Respirations, stertorous

Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less commonly, these respirations result from retained mucus in the upper airway.

This common sign occurs in about 10% of normal individuals, especially middle-age, obese men. It may be aggravated by use of alcohol or sedatives before bed, which increases oropharyngeal flaccidity, and by sleeping in the supine position, which allows the relaxed tongue to slip back into the airway. The major pathologic causes of stertorous respirations are obstructive sleep apnea and life-threatening upper airway obstruction associated with an oropharyngeal tumor or with uvular or palatal edema. This obstruction may also occur during the postictal phase of a generalized seizure when mucous secretions or a relaxed tongue blocks the airway.

Occasionally, stertorous respirations are mistaken for stridor, which is another sign of upper airway obstruction. However, stridor indicates laryngeal or tracheal obstruction, whereas stertorous respirations signal higher airway obstruction.

Emergency Actions

If you detect stertorous respirations, check the patient’s mouth and throat for edema, redness, masses, or foreign objects. If edema is marked, quickly take vital signs, including oxygen saturation. Observe the patient for signs and symptoms of respiratory distress, such as dyspnea, tachypnea, use of accessory muscles, intercostal muscle retractions, and cyanosis. Elevate the head of the bed 30 degrees to help ease breathing and reduce the edema. Then administer supplemental oxygen by nasal cannula or face mask, and prepare to intubate the patient, perform a tracheostomy, or provide mechanical ventilation. Insert an I.V. line for fluid and drug access, and begin cardiac monitoring.

History

When possible, question the patient’s partner about his snoring habits. Is the partner frequently awakened by the patient’s snoring? Does the snoring improve if the patient sleeps with the window open? Has the partner also observed the patient talk in his sleep or sleepwalk? Ask about signs of sleep deprivation, such as personality changes, headaches, daytime somnolence, or decreased mental acuity.

Physical assessment

When the patient is awake, perform a complete respiratory assessment, followed by an examination of his head, nose, and throat. If you detect stertorous respirations while the patient is sleeping, observe his breathing pattern for 3 to 4 minutes. Do noisy respirations cease when he turns on his side and recur when he assumes a supine position? Watch for periods of apnea and note their length.

Medical causes

Airway obstruction

Partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.

Obstructive sleep apnea

Loud and disruptive snoring is a major characteristic of obstructive sleep apnea, which commonly affects the obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. These episodes occur in a cyclic pattern throughout the night. Alternating tachycardia and bradycardia may occur as well as such sleep disturbances as somnambulism and talking during sleep. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.

Other causes

Procedures

Endotracheal intubation, suction, or surgery may cause significant palatal or uvular edema, resulting in stertorous respirations.

Special considerations

Monitor the patient’s respiratory status carefully. Administer a corticosteroid or an antibiotic and cool, humidified oxygen to reduce palatal and uvular inflammation and edema.

Laryngoscopy and bronchoscopy (to rule out airway obstruction) or formal sleep studies may be necessary.

Pediatric pointers

In children, the most common cause of stertorous respirations is nasal or pharyngeal obstruction secondary to tonsillar or adenoid hypertrophy or the presence of a foreign body.

Geriatric pointers

Encourage the patient to seek treatment for sleep apnea or significant hypertrophy of the tonsils or adenoids.

Patient counseling

Encourage the obese patient to lose weight. Show the patient how to set up and use continuous or bilevel positive airway pressure, if indicated.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Orthopnea

Read excerpts from these other book chapters related to Orthopnea:

Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

More About Causes of Orthopnea

• Back to symptom: Orthopnea: Introduction (review 41 causes)
• Next Book Extract About Orthopnea: Bradypnea (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• All Book Extracts: All Online Book Extracts for Orthopnea

More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Bradypnea (Signs & Symptoms: A 2-in-1 Reference for Nurses)

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