Sleep-related laryngospasm

Aloe, Flavio S.; Thorpy, Michael J.

doi:10.1590/S0004-282X1995000100008

Abstracts

Seven patients (mean age 46.6; range 33-58; 6M.1F) presented with sleep-related choking episodes and were found to have features in common that distinguished them from other known causes of choking episodes during sleep. The characteristic features include: an awakening from sleep with an acute choking sensation, stridor, panic, tachycardia, short duration of episode Gess than 60 seconds), infrequent episodes (typically less than 1 per month), and absence of any known etiology. The disorder most commonly occurs in middle-aged males who are otherwise healthy. In one patient an episode of laryngospasm was polysomnographically documented to occur during stage 3. The clinical features and the polysomnographic findings suggest spasm of the vocal cords of unknown etiology.

laryngospasm; vocal cord spasm; choking; stridor; sleep

Sete pacientes (média de idade = 46,6; variação de 33-58; 6M,1F) apresentavam episódios de sufocamento estritamente relacionados ao período de sono. Esses episódios tinham características que os diferiam de outras causas conhecidas de sufocamento durante o sono. Estas características incluem: despertar com súbita sensação de sufocamento, estridor, pânico, taquicardia. Os episódios eram breves (< 60s), infrequentes (< 1 por mês) e não apresentam qualquer evidência de etiologia conhecida. O distúrbio ocorre em homens saudáveis de meia idade. Em um paciente um episódio foi documentado polissonograficamente durante o estágio 3. Os aspectos clínicos e polissonográficos sugerem espasmo das cordas vocais de etiologia desconhecida.

laringospasmo; espasmo de cordas vocais; sufocamento; estridor; sono

Sleep-related laryngospasm

Laringospasmo relacionado ao sono

Flavio S. Aloe^I; Michael J. Thorpy^II

^ISleep-Wake Disorders Center, Department of Neurology of the University of São Paulo Medical School

^IISleep-Wake Disorders Center, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York

SUMMARY

Seven patients (mean age 46.6; range 33-58; 6M.1F) presented with sleep-related choking episodes and were found to have features in common that distinguished them from other known causes of choking episodes during sleep. The characteristic features include: an awakening from sleep with an acute choking sensation, stridor, panic, tachycardia, short duration of episode Gess than 60 seconds), infrequent episodes (typically less than 1 per month), and absence of any known etiology. The disorder most commonly occurs in middle-aged males who are otherwise healthy. In one patient an episode of laryngospasm was polysomnographically documented to occur during stage 3. The clinical features and the polysomnographic findings suggest spasm of the vocal cords of unknown etiology.

Key words: laryngospasm, vocal cord spasm, choking, stridor, sleep.

RESUMO

Sete pacientes (média de idade = 46,6; variação de 33-58; 6M,1F) apresentavam episódios de sufocamento estritamente relacionados ao período de sono. Esses episódios tinham características que os diferiam de outras causas conhecidas de sufocamento durante o sono. Estas características incluem: despertar com súbita sensação de sufocamento, estridor, pânico, taquicardia. Os episódios eram breves (< 60s), infrequentes (< 1 por mês) e não apresentam qualquer evidência de etiologia conhecida. O distúrbio ocorre em homens saudáveis de meia idade. Em um paciente um episódio foi documentado polissonograficamente durante o estágio 3. Os aspectos clínicos e polissonográficos sugerem espasmo das cordas vocais de etiologia desconhecida.

Palavras-chave: laringospasmo, espasmo de cordas vocais, sufocamento, estridor, sono.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 6-agosto-1994.

Dr. Flavio Aloe - Al. Jaú, 1791 - 01420-002 São Paulo SP - Brasil. FAX (55.11) 280 95 19.

