Stridor and Sleep Apnoea Flashcards
In a child with acute epiglottitis what do you need to be careful of?
Laryngoscopy- you need a senior anaesthetist
Common causes of stridor in children?
- Croup (RSV)
- Epiglottitis (haemophilus influenzae)
- Pseudomembranous croup
- Retropharyngeal abscess
- Diphtheria
- Infectious mononucleosis
- Foreign Body (CXR should be done)
- Anaphylaxis / angioneurotic oedema (more often adults but can happen)
- Burns
Common causes of stridor in adults?
- Neoplasms (larynx, trachea, major bronchi), most common.
- Anaphylaxis
- Goitre (retrosternal)
- Trauma (eg strangulation, burns, irritant gases)
- Other (eg bilateral vocal cord palsy; Wegener’s granulomatosis; cricoarytenoid arthritis (RA); tracheopathia
What is tracheomalacia?
Lack of/soft cartilage in the trachea makes it collapse slightly
What is obstructive sleep apnoea?
Intermittent upper airway collapse in sleep
Why is tiredness a symptom of sleep apnoea?
Recurrent arousals / sleep fragmentation, when you become hypoxic you wake up slightly to open up your airway again (micro-arousal)
Risk factors for sleep apnoea?
- Enlarged tonsils, adenoids
- Obesity
- Retrognathia (tongue base is further back, crowding in the back of the throat)
- Acromegaly (excessive growth hormone, causes hypertrophy of organs, particularly tongue), hypothyroidism
- Oropharyngeal deformity
- Neurological: stroke, MS, myesthenia gravis, myotonic dystrophy
- Drugs: benzodiazepines, opiates, alcohol,
- Post-operative period after anaesthesia
How is sleep apnoea diagnosed?
• Snoring & EDS (raised Epworth score)
• Overnight sleep study
- oximetry
- domicillary recording (airflow, oximetry, thoracic/abdominal movement)
- full polysomnography
How is sleep apnoea treated?
- Remove underlying cause (e.g. tonsillectomy, lose weight)
* CPAP (continuous positive airway pressure), most effective therapy, wear a mask at night
