stridor and sleep apnoea

Question 1

what is stridor?

Answer 1

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

Question 2

what are the causes of stridor in children?

Answer 2

• infections eg croup, epiglottitis, diptheria
• foreign body
• anaphalaxis
• other eg burns

Question 3

what are the causes of stridor in adults?

Answer 3

• neoplasms eg larynx, trachea, major bronchi
• anaphalaxis
• trauma eg strangulation, burns

Question 4

how do you treat laryngeal obstruction?

Answer 4

• treat underlying cause eg foreign body removal, anaphalaxis
• mask bag ventilation with high flow O2
• cricothyroidotomy
• tracheostomy

Question 5

how do you treat malignancy airway obstruction?

Answer 5

• tumour removal
• tumour compression
• radiotherapy

Question 6

what is acute anaphylaxis?

Answer 6

type 1 immediate hypersensitvity (IgE)

• flushing, pruritusm urticaria
• hypotension
• stridor, wheeze and resp failure

Question 7

how do you treat anaphylaxis?

Answer 7

• IM epinephrine (adrenaline)
• IV antihistamine
• IV corticosteroid
• high flow O2
• nebulised bronchodilators
• endotracheal intubation if necessary

Question 8

how do you precaution for anaphylaxis?

Answer 8

• allergen avoidance
• immunotherapy - for bee stings
• self-administered epinephrine

Question 9

what is snoring?

Answer 9

• relaxation of pharyngeal dilator muscles during sleep

- upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base

Question 10

what is obstructive sleep apnoea?

Answer 10

• intermittent upper airway collapse in sleep
• apnoeas or hypopnoeas +/- hypoxaemia
• recurrent arousals/sleep fragmentation

Question 11

what are risk factors for sleep apnoea?

Answer 11

• enlarged tonsils, adenoids
• obesity
• oropharyngeal deformity
• drugs : benzodiazepines, opiates, alcohol
• post-operative period after anaesthesia

Question 12

what are the consequences of sleep apnoea?

Answer 12

• excessive daytime sleepiness
• personality change
• cognitive / functional impairment
• hypertension
• raised CRP
• impaired endothelial function and impaired glucose tolerance

Question 13

how do you diagnose OSA?

Answer 13

• snoring and EDS
• overnight sleep study eg
  full polysomnography

Question 14

how do you treat OSA?

Answer 14

• remove underlying cause

- CPAP (continuous positive airway pressure)