Interventions in the Pediatric Sleep Laboratory

LAREE FORDYCE

NOTE: This chapter corresponds to Chapter 48 in Fundamentals of Sleep Technology, 2nd edition.

CASE STUDY NO. 1

A 10-year-old boy with severe obstructive sleep apnea (OSA) has enuresis for 8 months. He is not taking any medications. BMI is 33 kg/m². Polysomnographic tracing in Figure 41-1 shows continuous positive airway pressure (CPAP) titration at 13 cm H₂O.

Figure 41-1

1. What is the best course of action at this time?

A. Stay at 13 cm H₂O CPAP setting.

B. Switch to bilevel positive airway pressure (BPAP) titration.

C. Increase CPAP setting to 14 cm H₂O.

D. Add supplemental O₂.

2. In switching to bilevel positive airway pressure (BPAP) titration, which setting should be chosen?

A. EPAP 13, IPAP 17 cm H₂O

B. EPAP 4, IPAP 8 cm H₂O

C. EPAP 5, IPAP 9 cm H₂O

D. EPAP 9, IPAP 13 cm H₂O

CASE STUDY NO. 2

A 13-year-old girl with a BMI of 47 kg/m² demonstrates a respiratory pattern similar to the polysomnographic tracing in Figure 41-2.

Figure 42-1

3. What is the respiratory pattern in this tracing?

A. Biot’s breathing

B. Tachypnea

C. Cheyne-Stokes respiration

D. Paradoxical respiration

4. What is the most likely diagnosis?

A. Obstructive sleep apnea

B. Central sleep apnea

C. Hypoventilation

D. Diaphragm paralysis

5. In Figure 41-2, continuous positive airway pressure (CPAP) has been titrated to 15 cm H₂O CPAP pressure. What is the best intervention at this time?

A. Increase CPAP setting to 16 cm H₂O.

B. Switch to bilevel positive airway pressure (BPAP) titration.

C. Add supplemental oxygen.

D. Continue at current CPAP setting.