*Stridor and Sleep Apnoea

Question 1

What is stridor?

Answer 1

Predominantly inspiratory wheeze due to large airway (larynx, trachea, major bronchi) obstruction (wheeze is an expiatory noise)

Question 2

Causes of stridor in children?

Answer 2

Infections (croup, epiglottitis, pseudomembranous croup, retropharyngeal abscess, diphtheria, infectious mononucleosis)
Foreign body
Anaphylaxis/ angioneurotic oedema
Other e.g. burn

Question 3

What is croup?

Answer 3

Inflammation of the larynx and trachea in children

Question 4

Causes of stridor in adults?

Answer 4

Neoplasms (larynx, trachea, major bronchi)
Anaphylaxis
Goitre
Trauma
Other e.g. bilateral vocal cord palsy

Question 5

Investigations of stridor? (4)

Answer 5

Laryngoscopy (beware in acute epiglottitis)
Bronchoscopy
Flow volume loop
Chest x-ray (other imaging e.g. CT)

Question 6

Treatment of laryngeal obstruction?

Answer 6

Treatment of underlying cause e.g. foreign body removal, anaphylaxis
Mask bag ventilation with high flow O2
Cricothroidotomy
Tracheostomy

Question 7

Treatment of malignant airway obstruction?

Answer 7

Tumour removal (laser, photodynamic therapy, cryotherapy, diathermy, surgical resection)
Tumur compression e.g. intraluminal stent (if tumour out with the airway)
Radiotherapy
Chemotherapy

Question 8

What type of hypersensitivity reaction is acute anaphylaxis?

Answer 8

Type 1 (immediate) hypersensitiviy IgE

Question 9

What is the name for swelling of the mouth, etc. during anaphylaxis?

Answer 9

Angioneurotic oedema

Question 10

Why does anaphylaxis cause hypotension?

Answer 10

Vasodilation and plasma exudation

Question 11

Treatment of anaphylaxis?

Answer 11

IV adrenaline (epinephrine)
IV anti-histamine
IV corticosteroid
High flow O2
Nebulised bronchodilator
Endotracheal intubation if necessary

Question 12

What scale can be used to assess a patients sleepiness and therefore likelihood to have sleep apnoea?

Answer 12

Epworth sleepiness scale = normal = score of less than 10

Question 13

What is snoring?

Answer 13

Relaxation of pharyngeal dilator muscles during sleep leading to upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base

Question 14

What is sleep apnoea?

Answer 14

An extension of snoring where the throat gets so relaxed that it flops all the way in causing of obstruction of upper airways - O2 levels will dip after the apnoea as by the time they dip you are breathing again (in brief it is intermittent upper airway obstruction in sleep)

Question 15

What are risk factors for sleep apnoea?

Answer 15

Enlarged tonsils/ adenoids
Obesity
Retrognathia (abnormal posterior positioning of the mandible)
Acromegaly, hypothyroidism
Oropharyngeal deformity
Neutrological conditions such as MS
Drugs e.g. opiates, alcohol
Post-operative period after anaesthesia

Question 16

Consequences of sleep apnoea?

Answer 16

Excessive daytime sleepiness
Personality change
Risk factor for hypertension
Raised CRP
Impaired endothelial function, etc.

Question 17

Diagnosis of sleep apnoea?

Answer 17

Snoring and raised Hepworth scale

Overnight sleep study

Question 18

Treatment of sleep apnoea?

Answer 18

Remove underlying causes

CPAP