Stridor & Sleep Apnoea

Question 1

What is Stridor?

Answer 1

Large airways obstruction (larynx, trachea, main bronchi) producing wheeze

Question 2

Causes of Stridor in children? (4)

Answer 2

1. Infection- epiglottitis
2. Foreign body
3. Anaphylaxis
4. Other- burns

Question 3

Causes of Stridor in adults (4)

Answer 3

1. Neoplasms- larynx, trachea, main bronchi
2. Anaphylaxis
3. Trauma
4. Others-

Question 4

What investigations would you do for Stridor? (5)

Answer 4

1. Laryngoscopy (beware in acute epiglottitis)
2. Bronchoscopy
3. Chest Xray
4. CT
   5 Flow vol loop

Question 5

How would you treat Laryngeal obstruction?

Answer 5

1. Remove object
2. High flow O2
3. Cricothryoidotomy (incision made through Cricothyroid membrane to maintain ventilation)
4. Tracheostomy (incision in wind pipe to facilitate breathing)

Question 6

What is the Heimlich Manoeuvre?

Answer 6

Rapid thrusts in epigastric forces upward diaphragm movement and forced expiration

Question 7

How would you treat a malignant arirway obstruction in stridor?

Answer 7

1. Tumour removal- surgery, laser, photo therapy
2. Tumour suppression- Stent
3. Radiotherapy
4. Chemotherapy/ Drugs

Question 8

What is acute Anaphylaxis?

Answer 8

A type I hypersensitivity reaction. Histamine release from mast cells

Question 9

What are the systemic effects of acute Anaphylaxis? (3)

Answer 9

1. Life threatening airway obstruction/ breathing problem- stridor, wheeze, respiratory failure
2. Skin/ mucosal changes- angioneurotic oedema, urticaria, flushing.
3. Hypotension- shock

Question 10

Common causes of acute anaphylaxis? (4)

Answer 10

1. Food- nuts
2. Venom- bee, wasps
3. Drugs- penicillin, aspirin
4. Others- latex

Question 11

Treatment for anaphylaxis?

Answer 11

1. Secure airway, Give High flow O2
2. IM adrenaline (0.5mg)
3. IV antihistamine
4. IV corticosteroid
5. Nebulised bronchodilator
6. Endotracheal intubation if necessary

Question 12

Prevention for anaphylaxis?

Answer 12

1. Allergy avoidance
2. Desensitisation
3. Personal use of adrenaline

Question 13

What causes snoring?

Answer 13

Relaxation of pharyngeal muscle, partially obstructing upper airway causing turbulent airflow i.e sound

Question 14

What happens in sleep apnoea?

Answer 14

Relaxed pharyngeal muscle doesnt pull inwards, tongue rests backwards onto the roof of the mouth

Effect- full airway obstruction

Person gasps for breath, then goes back to sleep unaware of what happened. This repeats throughout the night.

Question 15

Risk factors for sleep apnoea?

Answer 15

1. Obesity
2. Inflamed tonsils
3. Acromegaly (too much growth hormone)
4. Drugs

Others- retrognathia, neurological, oropharyngeal deformities.

Question 16

What are the effects of sleep apnoea on a persons day to day life?

Answer 16

1. Poor sleep at night
2. Excessive day time sleepness
3. Tired/ irritable
4. Cognitive/functional impairment

Question 17

What diseases can sleep apnoea cause?

Answer 17

1. Hypertension
2. Impaired endothelial function
3. Impaired glucose function

Question 18

How is diagnosis established in sleep apnoea?

Answer 18

1. Snoring & EDS (raised epworth score)

2. Overnight sleep study- oximetry

Question 19

Treatment options for sleep apnoea?

Answer 19

1. CPAP - continuous positive airway pressure- device applies mild pressure to keep the airway pressure + and the airways open
2. Remove underlying cause

Other- mandibular advancement device, surgery