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Advanced PAP Therapies
LISA BOND
NOTE: This chapter corresponds to Chapter 37 in Fundamentals of Sleep Technology, 2nd edition.
1. Adaptive servo ventilation devices provide varying amounts of inspiratory support. The support is lowest during:
A. Hyperpneic phase of periodic breathing
B. Central sleep apnea
C. Obstructive sleep apnea
D. Episodes of snoring with mild-to-moderate flow limitation
2. During a sleep study, the technologist using adaptive servo ventilation should increase expiratory positive airway pressure (EPAP) when which of the following are present?
A. Periods of hypoventilation
B. Central apneas
C. Obstructive apneas
D. Hyperpneas
3. How does adaptive servo ventilation treat central apneas?
A. Provides auto-titrating expiratory positive airway pressures
B. Increases pressure support
C. Decreases pressure support
D. Follows predetermined backup breathing rate
4. Adaptive servo ventilation is an effective treatment for which of the following disorders?
A. Obesity hypoventilation syndrome
B. Nocturnal asthma
C. Hunter-Cheyne-Stokes breathing pattern
D. Congenital central hypoventilation syndrome
5. Central apnea may emerge during PAP titration and may persist in some patients, leading to a possible diagnosis of complex sleep apnea. If overtitration of positive airway pressure is not suspected, consideration should be given to which of the following?
A. Adaptive servo ventilation
B. Respiratory stimulants, such as theophylline
C. Recommendation for weight loss
D. Tracheostomy
CASE STUDY
A 42-year-old man has chronic low back pain that has worsened recently. He has been taking over-the-counter pain medications but reports that they have stopped working. His pain specialist starts him on oxycodone hydrochloride, a narcotic analgesic. Since starting this new medication, he begins to have very loud snoring and pauses in breathing along with daytime sleepiness and difficulty concentrating at work. His blood pressure is 145/95 mm Hg, pulse is 82 per minute and regular, and BMI is 32.5 kg/m2. The lungs are clear to auscultation, and both cardiac and neurologic examinations are unremarkable. Match the symptom with the most likely diagnosis:
| 6. | Use of opiates | A. | OSA |
| 7. | Loud snoring | B. | CSA |
| 8. | Breathing pauses | C. | Both OSA and CSA |
| 9. | Hypertension | ||
| 10. | Obesity |
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