stridor and sleep apnoea

Question 1

What is stridor

Answer 1

Predominantly inspiratory wheeze due the large airways (larynx/trachea/major bronchi) obsturction

Question 2

Causes of stridor (children)

Answer 2

Infections:
Croup
Epiglottitis
Pseudomembranous croup
Retropharyngeal abscess
Diphtheria

Foreign body
Anaphylaxis
Other (eg: burns)

Question 3

Causes of stridor (adult)

Answer 3

Neoplasms: larynx, trachea, major bronchi
Anaphylaxis
Goitre (enlargement of the thyroid gland.)
Trauma (eg: burns, strangulation)
OTher (eg: bilateral vocal cord palsy)

Question 4

What is tracheomalacia

Answer 4

the collapse of the airway when breathing

Question 5

investigations for stridor?

Answer 5

Laryngoscopy (beware in acute epiglottitis)
bronchoscopy
flow volume loop
Chest X ray
Other imaging (CT, thyroid scan)

Question 6

treatment of laryngeal obstruction

Answer 6

treat underlying cause (eg: foreign body removal, anaphylaxis)
Mask bag ventilation with high flow O2
Cricothyroidotomy
Tracheostomy

Question 7

Treatment of malignant airway obstruction

Answer 7

Tumour removal
Tumour compression (stent)
Radiotherapy

Question 8

acute anaphylaxis

Answer 8

Type 1 - intermediate:
IgE hypersensitivity reaction
systemic condition (fever, itching)
can cause: stridor, wheeze and respiratory failure

Question 9

causes of anaphylaxis

Answer 9

foods (eg: nuts, shellfish)
insect venom (bee, wasp)
Drugs (eg: penicillin, aspirin, anaesthetics)
Other eg: latex

Question 10

treatment of anaphylaxis

Answer 10

IM Epinephrine (adrenaline)
IV antihistamine
IV corticosteroid
High flow O2
Nebulised  bronchodilators

Allergen avoidance
Desensitisation (immunotherapy) eg: venom
Self-administered epinephrine

Question 11

how is sleep apnoea measured?

Answer 11

Epworth sleepiness scale

Question 12

what is snoring

Answer 12

the relaxation of pharyngeal dilator muscles during sleep (esp. REM)
Upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base

Question 13

what is obstructive sleep apnoea

Answer 13

intermittent upper airway collapse in sleep

recurrent arousals/sleep fragmentation

Question 14

Risk factors for sleep apnoea

Answer 14

enlarged tonsils
obesity
retrognathia (abnormal posterior positioning of the maxilla or mandible)
hypothyroidism
drugs: opiates, alcohol
post-operative period after anaesthesia

Question 15

consequences of sleep apnoea

Answer 15

excessive daytime sleepiness
personality change
cognitive/functional impairment
major impact on daytime function

Question 16

consequences of sleep apnoea

Answer 16

increase risk of RTA
driving simulation - equivalent to being twice legal limit for alcohol

risk of hypertension
activated sympathetic system
raised CRP
impaired endothelial function and glucose tolerance

Question 17

diagnosis of obstructive sleep apnoea

Answer 17

snoring & EDS (raised epworth score)

overnight sleep study

Question 18

treatment of ob. sleep apnoea

Answer 18

remove underlying cause

CPAP (continuous positive airway pressure)