FREE RST Therapeutic Interventions and Titration Questions and Answers

Question 1

A patient on CPAP at 15 cm H2O continues to have obstructive hypopneas and reports significant discomfort exhaling against the pressure. According to AASM guidelines, which of the following is the most appropriate next step?

Accepted Answer

Switch to bilevel PAP with an IPAP of at least 15 cm H2O and an EPAP of 11 cm H2O.

Answer

AASM guidelines suggest considering a switch to bilevel PAP when CPAP pressures reach 15 cm H2O and respiratory events persist, or if the patient is intolerant of high CPAP pressures. When switching from CPAP, the IPAP should be set at or above the previous CPAP level, and the EPAP should be set lower to provide pressure support (a difference of at least 4 cm H2O is recommended), making it easier for the patient to exhale.

Question 2

During a PAP titration, a patient begins to exhibit frequent central apneas after obstructive events have been eliminated at a CPAP pressure of 10 cm H2O. This phenomenon is best described as:

Accepted Answer

Treatment-Emergent Central Sleep Apnea

Answer

Treatment-emergent central sleep apnea (TECSA), previously known as complex sleep apnea, is characterized by the emergence of central apneas or hypopneas during the application of PAP therapy after obstructive events have resolved.

Question 3

According to the AASM Manual, which of the following criteria defines an OPTIMAL PAP titration?

Accepted Answer

The RDI is <5/hour for at least a 15-minute duration, including supine REM sleep, with SpO2 >90%.

Answer

An optimal PAP titration is defined by the AASM as one that reduces the Respiratory Disturbance Index (RDI) to less than 5 events per hour for at least a 15-minute duration. This period must include REM sleep in the supine position (the position where events are often most severe), and the SpO2 must be maintained above 90% at the selected pressure.

Question 4

A patient is being titrated on bilevel PAP for hypoventilation. The technologist has increased the IPAP to augment ventilation, but the SpO2 remains at 87% for over 5 minutes despite the absence of discrete apneas or hypopneas. What is the recommended intervention?

Accepted Answer

Add supplemental oxygen, starting at 1 L/min.

Answer

The AASM guidelines recommend adding supplemental oxygen during a PAP titration if the SpO2 remains ≤88% for 5 minutes or longer after respiratory events have been resolved. The initial rate should be 1 L/min and titrated up in 1 L/min increments every 15 minutes to maintain an SpO2 between 88% and 94%.

Question 5

Adaptive Servo-Ventilation (ASV) is a therapeutic option for specific types of sleep-disordered breathing. However, its use is contraindicated in which of the following patient populations due to increased mortality risk?

Accepted Answer

Patients with heart failure and a left ventricular ejection fraction (LVEF) of ≤ 45%.

Answer

The SERVE-HF trial demonstrated an increased risk of cardiovascular mortality in patients with chronic, symptomatic heart failure (NYHA 2-4) with a reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea who were treated with ASV. Therefore, ASV is contraindicated in this specific population.

RST - Registered Sleep Technologist Practice Test

RST - Registered Sleep Technologist Practice Test

FREE RST Therapeutic Interventions and Titration Questions and Answers