Stridor and Sleep Apnoea

Question 1

What is stridor

Answer 1

Inspiratory wheeze due to large airways (larynx/trachea/major bronchi) obstruction

Question 2

What is croup

Answer 2

Laryngotracheobronchitis caused by a viral infection that leads to swelling inside the trachea causing a barking cough

Question 3

What is tracheomalacia

Answer 3

Tracheal cartilage becomes flaccid causing widening of posterior membranous wall and reducing airway calibre. This can cause tracheal collapse

Question 4

How can stridor be investigated

Answer 4

Laryngoscopy, bronchoscopy, spirometry, chest x-ray and other imaging (CT scan, thyroid scan)

Question 5

Treatment of laryngeal obstruction

Answer 5

Treat underlying cause such as foreign body removal, mask bag ventilation with high flow O2, cricothyroidotomy, tracheostomy

Question 6

Cricothyroidotomy vs tracheostomy

Answer 6

Cricothyroidotomy - Incision made through skin and cricoid membrane to establish a patent airway
Tracheostomy - Opening in front of neck so tube can be inserted

Question 7

What type of hypersensitivty is anaphylaxis

Answer 7

Type 1 (immediate) hypersensitivity - IgE

Question 8

Symptoms of acute anaphylaxis

Answer 8

Flushing, urticaria, pruritus, angioneurotic oedema, abdominal pain, vomiting, hypotension, stridor, wheeze and respiratory failure

Question 9

Why hypotension in acute anaphylaxis

Answer 9

Vasodilation and plasma exudation leading to circulatory collapse and shock

Question 10

Why wheeze and stridor in acute anaphylaxis

Answer 10

Due to inflammation of larynx and bronchi

Question 11

Treatment of anaphylaxis

Answer 11

BOCAE -
Bronchodilators nebulized
Oxygen, high flow
Corticosteroids IV
Antihistamine IV
Epinephrine IM

Question 12

What causes snoring

Answer 12

Relaxation of pharyngeal dilator muscles during sleep. Upper airway narrows causing turbulent airflow and vibration of soft palate and tongue base

Question 13

What is sleep apnoea

Answer 13

Repeat starting and stopping of breathing during sleep

Question 14

Comon sign of obstructive sleep apneo

Answer 14

Snoring

Question 15

What drugs can cause sleep apnoea

Answer 15

Benzodiazepine, opiates, alcohol, post operative after anaesthesia

Question 16

Consequences of sleep apnoea

Answer 16

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

Question 17

Adverse health effects of sleep apnoea

Answer 17

Independent risk factor for hypertension, activated sympathetic system, raised CRP, impaired endothelial function, impaired glucose tolerance, increase risk of CV events and stroke

Question 18

How can obstructive sleep apnoea be diagnosed

Answer 18

Overnight sleep study -

Oximetry, domiciliary recording of oximetry/airflow/thoracic/abdominal movement, full polysomnography

Question 19

Treatment of obstructive sleep apnoea

Answer 19

Remove underlying cause

CPAP - Continuous positive airway pressure

Question 20

Other treatment for sleep apnoea

Answer 20

Mandibular advancement device -
Improves snoring
Moderate reduction in number of apnoeas recorded during study per hour of sleep
Used in mild obstructive sleep apnoea
Surgery -
Avoid if sleep apnoea as CPAP in future becomes less effective
Used in simple snoring

Question 21

Surgery option for sleep apnoe

Answer 21

Uvulopalatopharyngoplasty - Remodel/remove tissue in throat