Stridor and Sleep Apnoea

Question 1

What is stridor?

Answer 1

Predominantly inspiratory wheeze in the large airways in the URT due to obstruction. Slide 4

Question 2

What can be causes of inspiratory stridor in the supraglottis/larynx?

Answer 2

Laryngomalacia, supraglottic massm glottic lesions and vocal cord paralysis. Slide 5

Question 3

What are causes of stridor in children?

Answer 3

Infections e.g. croup, epiglottitis
Foreign body
Anaphylaxis
Other e.g. inhaled burns

Question 4

What are causes of stridor in adults?

Answer 4

Neoplasms on the larynx, trachea and major bronchi
Anaphylaxis
Goitre
Trauma
Other e.g. cricoarytenoid arthritis. Slide 9

Question 5

What is tracheomalacia?

Answer 5

Loss of structure in the cartilage of the trachea. Slide 16

Question 6

How do you investigate stridor?

Answer 6

Laryngoscopy, bronchoscopy, flow volume loop, CXR and other imaging. Slide 19

Question 7

How do you treat a laryngeal obstruction

Answer 7

Treat underlying cause e.g. foreign body removal
Cricothyroidotomy
Tracheostomy. Slide 22

Question 8

What is acute anaphylaxis?

Answer 8

Type 1 hypersensitivity. Slide 30

Question 9

What are the treatments of anaphylaxis?

Answer 9

Immediate IM adrenaline (epipen)
IV antihistamine+corticosteroid
High flow O2
Endotracheal intubation if necessary.
Long term: Allergen avoidance, desensitisation. Slide 33

Question 10

What is the Epworth Sleepiness scale and what is normal?

Answer 10

A scale to measure daytime sleepiness. Normal is <10/24. Slide 38

Question 11

What is snoring?

Answer 11

Relaxation of pharyngeal dilator muscles so the upper airway is narrowed and causes turbulent airflow and vibration of the soft palate. Slide 40

Question 12

What is obstructive sleep apnoea?

Answer 12

Intermittent upper airway collapse in sleep and causes sleep fragmentation. Slide 43

Question 13

What are the risk factors for sleep apnoea?

Answer 13

Enlarged tonsils
Obesity
Retrognathia - lower jaw set back
Acromegaly
Neurological problems e.g. stroke
Drugs. Slide 45

Question 14

What are some consequences of Sleep Apnoea?

Answer 14

Excessive daytime sleepiness
Personality change
Cognitive impairment 
Hypertension
Raised CRP
Impaired endothelial function.
Slide 46+49

Question 15

What features help diagnose Obstructive Sleep Apnoea?

Answer 15

Snoring and EDS

Overnight sleep study of patient - oximetry and domicillary recording. Slide 50

Question 16

How can you treat Obstructive Sleep Apnoea?

Answer 16

Remove underlying cause
CPAP (continuous positive airway pressure
Mandibular Advancement Device
Surgery
Slide 52+55