RST Therapeutic Interventions and Titration Questions and Answers

Question 1

A 45-year-old male on a CPAP titration study continues to have obstructive hypopneas and loud snoring at a pressure of 14 cm H2O.
The technologist increases the pressure to 15 cm H2O, but the patient awakens and complains of difficulty exhaling.
According to AASM guidelines, what is the most appropriate next step?

Accepted Answer

Switch to Bi-level PAP therapy.

Answer

Decrease CPAP to 13 cm H2O and add a chin strap.

Answer

End the titration and recommend a different mask interface.

Answer

Add supplemental oxygen at 1 L/min.

Question 2

Which of the following conditions is a primary contraindication for the use of Adaptive Servo-Ventilation (ASV) therapy?

Accepted Answer

Chronic, symptomatic heart failure with reduced left ventricular ejection fraction (LVEF ≤ 45%).

Answer

Complex Sleep Apnea Syndrome.

Answer

Cheyne-Stokes Respiration with preserved ejection fraction.

Answer

Opioid-induced central sleep apnea.

Question 3

According to AASM guidelines, supplemental oxygen should be initiated and titrated during a PAP study under which of the following conditions?

Accepted Answer

The patient's SpO2 is consistently ≤ 88% for at least 5 minutes despite an optimally titrated PAP pressure that has eliminated respiratory events.

Answer

The patient's SpO2 drops to 89% for 2 minutes despite an open airway.

Answer

The patient has an AHI of 6 events/hour with associated desaturations.

Answer

The patient reports shortness of breath at the beginning of the study.

Question 4

During a Bi-level PAP titration for obstructive sleep apnea, the technologist has set the EPAP to 8 cm H2O, which has eliminated apneas. However, the patient continues to have obstructive hypopneas and snoring. What is the correct action to resolve the remaining events?

Accepted Answer

Increase the IPAP to 12 cm H2O.

Answer

Increase the EPAP to 10 cm H2O.

Answer

Decrease the EPAP to 6 cm H2O.

Answer

Decrease the Pressure Support by lowering IPAP.

Question 5

Which of the following best defines an "optimal" PAP titration according to AASM guidelines?

Accepted Answer

The RDI is reduced to < 5 events/hour for at least 15 minutes, including supine REM sleep.

Answer

The AHI is reduced to < 10 events/hour for at least 30 minutes.

Answer

All snoring is eliminated for the entire duration of the study.

Answer

The SpO2 nadir remains above 90% for at least 15 minutes, regardless of the RDI.

Question 6

A patient on CPAP at 12 cm H2O has a persistent large leak that is obscuring the airflow signal and causing multiple arousals. The technologist has already tried to refit and adjust the nasal mask straps without success. What should be the technologist's next action?

Accepted Answer

Switch the patient to a different size or style of mask, such as an oronasal mask.

Answer

Increase the CPAP pressure to 14 cm H2O to compensate for the leak.

Answer

Add a chin strap to prevent mouth breathing.

Answer

Document the leak and continue the titration at the current pressure.