Therapeutic Treatment & Intervention

Question 0

What is the recommended min stating CPAP?

What is the recommended max CPAP?

Answer 0

4 cmh2o in adults & pediatric patients.

15 cmh2o for patients 12

Higher starting CPAP may be selected for elevated BMIs & retitration studies

Question 1

What are the general recommendations for CPAP titration studies in pediatric or Adult patients with OSA

Answer 1

CPAP should be increased until the following obstructive respiratory events are eliminated.
Or the recommended max CPAP is reached

Apneas
Hypopneas
RERAs and
Snoring

Question 2

How should CPAP be titrated overnight?

Answer 2

CPAP should be increased by at least 1cm H2O with an interval no shorter than 5 min, with a goal of eliminating obstructive respiratory events.

Question 3

What is the recommended titration protocol for CPAP in patients <12 years old?

Answer 3

For pts <12 pressure should be Increased 1cm
if at least:
1 obstructive apnea is observed

1hypopnea

3 RERAs

1 min of loud or unambiguous snoring

Question 4

What is the recommended titration protocol for CPAP in patients >=12 years old?

Answer 4

For pts >=12 pressure should be Increased
if at least:
2 obstructive apnea is observed

3 hypopnea

5 RERAs

3 min of loud or unambiguous snoring

Question 5

Why would someone be tried on Bipap?

Answer 5

If patient is uncomfortable or intolerant of high pressures on CPAP or

If there are continued obstructive respiratory events at 15cm.

Question 6

What is the recommended min stating IPAP & EPAP?

What is the recommended max IPAP & EPAP?

Answer 6

Starting IPAP & EPAP should be 8cmH2O & 4 cmH2O in both pediatric & adult patients.

Max IPAP for =12 years is 30 cmh2o

Question 7

What is the recommended min & max IPAP - EPAP differential

Answer 7

Min= 4cmH2O

Max= 10 cmH2O

Question 8

What is the recommended titration protocol for Bipap in patients >=12 years old?

Answer 8

For pts >=12 IPAP & EPAP pressure should be Increased
if at least:
2 obstructive apnea is observed

IPAP pressure should be Increased if
3 hypopnea

5 RERAs

3 min of loud or unambiguous snoring

Question 9

What is the recommended titration protocol for Bipap in patients <12 years old?

Answer 9

For pts <12 IPAP & EPAP pressure should be Increased
if at least:
1 obstructive apnea is observed

IPAP pressure should be Increased if
1 hypopnea

3 RERAs

1 min of loud or unambiguous snoring

Question 10

When should supplemental O2 be added to the PAP titration?

What is the titration protocol?

Answer 10

Supplemental O2 should be added during the PAP titration when, prior to the PAP titration, the patient’s awake supine SpO2 while breathing room air is ≤88%.
During the PAP titration when SpO2 is ≤88% for ≥5 minutes in the absence of obstructive respiratory events.

In both instances, supplemental O2 should be introduced at 1 L/min and titrated upwards to achieve a target SpO2 between 88% and 94% (Consensus).

Question 11

What is the required interval before O2 can be increased again?

Answer 11

Increased by 1L/min with an interval no shorter than 15 min until SpO2 is between 88-94%

Question 12

Where should supplemental O2 be connected during PAP study

Answer 12

At the device outlet using a t-connector

Question 13

When can ASV be considered in a PAP titration?

Answer 13

When Cheyne-Stokes observed

Or if treatment emergent CSA (complex SA) is not eliminated by down titration of pressure.

Question 14

What is an acceptable Pressure selected for use following a titration study?

Answer 14

Control of Obstructive respiration by RDI

Question 15

What is an optimal titration for PAP?

Answer 15

An optimal titration reduces RDI <5 per hour for at least a 15-min duration and should include supine REM sleep at the selected pressure that is not continually interrupted by spontaneous arousals or awakenings (Consensus)

Question 16

What is considered a GOOD titration?

Answer 16

A good titration reduces the overnight RDI ≤10 per hour or by 50% if the baseline RDI <15 per hour and should include supine REM sleep that is not continually interrupted by spontaneous arousals or awakenings at the selected pressure

Question 17

What is considered an ADEQUATE titration?

Answer 17

An adequate titration is one that does not reduce the overnight RDI ≤10 per hour but does reduce the RDI by 75% from baseline (especially in severe OSA patients), or one in which the titration grading criteria for optimal or good are met with the exception that supine REM sleep did not occur at the selected pressure

Question 18

State the Positional and Sleep Stage Factors of a good titration?

Answer 18

Ideally, the patient should be recorded in supine REM sleep for at least 15 min at the designated optimal pressure during the PAP titration study. If the patient is in REM sleep but not in the supine position while at the designated optimal pressure, the patient may be awakened and instructed to lie in the supine position

Question 19

What are the effects on sleep of try cyclic antidepressants?

Answer 19

Increase total sleep time.
Decrease rapid eye movement sleep.
Increase periodic leg movements while sleeping.

Question 20

What are the effects on sleep of MAOIs antidepressants?

Answer 20

Decrease total sleep time.
Increase wake after sleep onset.
decrease rapid I movement sleep.

Question 21

What are the effects on sleep of SSRIs antidepressants?

Answer 21

Increase wake after sleep onset
Decrease slow wave sleep
Increase periodic limb movement while asleep.

Question 22

Effects on sleep of pain medications?

Answer 22

Decrease slow wave sleep.

Question 23

Effects on sleep of Barbituates?

Answer 23

Increase total sleep time
increase slow wave sleep
decrease rapid I movement sleep.

Question 24

Effects on slate of benzodiazepines?

Answer 24

Increase total sleep time
decrease wake after sleep onset
decrease slow wave sleep.

Question 25

Effects on sleep of antihistamines?

Answer 25

Decrease sleep latency

Decrease rapid eye movement sleep

Question 26

Effects on slate of stimulants?

Answer 26

Increase wake after sleep onset
decrease slow wave sleep
increase sleep latency

Question 27

Effects on sleep of stimulants?

Answer 27

Increase WASO
Decrease slow wave sleep
Increase sleep latency

Question 28

Effects on sleep of Melatonin?

Answer 28

Decrease WASO

Decease sleep latency

Question 29

Effects on sleep of alcohol?

Answer 29

Increase WASO
Decrease rem
Decrease sleep latency