1. Abreu e Silva FA, Williams A, Simpson H. Sleep apnea in infants with congenital stridor. Arch Dis Child 1986, 61: 1125-1126
²
American Psychiatric Association: Diagnostic and statistical manual of mental disorders. Ed 3 rev. Washington DC: American Psychiatric Association, 1987.
³
American Sleep Disorders Association. ICSD-International classification of sleep disorders: diagnostic and coding manual. (Diagnostic Classification Committee, Thorpy MJ, Chairman). Rochester, 1990.
4. Amir J, Ashkenazi S, Shonfeld T, Weitz R, Nitzan M. Laryngospasm as a single manifestation of epilepsy. Arch Dis Child 1983, 58: 151-153.
5. Appelblat NH, Baker SR. Functional upper airway obstruction: a new syndrome. Arch Otolaryngol 1981, 107: 305-306.
6. Aragane N, Katoh O, Yamada H, Kuroda Y, Maeyama T. Respiratory failure due to vocal cord dyskinesia in olivo-ponto-cerebellar atrophy. Chest 1989, 96: 1212-1214.
7. Ballantyne J, Groves J. Scott's-Bronw's diseases of the ear nose and throat. London: Butterworths, 1971.
8. Bannister R, Gibson W, Michaels L Laryngeal abductor paralysis in multiple system atrophy. Brain 1981, 104: 351-368.
9. Bortolotti M. Laryngospasm and reflex central sleep apnoea caused by aspiration of refluxed gastric contents in adults. GUT 1989, 30: 223-228.
10. Broughton RJ, Poire R, Tassinari CA. The electrodermogram (Tachnoff effect) during sleep. Electroenceph Clin Neurophysiol 1965, 18: 691-708.
11. Collett PW, Brancatisano T, Engel LA. Spasmodic croup in the adult. Am Rev Respir Dis 1983, 12: 500-504.
12. Cormier YF, Camus P, Desmondes MJ. Nonorganic acute upper airway obstruction: description and diagnostic approach. Am Rev Respir Dis 1980, 121: 147-150.
13. Cristopher KL, Wood RP, Eckert B, Blager FB, Raney RA, Souhrada JF. Vocal cord dysfunction presenting as asthma. N Engl J Med 1983, 308: 1566-1570.
14. Dexter DD, Harris CD, Staats BA, Lin S, Shepard JW. Nocturnal stridor in patients with multiple system atrophy: diagnosis, treatment and prognosis (abstract). Sleep Res 1991, 20a: 417.
15. Downing ET, Braman SS, Fox MJ, Corrao WM. Factitious asthma: physiological approach to diagnosis. JAMA 1982, 248: 2787-2881.
16. Fisher CJ, Kahn E, Edwards A. A psychophysiological study of nightmares and night terrors. Arch Gen Psychiatry 1973, 28: 252-259.
17. Freixa i Baque E, Chevalier B, Grubar JC. Spontaneous electrodermal activity during sleep in man: an intranight study. Sleep 1983, 6: 77-81.
18. Guilleminault C, Miles L. Differential diagnosis of obstructive sleep apnea syndrome: the abnormal esophageal reflux and laryngospasm during sleep (abstract). Sleep Res 1980, 9: 200.
19. Guilleminault C. Obstructive sleep apnea syndrome. Psych Clin North Am 1987, 10: 607-621.
20. Hauri P, Friedman M, Ravaris C. Sleep in patients with spontaneous panic attacks. Sleep 1989, 12: 323-337.
21. Herman R. Nocturnal panic in a depressed patient: pathophysiological implications. Biol Psychiatry 1988, 24: 432-436.
22. Ikari T, Sasaki CT. Glottic closure reflex: control mechanisms. Ann Otol 1980, 89: 220-224.
23. Johnson LC, Lubin A. Spontaneous electrodermal activity during waking and sleeping. Psychophysiology 1966, 3: 8-17.
