stridor and sleep apnoea

Question 1

what is stridor

Answer 1

predominantly inspiratory wheeze due to larger airway obstruction.

Question 2

most common cause in children

Answer 2

croup

Question 3

causes from within the lumen

Answer 3

e.g. foreign body

Question 4

cause from within the wall

Answer 4

e.g. oedema from anaphylaxis

Question 5

extrinsic cause

Answer 5

goitre
oesophagus
lymphadenopathy

Question 6

what is tracheomalacia

Answer 6

loss of tracheal rings

Question 7

what is the main symptom of tracheomalacia

Answer 7

stridor

Question 8

investigation of stridor

Answer 8

laryngoscopy - be careful in acute epiglottis as can cause further irritation
bronchoscopy if need to look below larynx
flow volume loop
CXR

Question 9

stridor treatment

Answer 9

underlying cause
mask bag ventilation with his flow oxygen
Cricothyroidotomy
tracheotomy

Question 10

what is snoring

Answer 10

relaxation of the pharyngeal dilator muscle during sleep

vibration of the soft palate and tongue base

Question 11

what is sleep apnoea

Answer 11

intermittent upper airway collapse during sleep causing apnoeic episodes

Question 12

classical presentation of sleep apnoea

Answer 12

Typical patient is the obese middle-aged man who presents because of snoring or day time somnolence.

Question 13

CF of sleep apnoea

Answer 13

loud snoring 
daytime sleepiness 
poor sleep quality
morning headache 
dec libido

Question 14

what is sleep apnoea an independent risk factor for

Answer 14

hypertension

Question 15

complications of sleep apnoea

Answer 15

hyperaemia and hypercapnia (type II resp failure)

Question 16

diagnosis

Answer 16

snoring and raised epworth score

Question 17

overnight sleep studies

Answer 17

oximetry 
full polysomnography (sleep study)
domiciliary reading

Question 18

treatment

Answer 18

remove underlying cause
weight reduction
alcohol dn tobacco reduction
CPAP

Question 19

other treatments

Answer 19

mandibular advancement device

surgery

Question 20

when should surgery be used

Answer 20

after seeing chest physician

avoid in sleep apnoea, more for simple snoring