CPSGT Positive Airway Pressure Therapy & Treatment Modalities 2 — Questions and Answers
Question 1: During CPAP titration, what is the minimum recommended pressure increase when an obstructive apnea is observed?
- 0.5 cm H2O
- 1 cm H2O
- 2 cm H2O (Correct answer)
- 5 cm H2O
Correct answer: 2 cm H2O
AASM titration protocols recommend increasing CPAP by at least 1-2 cm H2O in response to observed obstructive apneas, with 2 cm H2O being the commonly cited increment.
Question 2: What is the maximum recommended CPAP pressure ceiling in standard adult titration protocols?
- 15 cm H2O
- 20 cm H2O (Correct answer)
- 25 cm H2O
- 30 cm H2O
Correct answer: 20 cm H2O
Standard AASM titration protocols set a maximum CPAP pressure of 20 cm H2O for adults; pressures above this level rarely provide additional benefit and increase side effects.
Question 3: Which type of PAP mask interface covers only the nostrils using small cushioned inserts that seal inside the nasal openings?
- Full face (oronasal) mask
- Nasal pillow mask (Correct answer)
- Total face mask
- Nasal cradle mask
Correct answer: Nasal pillow mask
Nasal pillow (nasal prong) masks use small cushioned inserts that fit directly into the nostrils, offering minimal contact area and are preferred by patients who feel claustrophobic with larger masks.
Question 4: When a patient on BiPAP continues to have central apneas with an adequate EPAP, what adjustment to the IPAP-EPAP relationship should the technologist consider?
- Increase EPAP to eliminate the pressure differential
- Decrease IPAP to reduce stimulation
- Increase the IPAP-EPAP differential (pressure support) to better stimulate breathing (Correct answer)
- Switch to CPAP
Correct answer: Increase the IPAP-EPAP differential (pressure support) to better stimulate breathing
Increasing pressure support (the difference between IPAP and EPAP) helps augment tidal volume and can reduce central apneas by providing greater ventilatory assistance.
Question 5: What does the 'ramp' feature on PAP devices do?
- Gradually increases humidity output over the night
- Gradually increases pressure from a lower starting point to the prescribed therapeutic pressure (Correct answer)
- Automatically decreases pressure in the early morning hours
- Adjusts pressure based on altitude changes
Correct answer: Gradually increases pressure from a lower starting point to the prescribed therapeutic pressure
The ramp feature allows the device to start at a low, comfortable pressure and gradually increase to the prescribed therapeutic pressure over a set time period, improving patient comfort at sleep onset.
Question 6: During a split-night study, diagnostic PSG typically transitions to PAP titration after how many hours of baseline recording if OSA criteria are met?
- 1 hour
- 2 hours (Correct answer)
- 4 hours
- The entire first half of the night
Correct answer: 2 hours
AASM guidelines for split-night studies require a minimum of 2 hours of diagnostic recording demonstrating AHI ≥40 (or ≥20 with severe desaturations) before initiating PAP titration.
Question 7: Which PAP mask interface is generally preferred for patients who breathe through their mouths during sleep?
- Nasal pillow mask
- Nasal mask
- Full face (oronasal) mask (Correct answer)
- Oral-only mask for PAP
Correct answer: Full face (oronasal) mask
Full face (oronasal) masks cover both the nose and mouth, preventing pressure loss through mouth breathing and ensuring effective PAP delivery regardless of the patient's breathing route.
CPSGT Positive Airway Pressure Therapy & Treatment Modalities 2
During CPAP titration, what is the minimum recommended pressure increase when an obstructive apnea is observed?