24. Kales JC, Kales A, Soldatos CR, Caldwell AB, Charney DS, Martin ED.Night terrors: clinical characteristics and personality patterns. Arch Gen Psychiatry 1980, 37: 1423-1417.
25. Kavey NB, Whyte J, Blitzer A, Gidro-Frank S Sleep-related laryngeal obstruction presenting as snoring or sleep apnea. Laryngoscope 1989, 99: 851-854.
26. Kellman R.M, Leopold DA: Paradoxical vocal cord movement: an important cause of stridor. Laryngoscope 1982, 92: 58-60.
27. Kenyon GS, Apps MC, Traub M. Stridor and obstructive sleep apnea in Shy-Drager syndrome treated by laryngofissure and cord lateralization. Laryngoscope 1984, 94: 1106-1108.
28. Kneisley LW, Rederich G. Nocturnal stridor in olivopontocerebellar atrophy. Sleep 1990, 13: 362-368.
29. Kryger MH, Acres CJ, Brownell L. A syndrome of sleep, stridor, and panic, (letter). Chest 1981, 80: 768.
30. Lesser IM, Poland RE, Holcomb C, Rose DE. Encephalographic study of nighttime panic attacks. J Nerv Ment Dis 1985. 173: 744-746.
31. McDonald DG, Shallenberger HD, Keosko RK, Kinney BG. Studies of spontaneous electrodermal responses in sleep. Psychophysiology 1976,13: 128-134.
32. Mellman TA, Uhde TW. Electroencephalographic sleep in panic disorders. Arch Gen Psychiatry 1989, 46: 178-184.
33. Mellman TA, Uhde TW: Sleep panic attacks: new clinical findings and theoretical implications. Am J Psychiatry 1989, 146: 1204-1207.
34. Mellman TA, Uhde T. Patients with frequent panic sleep: clinical findings and response to medication treatment. J Clin Psychiatry 1990, 51: 513-516.
35. Munschauer FE, Loh L, Bannister R, Newson-Davis J. Abnormal respiration and sudden death during sleep in multiple system atrophy with autonomic failure. Neurology 1990, 40: 677-679.
36. Nielson DW, Heldt GP. Gastroesophageal reflux and stridor in infancy. Pediatr Res 1982, 16: 358A.
37. Orenstein SR, Orenstein DM, Whitington P. Gastroesophageal reflux causing stridor. Chest 1983, 84: 301-302.
38. Patterson R, Schatz M, Horton M. Munchausen's stridor, non-organic laryngeal obstruction. Clin Allergy 1974, 4: 307-310.
39. Pellegrini CA, De Meester TR, Johnson LF, Skinner DB. Gastroesophageal reflux and pulmonry aspiration: incidence, functional abnormality, and results of surgical therapy. Surgery 1979, 86: 110-119.
40. Ramirez-R J, Leon I, Rivera LM. Episodic laryngeal dyskinesia: clinical and psychiatirc characterization. Chest 1986, 90: 716-720.
41. Ravindran M. Temporal lobe seizure presenting as "laryngospasm". Clin Electroencephalograph 1981,12: 129-130.
42. Rodenstein DO, Francis D, Stanescu DC. Emotional laryngeal wheezing: a new syndrome. Am Rev Respir Dis 1983, 127: 354-356.
43. Rogers JH, Stell PM. Paradoxical movement of the vocal cords as a cause of stridor. J Largyngol Otol 1978, 92: 157-158.
44. Rogers JH. Functional inspiratory stridor in children. J Laryngol Otol 1980, 94: 669-670.
45. Ware JC, Karacan I, Salis PJ, Thornby J, Hirshkowitz M. Sleep-related electrodermal activity patterns in impotent patients. Sleep 1984, 7: 247-254.
46. Williams A, Hanson D, Caine DB. Vocal cord paralysis in the Shy-Drager syndrome. J Neurol Neurosurg Psychiatry 1979, 42: 151-153.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abreu e Silva FA, Williams A, Simpson H. Sleep apnea in infants with congenital stridor. Arch Dis Child 1986, 61: 1125-1126

