Stridor and sleep apnoea Flashcards
What is stridor?
Predominantly inspiratory wheeze due to large airways (larynx/trachea/major bronchi) obstruction
What are the causes of stridor in children?
INfection
forgeign body
anaphylaxis
What infections can cause stridor in children
Croup Epiglottitis Pseudomembranous croup Retropharyngeal abscess Diphtheria Infectious mononucleosis
What are the causes of stridor in adults?
Neoplasms
Anaphylaxis
Goitre (retrosternal)
Trauma (eg strangulation, burns, irritant gases)
Other (eg bilateral vocal cord palsy; Wegener’s granulomatosis; cricoarytenoid arthritis (RA); tracheopathia
What is tracheomalacia?
is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse
How is stridor investigated?
Laryngoscopy (beware in acute epiglottitis) Bronchoscopy Flow volume loop Chest X ray Other imaging (CT; thyroid scan)
How can stridor be treated?
Treat underlying cause eg foreign body removal, anaphylaxis
Mask bag ventilation with high flow O2
Cricothyroidotomy
Tracheostomy
How can a malignant airway obstruction be treated?
Tumour removal:
laser; photodynamic therapy; cryotherapy; diathermy; surgical resection
Tumour compression: intraluminal stent
Radiotherapy (external beam; brachytherapy)
(Chemotherapy; Corticosteroids)
What type of hypersensitivity is associated with acute anaphylaxis
type one (IgE)
What are the clinical features of acute anaphylaxis?
flushing prutitus urticaria angionecrotic oedema abdominal pain hypotension- shock stridor wheeze resp failure
What can cause anaphylaxis?
Foods eg nuts; shellfish
Insect venom (bee, wasp)
Drugs (eg penicillin, aspirin, anaesthetics)
Other eg latex
HOw is anaphylaxis treated?
IM Epinephrine (adrenaline) IV antihistamine IV corticosteroid High flow O2 Nebulised bronchodilators Endotracheal intubation if necessary
What is the epworh sleepiness scale?
Measure how likely you are to fall asleep doing certain activites
What is obstructive sleep anoea syndrome?
Intermittent closure/collapse of the pharyngeal airway causing apnoeic episodes during sleep which are terminated by partial arousal
What is snoring?
Relaxation of pharyngeal dilator muscles during sleep (esp. REM)
Upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base
What are the risk factors for sleep apnoea
Enlarged tonsils, adenoids Obesity Retrognathia Acromegaly, hypothyroidism Oropharyngeal deformity Neurological: stroke, MS, myesthenia gravis, myotonic dystrophy Drugs: benzodiazepines, opiates, alcohol, Post-operative period after anaesthesia
WHat are the consequences of sleep apnoea?
excessive daytime sleepiness personality change cognitive / functional impairment Major impact on daytime function Road traffic accidents
What are the pathological consequences of sleep apnoea?
Independent risk factor for hypertension Activated sympathetic system Raised CRP Impaired endothelial function Impaired glucose tolerance (probable increased risk of stroke and cardiovascular events) All improved by CPAP
How is a diagnosis of sleep apnoea made?
Snoring & EDS (raised Epworth score) Overnight sleep study - oximetry - domicillary recording (airflow, oximetry, thoracic/abdominal movement) - full polysomnography
How is sleep apnoea treated?
Remove underlying cause
CPAP (continuous positive airway pressure)
- most effective therapy
What other treatments are there for sleep apnoea?
Mandibular Advancement Device - improves snoring - moderate reduction in AHI - use in mild OSA (AHI 5-15/hr) Surgery (UPPP, laser Rx) - avoid if sleep apnoea (future CPAP less effective) - may be used in simple snoring
