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Respiriatory: Airway Disease > Stridor and Sleep Apnoea > Flashcards

Stridor and Sleep Apnoea Flashcards

1
Q

What is stridor?

A

Predominantly inspiratory wheeze due to large airway (larynx/trachea/major bronchi) obstruction

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2
Q

What areas of the airway does inspiratory stridor affect?

A
  • Extrathoracic

* Suprglottis/larynx

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3
Q

What are some causes of inspiratory stridor?

A
  • Laryngomalacia
  • Supraglottic mass
  • Glottic lesions
  • Vocal cord paralysis (not if unilateral, as other side can usually compensate)
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4
Q

Name structures labelled A - C

pic of glotts, supra glottis, sub glottis

A

A - supraglottis
B - subglottis
C - epiglottis

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5
Q

What are causes of stridor in children?

A
  • Infections
  • Foreign Body
  • Anaphylaxis / angioneurotic oedema
  • Other (eg burns)
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6
Q

What is the difference between stridor and asthma?

A

Stridor - inspiratory wheeze

Asthma - expiratory wheeze

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7
Q

What infections can cause stridor?

A
  • Croup - respiratory syncytial virus (RSV)
  • Epiglottitis
  • Pseudomembranous croup
  • Retropharyngeal abscess
  • Diphtheria
  • Infectious mononucleosis
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8
Q

What individuals are at higher risk of choking?

A

Children <3 years at higher risk (common cause is peanuts)

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9
Q

What are the effects of airway foreign bodies in children?

A

Acute onset of stridor accompanied by a choking spell

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10
Q

What are causes of stridor in adults?

A
  • Neoplasms (larynx, trachea, major bronchi)
  • Anaphylaxis
  • Goitre (retrosternal)
  • Trauma (eg strangulation, burns, irritant gases)
  • Other (eg bilateral vocal cord palsy; Wegener’s granulomatosis; cricoarytenoid arthritis (RA); tracheopathia
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11
Q

What is tracheomalacia?

A

Any inflammatory condition which damages structure of the cartilage – causing collapse of trachea

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12
Q

What is the treatment for tracheomalacia?

A

Metal stents to maintain patency of the airway

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13
Q

What do investigations of stridor include?

A
  • Laryngoscopy
  • Bronchoscopy
  • Flow volume loop (obstructive airway disease)
  • Chest X ray
  • Other imaging (CT; thyroid scan)
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14
Q

What is the treatment for laryngeal obstruction?

A
  • Treat underlying cause e.g. foreign body removal, anaphylaxis
  • Mask bag ventilation with high flow O2
  • Cricothyroidotomy
  • Tracheostomy
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15
Q

What are abdominal thrusts?

A

Rapid upward thrust in epigastrium forces upward movement of diaphragm and forced expiration

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16
Q

When are abdominal thrusts used?

A

Foreign body inhalation

café coronary syndrome

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17
Q

What is the treatment of a malignant airway obstruction?

A
  • Tumour removal:
    laser, photodynamic therapy, cryotherapy, diathermy, surgical resection
  • Tumour compression: intraluminal stent
  • Radiotherapy: external beam, brachytherapy (internal beam)
  • Chemotherapy
  • Corticosteroids
18
Q

What is acute anaphylaxis?

A

Type 1 (immediate) hypersensitivity reaction (IgE)

19
Q

What immunoglobulin is involved in type 1 hypersensitive reaction e.g. anaphylaxis?

A

IgE

20
Q

What are clinical features of anaphylaxis?

A
  • Flushing, pruritus, urticaria,
  • Angioneurotic oedema (lips, tongue, face, larynx, bronchi)
  • Abdominal pain, vomiting
  • Hypotension (vasodilatation and plasma exudation) leads to circulatory collapse (shock)
  • Stridor, wheeze and respiratory failure
21
Q

What causes hypotension in acute anaphylaxis? And what does this lead to?

A
  • Hypotension is caused by vasodilation and plasma exudation
  • It can lead to shock (circulatory collapse)
22
Q

What are causes of anaphylaxis?

A
  • Foods e.g. nuts, shellfish
  • Insect venom (bee, wasp)
  • Drugs (e.g. penicillin, aspirin, anaesthetics)
  • Other e.g. latex
23
Q

What is the treatment for anaphylaxis?