[2] ²
American Psychiatric Association: Diagnostic and statistical manual of mental disorders. Ed 3 rev. Washington DC: American Psychiatric Association, 1987.

[3] ³
American Sleep Disorders Association. ICSD-International classification of sleep disorders: diagnostic and coding manual. (Diagnostic Classification Committee, Thorpy MJ, Chairman). Rochester, 1990.

[4] 4. Amir J, Ashkenazi S, Shonfeld T, Weitz R, Nitzan M. Laryngospasm as a single manifestation of epilepsy. Arch Dis Child 1983, 58: 151-153.

[5] 5. Appelblat NH, Baker SR. Functional upper airway obstruction: a new syndrome. Arch Otolaryngol 1981, 107: 305-306.

[6] 6. Aragane N, Katoh O, Yamada H, Kuroda Y, Maeyama T. Respiratory failure due to vocal cord dyskinesia in olivo-ponto-cerebellar atrophy. Chest 1989, 96: 1212-1214.

[7] 7. Ballantyne J, Groves J. Scott's-Bronw's diseases of the ear nose and throat. London: Butterworths, 1971.

[8] 8. Bannister R, Gibson W, Michaels L Laryngeal abductor paralysis in multiple system atrophy. Brain 1981, 104: 351-368.

[9] 9. Bortolotti M. Laryngospasm and reflex central sleep apnoea caused by aspiration of refluxed gastric contents in adults. GUT 1989, 30: 223-228.

[10] 10. Broughton RJ, Poire R, Tassinari CA. The electrodermogram (Tachnoff effect) during sleep. Electroenceph Clin Neurophysiol 1965, 18: 691-708.

[11] 11. Collett PW, Brancatisano T, Engel LA. Spasmodic croup in the adult. Am Rev Respir Dis 1983, 12: 500-504.

[12] 12. Cormier YF, Camus P, Desmondes MJ. Nonorganic acute upper airway obstruction: description and diagnostic approach. Am Rev Respir Dis 1980, 121: 147-150.

[13] 13. Cristopher KL, Wood RP, Eckert B, Blager FB, Raney RA, Souhrada JF. Vocal cord dysfunction presenting as asthma. N Engl J Med 1983, 308: 1566-1570.

[14] 14. Dexter DD, Harris CD, Staats BA, Lin S, Shepard JW. Nocturnal stridor in patients with multiple system atrophy: diagnosis, treatment and prognosis (abstract). Sleep Res 1991, 20a: 417.

[15] 15. Downing ET, Braman SS, Fox MJ, Corrao WM. Factitious asthma: physiological approach to diagnosis. JAMA 1982, 248: 2787-2881.

[16] 16. Fisher CJ, Kahn E, Edwards A. A psychophysiological study of nightmares and night terrors. Arch Gen Psychiatry 1973, 28: 252-259.

[17] 17. Freixa i Baque E, Chevalier B, Grubar JC. Spontaneous electrodermal activity during sleep in man: an intranight study. Sleep 1983, 6: 77-81.

[18] 18. Guilleminault C, Miles L. Differential diagnosis of obstructive sleep apnea syndrome: the abnormal esophageal reflux and laryngospasm during sleep (abstract). Sleep Res 1980, 9: 200.

[19] 19. Guilleminault C. Obstructive sleep apnea syndrome. Psych Clin North Am 1987, 10: 607-621.

[20] 20. Hauri P, Friedman M, Ravaris C. Sleep in patients with spontaneous panic attacks. Sleep 1989, 12: 323-337.

[21] 21. Herman R. Nocturnal panic in a depressed patient: pathophysiological implications. Biol Psychiatry 1988, 24: 432-436.

[22] 22. Ikari T, Sasaki CT. Glottic closure reflex: control mechanisms. Ann Otol 1980, 89: 220-224.

[23] 23. Johnson LC, Lubin A. Spontaneous electrodermal activity during waking and sleeping. Psychophysiology 1966, 3: 8-17.

[24] 24. Kales JC, Kales A, Soldatos CR, Caldwell AB, Charney DS, Martin ED.Night terrors: clinical characteristics and personality patterns. Arch Gen Psychiatry 1980, 37: 1423-1417.

