SLEEP-RELATED LARYNGOSPASM

The term ''sleep-related laryngospasm'' refers to episodic, abrupt int erruption of sleep accompanied by feelings of acute suffocation follow ed by stridor, The condition is included in the diagnostic and coding manual of the American Sleep Disorders Association (ASDA), but there a re few references in the peer-reviewed literature. Our description of the distinct clinical picture associated with this condition is based on an analysis of the histories of a series of 10 patients. The patien ts and their families gave precise, uniform accounts of the dramatic a ttacks. Diagnostic work-up included pulmonary and gastroenterological assessment. All patients reported sudden awakening from sleep due to f eelings of acute suffocation, accompanied by intense fear, Apnoea last ing 5-45 s was followed by strider. Breathing returned to normal withi n minutes, Patients were left exhausted by the attacks, Nine of our 10 patients had evidence of gastro-oesophageal reflux and six responded to antireflux therapy. We conclude that the nocturnal choking attacks (and the occasional daytime attacks experienced by some of the patient s) are caused by laryngospasm. The pathogenesis of the apparent underl ying laryngeal irritability is unknown, The condition may be related t o a gastro-oesophageal reflux.