A
  • IM Epinephrine (adrenaline)
  • IV antihistamine
  • IV corticosteroid
  • High flow O2
  • Nebulised bronchodilators
  • Endotracheal intubation if necessary
  • Allergen avoidance
  • Desensitisation (immunotherapy)
  • Self-adminstered epinephrine i.e. Epipen
24
Q

How is an Epipen used?

A
  • Epipen is removed from packaging
  • Grey safety cap is removed
  • Black tip of Epipen placed at right angles to the thigh
  • Pressed hard into the thigh until the auto-injector mechanism functions (there should be a click)
  • Epipen held in place for 10 seconds
  • Epipen removed and area massaged for 10 seconds
25
Q

What is a normal score on the Epworth Sleepiness Scale?

A

<10 out of 24

26
Q

What is an abnormal score on the Epworth Sleepiness Scale?

A

A score of 10 or more

27
Q

What is the Epworth Sleepiness Scale useful in diagnosing?

A
  • Obstructive sleep apnoea

* Sleep apnoea/hypopnoea syndrome

28
Q

What causes snoring?

A
  • Relaxation of pharyngeal dilator muscles during sleep (esp. REM)
  • Upper airway narrowing causes turbulent airflow and vibration of soft palate and tongue base
29
Q

What happens to airflow, effort (rib cage), effort (abdomen) and SaO2 in sleep apnoea?

A
  • Airflow flat-lines, then jumps up upon arousal
  • Effort by rib cage and abdomen do not flat line as body still trying to breathe - increase in effort upon arousal to increase oxygen levels
  • SaO2 low until arousal, where this is a small dip and then an increase where oxygen levels return to normal
30
Q

What is obstructive sleep apnoea?

A

Intermittent upper airway collapse in sleep

31
Q

What can apnoeas or hypopnoeas result in?

A

Hypoxaemia

32
Q

Why do people with obstructive sleep apnoea score higher of the Epworth Sleepiness Scale?

A

Recurrent arousals / sleep fragmentation

33
Q

What are risk factors for sleep apnoea?

A
  • 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
34
Q

What are consequences of sleep apnoea?

A
  • excessive daytime sleepiness
  • personality change
  • cognitive / functional impairment
  • Major impact on daytime function
  • 7-fold increase in road traffic accidents (equivalent of being twice the legal limit for alcohol)
35
Q

What are physical consequences of sleep apnoea?

A
  • Independent risk factor for hypertension
  • Activated sympathetic system
  • Raised CRP (C-reactive protein)
  • Impaired endothelial function
  • Impaired glucose tolerance
  • probable increased risk of stroke and cardiovascular events
36
Q

How are the consequences of sleep apnoea improved?

A

CPAP (continuous positive airway pressure)

37
Q

How is obstructive sleep apnoea diagnosed?

A
  • Snoring & Excessive daytime sleepiness (raised Epworth score)
  • Overnight sleep study - oximetry, domicillary recording (airflow, oximetry, thoracic/abdominal movement), full polysomnography
38
Q

What is the treatment for obstructive sleep apnoea?

A
  • Remove underlying cause (tonsillectomy for enlarged tonsils)
  • CPAP (continuous positive airway pressure) - most effective therapy
39
Q

What is the effect of positive airway pressure on upper airway?

A

CPAP maintains positive airway pressure eat back of throat to maintain airway patency

40
Q

What are other treatments for obstructive sleep apnoea excluding CPAP?

A

Mandibular Advancement Device (holds jaw forwards)

  • improves snoring
  • moderate reduction in apnoea-hyponoea index (AHI)
  • use in mild obstructive sleep apnoea (AHI 5-15/hr)

Surgery (UPPP, laser)

  • avoid if sleep apnoea (future CPAP less effective)
  • may be used in simple snoring
41
Q

What are the drawbacks of UPPP as a treatment for sleep apnoea?

A

Future CPAP less effective

42
Q

What is UPPP?

A

Uvulopalatopharyngoplasty - removes excess tissue in the throat to make the airway wider

Respiriatory: Airway Disease (10 decks)

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