Upper Airway

Question 1

What is sleep apnoea defined as?

Answer 1

30+ episodes of breathing cessation (10s+) in 7hrs sleep

Question 2

What happens in obstructive sleep apnoea? (OSAS) ± snoring

Answer 2

Collapse of upper airway
Chest movements continue but O2 sats fall
Waking reflex when sats low enough

Snoring = vibration of 1+ part of upper airway

Question 3

What are some long-term effects of obstructive sleep apnoea?

Answer 3

Pulm hypertension
RV strain
Cor pulmonale

Question 4

What is the typical presentation of OSAS in adults

Answer 4

High BMI + fat neck

Alcohol consumption

Question 5

What is the typical presentation of OSAS in children

Answer 5

Due to adenotonsillar hypertrophy
Aged 2-5 (when tonsils largest)
Failure to thrive / over-active

Question 6

List some RFs for adult OSAS (9)

Answer 6

Age
Male (oestrogen protective)
Obesity
Obstructed upper airway
FH
Smoking
Alcohol / Sedatives
Neuromuscular disease
Chronic lung disease

Question 7

List some symptoms assoc w. OSAS

Answer 7

Nocturia
Witnessed apnoea
Excessive daytime sleepiness
Irritability/mood changes
Decreased libido
Restless/unrefreshing sleep
Choking episodes during sleep
Snoring

Question 8

What Ix can be done for OSAS?

Answer 8

Sleep studies

ENdoscopy (invasive/w. probes detecting vibrations)

Question 9

How is OSAS managed?

Answer 9

Lifestyle: lose wt***, avoid alc/sedatives, partner ear plugs

Medical: drugs reducing REM sleep, respiratory stimulants, CPAP

Surgical: adenotonsillectomy (children), e.g. treat nasal polyps/deviated septum, tracheostomy

Question 10

List the signs/symptoms of upper airway obstruction

Answer 10

Stridor
Noisy breathing
Voice change
SOB (tachypnoea/suprasternal retraction/accessory)
Drooling
Subcutanous emphysema
?local pain / ? dysphagia

Question 11

What are the management options for upper airway obstruction? (4)

+ what first aid measures can be taken beforehand? (2)

Answer 11

Sustain an airway (Guedell/LMA)
Intubation
Cricothyroid puncture
Tracheostomy

Suction vomit/foreign body
Heliox if cyanosed but still breathing

Question 12

What is stridor?

Where is the source of pathology in inspiratory strider/ expiratory / mixed

Answer 12

Noisy breathing from lower respiratory level
Inspiratory = laryngeal
Expiritory = bronchi/oles (asthma)
Mixed = tracheal/laryngeal + lower airway

Question 13

What is stertor

Answer 13

Noisy breathing from naso/oropharynx level

Question 14

List some causes of stridor (3 + 8)

Answer 14

Congenital:
Laryngomalacia
Subglottic stenosis
Vocal cord palsy/web

Acquired:
Trauma
Foreign body
Angioedema
Vocal cord palsy
Subglottic stenosis
Extra-laryngeal compression (e.g. thyroid mass)
Epiglottitis/Croup
Laryngeal carcinoma/cysts/polyps

Question 15

How is stridor managed?

Answer 15

Assess severity (pt’s appearance + audibility categories)
If poss secure/improve airway
Treat underlying cause

Question 16

What are the indications for inserting a tracheostomy?

Answer 16

Bypass obstruction: infection/ anaphylaxis / foreign bodies/ cancers / OSAS

Avoid obstruction from post-op swelling

Long-term ventilation (allow easier secretion removal + avoid laryngeal scarring)

Avoid aspiration (neuromusc conditions where can’t cough/swallow)

Post-laryngectomy (permanent stoma)

Question 17

What are the 2 main types of tracheostomy

Answer 17

End-tracheostomy (part of laryngectomy)

Side-tracheostomy (larynx left in place)

Question 18

What are some early risks/complications of a tracheostomy? (5)

Answer 18

Blockage from dry secretions
Local infection
Tube displacement
Pneumothorax
Surgical emphysema
Dysphagia

Question 19

What are some late risks/complications of a tracheostomy? (2)

Answer 19

Fistula (tracheocutaneous/tracheoesophageal)

Tracheal stenosis

Question 20

When are sleep studies done for OSAS? (3)

Answer 20

COPD/Resp problems
Drivers / dangerous machinery workers
If pt considered for surgery