PAP Therapy Administration & Titration Flashcards

During a CPAP titration study, a patient continues to have obstructive apneas at 10 cmH2O. What is the recommended next step according to AASM titration guidelines?

Answer: Increase the CPAP pressure by 1-2 cmH2O and observe response

AASM guidelines recommend incremental pressure increases (1-2 cmH2O) during titration, waiting at least 5 minutes between adjustments to allow stabilization before escalating further. Switching to BiPAP or other interventions is premature without first optimizing CPAP pressure.

Which PAP modality delivers a higher inspiratory pressure (IPAP) and a lower expiratory pressure (EPAP), making it useful for patients who struggle to exhale against CPAP pressure?

Answer: BiPAP/BPAP (bilevel positive airway pressure)

BiPAP delivers two distinct pressure levels: a higher IPAP during inhalation and a lower EPAP during exhalation. This pressure differential reduces the work of exhalation and is particularly useful for patients who are intolerant of fixed CPAP pressure or have hypoventilation disorders.

During a split-night study, what minimum criteria must typically be met before transitioning from the diagnostic to the CPAP titration portion, per AASM guidelines?

Answer: At least 2 hours of diagnostic recording with an AHI ≥ 40 events/hour

AASM guidelines specify that a split-night study requires at least 2 hours of diagnostic sleep and an AHI ≥ 40 events/hour (or AHI 20-40 with clinical justification such as severe hypoxemia) before proceeding to CPAP titration in the same night.

A patient on CPAP therapy reports significant aerophagia (air swallowing and bloating). Which intervention is most appropriate?

Answer: Reduce CPAP pressure or switch to BiPAP to lower mean airway pressure

Aerophagia occurs when pressurized air is inadvertently swallowed rather than entering the airway. Reducing pressure or switching to BiPAP (which has a lower mean pressure due to the lower EPAP) decreases the amount of air forced into the esophagus, alleviating the symptom.

Adaptive servo-ventilation (ASV) is most appropriate for treating which sleep-related breathing disorder?

Answer: Complex sleep apnea (treatment-emergent central apnea) or predominant central sleep apnea

ASV continuously adjusts pressure support breath-by-breath to servo-control the patient's ventilation, targeting a recent average peak flow. It is specifically designed for complex (mixed/central-predominant) sleep apnea and Cheyne-Stokes respiration, conditions where fixed CPAP or BiPAP are insufficient.

What is the primary purpose of the expiratory pressure relief feature (e.g., EPR, C-Flex, or A-Flex) available on some CPAP devices?

Answer: To slightly reduce pressure during exhalation to improve patient comfort and adherence

Expiratory pressure relief reduces the delivered pressure by 1-3 cmH2O during the exhalation phase, easing the effort required to breathe out against CPAP pressure. This comfort feature improves patient tolerance and adherence without fundamentally changing the therapeutic pressure during inhalation.