CPSGT Positive Airway Pressure Therapy & Treatment Modalities 1 — Questions and Answers
Question 1: What is the primary mechanism by which CPAP treats obstructive sleep apnea?
- Reduces upper airway inflammation
- Creates a pneumatic splint to keep the airway open (Correct answer)
- Stimulates upper airway muscles electrically
- Decreases the patient's respiratory drive
Correct answer: Creates a pneumatic splint to keep the airway open
CPAP delivers continuous positive pressure that acts as a pneumatic splint, preventing the collapse of upper airway soft tissues during sleep.
Question 2: Which PAP modality automatically adjusts treatment pressure throughout the night based on detected respiratory events?
- CPAP
- BiPAP
- APAP (Auto-titrating PAP) (Correct answer)
- ASV (Adaptive Servo-Ventilation)
Correct answer: APAP (Auto-titrating PAP)
APAP devices use algorithms to detect apneas, hypopneas, snoring, and flow limitation, then automatically increase or decrease pressure within a preset range.
Question 3: What is the typical minimum starting pressure for CPAP titration in adult patients per AASM guidelines?
- 1-3 cm H2O
- 4-5 cm H2O (Correct answer)
- 8-10 cm H2O
- 12-15 cm H2O
Correct answer: 4-5 cm H2O
AASM titration guidelines recommend beginning CPAP titration at 4-5 cm H2O in adults and adjusting upward based on observed respiratory events.
Question 4: BiPAP therapy delivers pressure on two levels. What are the correct terms for these two pressure settings?
- IPAP and EPAP (Correct answer)
- PPAP and NPAP
- Peak pressure and trough pressure
- Inspiratory reserve and expiratory reserve
Correct answer: IPAP and EPAP
BiPAP delivers IPAP (Inspiratory Positive Airway Pressure) during inhalation and a lower EPAP (Expiratory Positive Airway Pressure) during exhalation.
Question 5: Which PAP device modality is specifically indicated for patients with complex sleep apnea or Cheyne-Stokes respiration associated with heart failure?
- CPAP
- APAP
- ASV (Adaptive Servo-Ventilation) (Correct answer)
- Standard BiPAP
Correct answer: ASV (Adaptive Servo-Ventilation)
ASV uses a servo-controlled algorithm to provide varying levels of ventilatory support that counteracts the waxing and waning breathing pattern seen in Cheyne-Stokes respiration and complex sleep apnea.
Question 6: A patient complains of aerophagia (air swallowing) during CPAP therapy. What is the most likely cause?
- Excessive mask leak
- High pressure causing air to enter the esophagus (Correct answer)
- Incorrect mask size
- Low humidity setting
Correct answer: High pressure causing air to enter the esophagus
Aerophagia occurs when PAP pressure is high enough to force air past the lower esophageal sphincter into the stomach, causing bloating and discomfort.
Question 7: What is the primary parameter used to evaluate the effectiveness of PAP therapy during a titration polysomnogram?
- Reduction in Apnea-Hypopnea Index (AHI) (Correct answer)
- Reduction in oxygen desaturation events only
- Improvement in sleep efficiency
- Increase in total sleep time
Correct answer: Reduction in Apnea-Hypopnea Index (AHI)
The goal of PAP titration is to eliminate or substantially reduce respiratory events, measured by the residual AHI, while maintaining oxygen saturation above 90%.
CPSGT Positive Airway Pressure Therapy & Treatment Modalities 1
What is the primary mechanism by which CPAP treats obstructive sleep apnea?