[25] 25. Kavey NB, Whyte J, Blitzer A, Gidro-Frank S Sleep-related laryngeal obstruction presenting as snoring or sleep apnea. Laryngoscope 1989, 99: 851-854.

[26] 26. Kellman R.M, Leopold DA: Paradoxical vocal cord movement: an important cause of stridor. Laryngoscope 1982, 92: 58-60.

[27] 27. Kenyon GS, Apps MC, Traub M. Stridor and obstructive sleep apnea in Shy-Drager syndrome treated by laryngofissure and cord lateralization. Laryngoscope 1984, 94: 1106-1108.

[28] 28. Kneisley LW, Rederich G. Nocturnal stridor in olivopontocerebellar atrophy. Sleep 1990, 13: 362-368.

[29] 29. Kryger MH, Acres CJ, Brownell L. A syndrome of sleep, stridor, and panic, (letter). Chest 1981, 80: 768.

[30] 30. Lesser IM, Poland RE, Holcomb C, Rose DE. Encephalographic study of nighttime panic attacks. J Nerv Ment Dis 1985. 173: 744-746.

[31] 31. McDonald DG, Shallenberger HD, Keosko RK, Kinney BG. Studies of spontaneous electrodermal responses in sleep. Psychophysiology 1976,13: 128-134.

[32] 32. Mellman TA, Uhde TW. Electroencephalographic sleep in panic disorders. Arch Gen Psychiatry 1989, 46: 178-184.

[33] 33. Mellman TA, Uhde TW: Sleep panic attacks: new clinical findings and theoretical implications. Am J Psychiatry 1989, 146: 1204-1207.

[34] 34. Mellman TA, Uhde T. Patients with frequent panic sleep: clinical findings and response to medication treatment. J Clin Psychiatry 1990, 51: 513-516.

[35] 35. Munschauer FE, Loh L, Bannister R, Newson-Davis J. Abnormal respiration and sudden death during sleep in multiple system atrophy with autonomic failure. Neurology 1990, 40: 677-679.

[36] 36. Nielson DW, Heldt GP. Gastroesophageal reflux and stridor in infancy. Pediatr Res 1982, 16: 358A.

[37] 37. Orenstein SR, Orenstein DM, Whitington P. Gastroesophageal reflux causing stridor. Chest 1983, 84: 301-302.

[38] 38. Patterson R, Schatz M, Horton M. Munchausen's stridor, non-organic laryngeal obstruction. Clin Allergy 1974, 4: 307-310.

[39] 39. Pellegrini CA, De Meester TR, Johnson LF, Skinner DB. Gastroesophageal reflux and pulmonry aspiration: incidence, functional abnormality, and results of surgical therapy. Surgery 1979, 86: 110-119.

[40] 40. Ramirez-R J, Leon I, Rivera LM. Episodic laryngeal dyskinesia: clinical and psychiatirc characterization. Chest 1986, 90: 716-720.

[41] 41. Ravindran M. Temporal lobe seizure presenting as "laryngospasm". Clin Electroencephalograph 1981,12: 129-130.

[42] 42. Rodenstein DO, Francis D, Stanescu DC. Emotional laryngeal wheezing: a new syndrome. Am Rev Respir Dis 1983, 127: 354-356.

[43] 43. Rogers JH, Stell PM. Paradoxical movement of the vocal cords as a cause of stridor. J Largyngol Otol 1978, 92: 157-158.

[44] 44. Rogers JH. Functional inspiratory stridor in children. J Laryngol Otol 1980, 94: 669-670.

[45] 45. Ware JC, Karacan I, Salis PJ, Thornby J, Hirshkowitz M. Sleep-related electrodermal activity patterns in impotent patients. Sleep 1984, 7: 247-254.

[46] 46. Williams A, Hanson D, Caine DB. Vocal cord paralysis in the Shy-Drager syndrome. J Neurol Neurosurg Psychiatry 1979, 42: 151-153.