학술논문
Stridor during sleep: description of 81 consecutive cases diagnosed in a tertiary sleep disorders center
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Source
SLEEP. March 2021, Vol. 44 Issue 3, p1H, 13 p.
Subject
Language
English
ISSN
0161-8105
Abstract
Introduction Stridor is a high-pitched respiratory sound produced by turbulent airflow through a partially obstructed upper airway [1]. Abnormalities that obstruct the upper airway and cause stridor are usually located [...]
Study Objectives: To describe the characteristics of stridor during sleep (SDS) in a series of adults identified by video-polysomnography (V-PSG). Methods: Retrospective clinical, V-PSG, laryngoscopic, and therapeutic data of patients diagnosed with SDS in a tertiary referral sleep disorders center between 1997 and 2017. Results: A total of 81 patients were identified (56.8% males, age 61.8 [+ or -] 11.2 years). Related etiologies were multiple system atrophy (MSA), amyotrophic lateral sclerosis, spinocerebellar ataxia type 1, anti-IgLON5 disease, fatal familial insomnia, brainstem structural lesions, vagus nerve stimulation, recurrent laryngeal nerve injury, the effect of radiotherapy on the vocal cords, cervical osteophytes, and others. Stridor during wakefulness coexisted in 13 (16%) patients and in MSA was only seen in the parkinsonian form. Laryngoscopy during wakefulness in 72 (88.9%) subjects documented vocal cord abductor impairment in 65 (90.3%) and extrinsic lesions narrowing the glottis in 2 (2.4%). The mean apnea-hypopnea index (AHI) was 21.4 [+ or -] 18.6 and CT90 was 11.5 [+ or -] 19.1. Obstructive AHI > 10 occurred in 52 (64.2%) patients and central apnea index >10 in 2 (2.4%). CPAP abolished SDS, obstructive apneic events and oxyhemoglobin desaturations in 58 of 60 (96.7%) titrated patients with optimal pressure of 9.0 [+ or -] 2.3 cm H20. Tracheostomy in 19 (23.4%) and cordotomy in 3 (3.7%) subjects also eliminated SDS. Conclusions: SDS in adults is linked to conditions that damage the brainstem, recurrent laryngeal nerve, and vocal cords. V-PSG frequently detects obstructive sleep apnea and laryngoscopy usually shows vocal cord abductor dysfunction. CPAP, tracheostomy, and laryngeal surgery abolish SDS. Key words: stridor; sleep; vocal cord abductor impairment; laryngoscopy; video-polysomnography; continuous positive airway pressure; tracheostomy; laryngeal surgery
Study Objectives: To describe the characteristics of stridor during sleep (SDS) in a series of adults identified by video-polysomnography (V-PSG). Methods: Retrospective clinical, V-PSG, laryngoscopic, and therapeutic data of patients diagnosed with SDS in a tertiary referral sleep disorders center between 1997 and 2017. Results: A total of 81 patients were identified (56.8% males, age 61.8 [+ or -] 11.2 years). Related etiologies were multiple system atrophy (MSA), amyotrophic lateral sclerosis, spinocerebellar ataxia type 1, anti-IgLON5 disease, fatal familial insomnia, brainstem structural lesions, vagus nerve stimulation, recurrent laryngeal nerve injury, the effect of radiotherapy on the vocal cords, cervical osteophytes, and others. Stridor during wakefulness coexisted in 13 (16%) patients and in MSA was only seen in the parkinsonian form. Laryngoscopy during wakefulness in 72 (88.9%) subjects documented vocal cord abductor impairment in 65 (90.3%) and extrinsic lesions narrowing the glottis in 2 (2.4%). The mean apnea-hypopnea index (AHI) was 21.4 [+ or -] 18.6 and CT90 was 11.5 [+ or -] 19.1. Obstructive AHI > 10 occurred in 52 (64.2%) patients and central apnea index >10 in 2 (2.4%). CPAP abolished SDS, obstructive apneic events and oxyhemoglobin desaturations in 58 of 60 (96.7%) titrated patients with optimal pressure of 9.0 [+ or -] 2.3 cm H20. Tracheostomy in 19 (23.4%) and cordotomy in 3 (3.7%) subjects also eliminated SDS. Conclusions: SDS in adults is linked to conditions that damage the brainstem, recurrent laryngeal nerve, and vocal cords. V-PSG frequently detects obstructive sleep apnea and laryngoscopy usually shows vocal cord abductor dysfunction. CPAP, tracheostomy, and laryngeal surgery abolish SDS. Key words: stridor; sleep; vocal cord abductor impairment; laryngoscopy; video-polysomnography; continuous positive airway pressure; tracheostomy; laryngeal surgery