动态胸外气道阻塞

A 53-year-old woman with a history of traumatic laryngeal fracture in childhood was referred for evaluation of excessive daytime somnolence. Inspiratory stridor was evident on physical examination. A spirometric flow-volume loop (Panel A) revealed an abnormal inspiratory airflow plateau (dashed line) and inspiratory flow oscillations (arrowhead), a pattern suggesting the presence of a dynamic extrathoracic airway obstruction (a normal flow-volume loop is shown in orange). Polysomnography confirmed that intermittent dynamic limitation of inspiratory flow was resulting in snoring and sleep disruption. Laryngoscopy revealed redundant