Performing a PAP Titration

Question 1

______
therapy remains the preferred and most widely used therapy for the treatment of sleep-related breathing disorders (SRBDs).

Answer 1

Positive airway pressure (PAP)

Question 2

PAP therapy is noninvasive and
includes three main equipment
components: a _____,
_____, and an _____.

Answer 2

blower unit,
corrugated tubing, and an
interface.

Question 3

The therapy works by pulling in
and filtering normal room air (21% oxygen) and applying it to a
blower.

Answer 3

Positive airway pressure (PAP)

Question 4

The blower sends air through the tubing to an interface, most
commonly a ____, at a set
pressure that is measured in
______

Answer 4

nasal mask / centimeters of water pressure
(cm2HO).

Question 5

The air pressure that is delivered
can be adjusted to act as a
_______ to hold the patient’s airway open, assist with
ventilating the patient while the
patient sleeps, or both.

Answer 5

mechanical splint

Question 6

____ remains the preferred and
most widely used therapy for
obstructive sleep apnea (OSA).

Answer 6

CPAP

Question 7

_______ is characterized by a complete or partial obstruction in the upper airway during sleep that results in frequent arousals, among other deleterious consequences.

Answer 7

Obstructive sleep apnea

Question 8

_____ is characterized
by two separate pressures
corresponding with inhalation and exhalation.

Answer 8

Bi-level therapy

Question 9

The ___ and ___ settings serve
different purposes.

Answer 9

EPAP and IPAP

Question 10

____ acts to maintain
the patency of the airway.

Answer 10

EPAP

Question 11

____ provides a means to provide ventilatory support and increased tidal volumes.

Answer 11

IPAP

Question 12

_____ is used to treat
patients with complex SRBDs, like hypoventilation disorders or
Cheyne–Stokes respiration, and
those who have difficulty tolerating high CPAP pressures.

Answer 12

Bi-level therapy

Question 13

____ allows the
patient to exhale more easily
without having to push as hard
against the incoming positive
pressure.

Answer 13

lower EPAP

Question 14

_____ allows the patient to inhale larger volumes of air with greater ease.

Answer 14

increased IPAP

Question 15

(PAP)
Pressures are measured in
______

Answer 15

centimeters of water (cmH2O).

Question 16

PAP levels can be verified by a
device called a ______.

Answer 16

water column
manometer

Question 17

_____ typically include
options for remote monitoring and controlling, live output data for recording on the polysomnograph, leak measurements, and the ability to switch modes among CPAP, bi-level PAP, and auto positive airway pressure (auto PAP).

Answer 17

Diagnostic units

Question 18

_____ mode automatically
adjusts CPAP as needed, based
on detected airflow and vibrations from the upper airway.

Answer 18

Auto PAP

Question 19

If the system detects vibrations in the upper airway from snoring or a decrease or absence of airflow, then the pressure ____.

Answer 19

increases

Question 20

After a period of time without
detected vibrations or changes in airflow, the pressure ____.

Answer 20

decreases

Question 21

Bi-level units include settings for
backup ______ and
timing of the _____.

Answer 21

respiratory rates / respiratory cycle

Question 22

A _______ does not
detect the changes in patient
respirations but switches between IPAP and EPAP on a specific time base as defined by the user.

Answer 22

timed bilevel mode

Question 23

A ______ automatically shifts between IPAP and EPAP when it detects a change in the patient’s
respirations.

Answer 23

spontaneous bi-level mode

Question 24

A third option available on many bi- level machines is a _____

Answer 24

spontaneous mode with a timed backup.

Question 25

This allows the patient to determine the change of respirations but with the safety of a timed backup in case the patient does not breathe on his or her own.

Answer 25

spontaneous mode with a timed backup

Question 26

As noted previously, advanced forms of _____ have been developed to address more complex SRBDs.

Answer 26

bi-level therapies

Question 27

____ is a positive pressure mode of ventilation that can automatically adjust respiratory rate, tidal volume, and inspiratory time based on the patient’s requirements.

Answer 27

ASV

Question 28

It collected information on a breath-by-breath basis and adjusts pressure support to optimize a patient’s breathing pattern.

Answer 28

ASV

Question 29

_____ are used to treat central sleep apnea, mixed sleep apnea, and Cheynes–Stokes respiration, an abnormal waxing and waning breathing with central apneic events.

Answer 29

ASV machines (adaptive servo ventilation)

Question 30

_____ is a positive pressure mode of ventilation that automatically adapts the pressure support (IPAP) a patient needs to maintain an average tidal volume.

Answer 30

Average Volume- Assured Pressure Support

Question 31

____ uses an algorithm to estimate tidal volume at each breath, compares it to the target volume, and adjusts IPAP accordingly.

Answer 31

AVAPS

Question 32

These units are commonly used to treat patients with complex SRBDs such as obesity hypoventilation syndrome and chronic obstructive pulmonary disease. The prescribed settings would include the target tidal volume and IPAP limits.

