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PAP Titration Protocols Flashcards

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  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?

    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.

  2. What is the primary indication to switch a patient from CPAP to BiLevel PAP during a titration study?

    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.

  3. When titrating BiLevel PAP, the EPAP is primarily increased to treat which events?

    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.

  4. After resolving obstructive apneas with EPAP, a patient on BiLevel PAP continues to have hypopneas. What is the correct action?

    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.

  5. Adaptive Servo-Ventilation (ASV) is the recommended treatment for which of the following conditions?

    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.

  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?

    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.