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 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 mucus secretions or a relaxed tongue blocks the airway or during postsurgery or conscious sedation.
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.
Act Now: 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 his vital signs, including oxygen saturation. Observe the patient for signs and symptoms of respiratory distress, such as dyspnea, tachypnea, accessory muscle use, intercostal muscle retractions, and cyanosis. Elevate the head of the bed 30 degrees to help ease breathing and reduce 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.
Assessment
History
Ask the patient about signs of sleep deprivation, such as personality changes, headaches, daytime somnolence, or decreased mental acuity. When possible, ask a family member whether the patient snores. If so, does his snoring awaken others? Does the snoring improve if he sleeps with the window open? Does the patient talk in his sleep or sleepwalk?
Physical examination
Perform a complete respiratory assessment. Examine the 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 carefully for periods of apnea and note their length. Monitor the patient’s level of oxygenation.
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.
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 the obese. Typically, 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 intubation, suction, or surgery
These procedures may cause significant palatal or uvular edema, resulting in stertorous respirations.
Nursing 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.
Patient teaching
If excessive weight is related to the condition, discuss the importance and methods of weight loss. Explain the assembly and use of a continuous or bilevel positive airway pressure device for a patient with sleep apnea. Teach the patient to elevate his head while sleeping. Provide information and recommend a smoking cessation program if the patient smokes.
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Snoring
Read excerpts from these other book chapters related to Snoring:
Medical Books Excerpts
- STRIDOR
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- WHEEZING
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- SNORING
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Stridor
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Wheezing
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Snoring
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Stridor
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Wheezing
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Stridor
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Stridor
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Wheezing
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Stridor
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Wheezing
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Stridor
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Wheezing
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Wheezing
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Stridor
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Snoring
» Next page: Stridor (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