Answer 32

AVAPS

Question 33

____ are typically much simpler and easier to use.

Answer 33

Home units

Question 34

The pressure on these units cannot be changed without an interface device or a combination of key entries on the machine.

Answer 34

Home units

Question 35

_____ include memory cards, data storage, or Wi-Fi capabilities with downloadable data, for use at patient follow-ups.

Answer 35

home PAP devices

Question 36

Many have pressure reliefs at the end of inhalation and the beginning of exhalation to allow for a more comfortable transition. Many patients find this option much more comfortable and tolerable.

Answer 36

Home units

Question 37

A common side effect of PAP therapy is ___ and _____.

Answer 37

nasal and upper airway dryness.

Question 38

Adjustments in _____ and ____ can be tailored to improve patient comfort.

Answer 38

humidity levels and temperature

Question 39

Many ____ machines have integrated heated humidifiers, whereas others use external humidifiers.

Answer 39

PAP

Question 40

When _____ is used, water sometimes pools inside the hose when the room air temperature is significantly cooler than the hose temperature.

Answer 40

heated humidification

Question 41

Adverse Effects

Answer 41

• Nasal dryness • difficulty tolerating the air pressure that is delivered. • Facial soreness at various pressure points

Question 42

This is most appropriately addressed by confirming that the correct size interface is being used and readjusting the head straps for comfort. If the problem persists, a different style interface should be considered.

Answer 42

Facial soreness

Question 43

___ refers to the gradual process of adjusting the strength or dose of a medication or treatment until an acceptable or optimal treatment level is achieved.

Answer 43

Titration

Question 44

The hookup procedure for a PAP titration study mirrors that of the diagnostic study with one exception: The two airflow sensors used in a PSG are replaced with a ____ for the titration.

Answer 44

PAP mask

Question 45

The montage selected for these two studies are nearly identical, usually with the addition of a ______ and ______.

Answer 45

PAP pressure channel and PAP flow channel.

Question 46

The PAP flow is detected by the PAP machine rather than, or in addition to, a _____, ______, or _____.

Answer 46

thermistor, thermocouple, or pressure transducer.

Question 47

During a CPAP titration study, _____ is used as a splint to maintain the patency of the upper airway.

Answer 47

pressure

Question 48

Pressures should be titrated upward in ___ increments over at least 5-minute periods of time

Answer 48

≥1 cm

Question 49

the following breathing events:

Answer 49

a. Two or more obstructive apneas b. Three or more hypopneas c. Five or more respiratory effort–related arousals (RERAs) d. Three or more minutes of loud snoring

Question 50

According to the AASM clinical guidelines for the manual titration of PAP therapy, an _____ is defined as: a) A respiratory disturbance index (RDI) of less than five events for a period of 15 minutes b) SpO > 90% c) Fewer than five electroencephalogram (EEG) arousals per hour in supine rapid eye movement (REM) d) Snoring eliminated.

Answer 50

optimal titration

Question 51

According to the AASM Clinical Guidelines, the recommended minimum starting IPAP should be _____, whereas EPAP should be set at ____.

Answer 51

8 cmH2O / 4 cmH2O

Question 52

If a patient is uncomfortable or intolerant of high CPAP above 14 cmH20, then the mode may be switched over from CPAP to ____

Answer 52

bi-level.

Question 53

The recommended minimum IPAP– EPAP differential is _____, while the maximum differential is _____.

Answer 53

4 cm H2O / 10 cmH2O

Question 54

The titration of bi-level therapy should include upward titration of the IPAP and EPAP by at least ____ for apneic events and upward titration of the IPAP pressure only by at least ___ in response to hypopnea, RERAs, or snoring.

Answer 54

1 cmH2O / 1 cm H2O

Question 55

___ can also be increased to correct for hypoxemia that persists despite a patent airway.

Answer 55

IPAP

Question 56

• If treatment-emergent central apneas are observed, a decrease in IPAP or a switch to ______ may be helpful.

Answer 56

spontaneously timed mode with backup rate

Question 57

The recommended maximum IPAP pressure is ____ for patients 12 years of age and older.

Answer 57

30 cmH2O

Question 58

An optimal bi-level titration is defined the same as for a _____

Answer 58

CPAP titration.

Question 59

_____ is often used in the sleep lab to address hypoxemia.

Answer 59

Supplemental oxygen

Question 60

Technologists should check the baseline oxygen saturation at the beginning of the night by using a ____ (SpO2).

Answer 60

pulse oximeter

Question 61

If a patient demonstrates decreased SpO2 levels, the technologist should notify the physician to make him or her aware and obtain an order for ______.

Answer 61

supplemental O2

Question 62

For patients with SRBDs that demonstrate decreased SpO2 levels during the study, it is most often recommended to correct the respiratory events via ____ first.

Answer 62

PAP therapy

Question 63

Once the SRBD is addressed, if oxygen desaturation persists, then _____ may be indicated.

Answer 63

supplemental oxygen

Question 64

_____ can be introduced into the PAP circuit by connecting oxygen tubing to one of the small outlet holes on the PAP interface.

Answer 64

supplemental O2