Free BRPT PAP Titration Protocols Questions and Answers — Questions and Answers
Question 1: During a CPAP titration, after observing two obstructive apneas, three hypopneas, and five RERAs within a 15-minute period, what is the technologist's most appropriate action?
- Decrease the CPAP pressure by 1 cm H2O.
- Switch the patient to BiLevel PAP.
- Increase the CPAP pressure by at least 1 cm H2O. (Correct answer)
- Continue at the current pressure for another 30 minutes.
Correct answer: Increase the CPAP pressure by at least 1 cm H2O.
Standard AASM titration guidelines recommend increasing CPAP pressure when a specific pattern of respiratory events is observed. The presence of 2 obstructive apneas, 3 hypopneas, 5 RERAs, or 3 minutes of loud snoring within a defined period are all triggers to increase the pressure.
Question 2: What is the primary indication to switch a patient from CPAP to BiLevel PAP during a titration study?
- The patient has central apneas at a low CPAP pressure.
- Obstructive respiratory events persist at a CPAP pressure of 15 cm H2O or greater. (Correct answer)
- The patient reports dry mouth.
- The AHI is less than 5 events per hour on CPAP.
Correct answer: Obstructive respiratory events persist at a CPAP pressure of 15 cm H2O or greater.
While CPAP is effective for many, some patients continue to have obstructive events (apneas, hypopneas) even at high pressures (e.g., ≥15 cm H2O). In these cases, or if the patient cannot tolerate the high pressure, switching to BiLevel PAP is indicated to improve efficacy and comfort.
Question 3: When titrating BiLevel PAP, the EPAP is primarily increased to treat which events?
- Central apneas
- Hypopneas and snoring
- Obstructive apneas (Correct answer)
- Periodic limb movements
Correct answer: Obstructive apneas
In BiLevel therapy, EPAP (Expiratory Positive Airway Pressure) functions similarly to CPAP by splinting the upper airway open. Therefore, EPAP is the primary setting adjusted to eliminate obstructive apneas.
Question 4: After resolving obstructive apneas with EPAP, a patient on BiLevel PAP continues to have hypopneas. What is the correct action?
- Decrease the EPAP.
- Increase the IPAP. (Correct answer)
- Switch back to CPAP.
- Decrease both IPAP and EPAP.
Correct answer: Increase the IPAP.
Once EPAP has resolved obstructive apneas, the IPAP (Inspiratory Positive Airway Pressure) should be increased to treat remaining events like hypopneas, RERAs, and snoring. The difference between IPAP and EPAP is the pressure support, which helps augment ventilation.
Question 5: Adaptive Servo-Ventilation (ASV) is the recommended treatment for which of the following conditions?
- Mild obstructive sleep apnea.
- Primary snoring without apneas.
- Insomnia.
- Complex sleep apnea and Cheyne-Stokes Respiration. (Correct answer)
Correct answer: Complex sleep apnea and Cheyne-Stokes Respiration.
ASV is an advanced PAP therapy specifically designed to treat complex and central sleep apnea syndromes. It is particularly effective for managing Cheyne-Stokes Respiration, treatment-emergent central sleep apnea, and central sleep apnea related to opioid use.
Question 6: According to AASM guidelines, what is the minimum time a technologist should wait at a specific CPAP pressure before making an increase, assuming scorable events are occurring?
- 1 minute
- 5 minutes (Correct answer)
- 15 minutes
- 30 minutes
Correct answer: 5 minutes
To properly assess the effectiveness of a given pressure setting, the technologist must allow the patient to sleep at that pressure for a sufficient duration. The AASM guideline specifies a minimum of 5 minutes at a new pressure before increasing it further, allowing time to observe if the events resolve.
Free BRPT PAP Titration Protocols Questions and Answers
During a CPAP titration, after observing two obstructive apneas, three hypopneas, and five RERAs within a 15-minute period, what is the technologist's most appropriate action?