and metabolic health.


It is our object to determine if a man’s shirt size, particularly the collar size, can serve as a predictor variable to determine if there is an association between outcome variables of having an underlying sleep disorder and chronic disease.  This research is designed to collect data only, not to screen or treat medical conditions.  By using an anonymous survey, we do not plan to contact patients post survey.


Setting- Outpatient family medicine clinics in the department of family medicine at the Brooklyn Hospital Center. Participants- Adult male patients ranging in age from 18-80 years old. Inclusion criteria-male patients with chronic illnesses seen in the Department of Family Medicine at The Brooklyn Hospital Center. Exclusion criteria- men with tracheotomies, neck masses, or traumatic injury to the anterior or posterior neck.  Women and the pediatric population were excluded from this study. Patients were asked if they would like to volunteer to participate in a research study about sleep disorders.   An anonymous survey with 19 items were given to the patient to be completed. Patients were asked: marital status, education, ethnic group, neck size, any medical condition, sleep patterns, height, weight, hours of sleep, wake up times during the night, if so, reason, use of sleep aide and what type.  Patient neck size was measured by MD at the end of the survey.

The Descriptive Statistics and Cross Tabulation Module of SPSS Version 11.0 for Windows was used to analyze the data.