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 healthy individuals; however, it’s especially prevalent in middle-age men who are obese. It may be aggravated by the use of alcohol or a sedative 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 interventions

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 carefully for periods of apnea and note their length. When possible, question the patient’s partner about his snoring habits. Is she frequently awakened by the patient’s snoring? Does the snoring improve if the patient sleeps with the window open? Has she 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.

Medical causes

Airway obstruction

Regardless of its cause, 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 people who are obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. Alternating tachycardia and bradycardia may occur.

Episodes of snoring and apnea recur in a cyclic pattern throughout the night. Sleep disturbances, such as somnambulism and talking during sleep, may also occur. 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

Endotracheal (ET) intubation, suction, or surgery

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

Special considerations

Continue to 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.

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Orthopnea

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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Orthopnea

• Back to symptom: Orthopnea: Introduction (review 41 causes)
• Next Book Extract About Orthopnea: Apnea (Handbook of Signs & Symptoms (Third Edition))
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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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