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Titration of Continuous Positive Airway Pressure and Application and Adjustment of Positive Airway Pressure Devices
JOYCE BLACK
NOTE: This chapter corresponds to Chapter 34 in Fundamentals of Sleep Technology, 2nd edition.
1. An American Academy of Sleep Medicine (AASM) literature review found that appropriate settings for positive airway pressure (PAP) therapy can be determined with mathematical models that use height, weight, neck size, airway size, or other measurements. True or false?
2. It would be inappropriate to use a full-face mask:
A. With every patient
B. When the patient is a mouth breather
C. When the patient states he or she is a mouth breather
D. When the patient does not have teeth
3. According to the American Academy of Sleep Medicine (AASM) Guidelines, an optimal positive airway pressure (PAP) titration occurs when the selected setting keeps the Respiratory Disturbance Index (RDI) below ______________ for at least ______________ minutes.
A. 3, 10
B. 4, 12
C. 5, 15
D. 10, 20
4. When performing a positive airway pressure (PAP) titration on a pediatric patient younger than 12 years of age, the PAP setting should be increased when at least ______________ obstructive apnea(s) or hypopnea(s) are seen.
A. 1
B. 2
C. 3
D. 4
5. It is possible to determine the proper starting size for a given mask using measurements of the nose, but there is no way to predict the best mask type for a patient. True or false?
6. The primary goals of positive airway pressure (PAP) titration include all of the following EXCEPT:
A. Elimination of apneas
B. Elimination of hypopneas
C. Elimination of respiratory event–related arousals (RERAs)
D. Elimination of periodic limb movements
7. The basic American Academy of Sleep Medicine (AASM) recommendation for starting the titration portion of a split-night study is after a diagnostic study of:
A. 1 hour with an apnea–hypopnea index (AHI) of 20
B. 2 hours with an AHI of 30
C. 2 hours with an AHI of 40
D. None of the above
8. An inadequate PAP titration is defined by the American Academy of Sleep Medicine (AASM) Guidelines as ≥______________ obstructive apneas, or ≥______________ hypopneas, or ≥______________ respiratory event–related arousals (RERAs) or ≥3 minutes of loud snoring in adults.
A. 2, 3, 2
B. 1, 2, 3
C. 3, 5, 7
D. 2, 3, 5
9. The American Academy of Sleep Medicine (AASM) Guidelines for continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea recommend a starting pressure of ______________ cm H2O with a maximum pressure of ______________cm H2O for adults.
A. 4, 15
B. 4, 20
C. 5, 15
D. 5, 20
10. BPAP is useful for patients who cannot tolerate continuous positive airway pressure (CPAP) or who complain of trouble exhaling during CPAP therapy. True or false?
11. What is the most effective method for improving adherence to therapy?
A. Changing the mask
B. Decreasing pressure
C. Changing to bilevel positive airway pressure (BPAP)
D. Early intervention to address patient complaints
12. Continuous positive airway pressures (CPAPs) that are too high may cause:
A. Excessive sneezing
B. Arousals and unwanted changes in respiratory patterns
C. Increase in oxygen saturation
D. More obstructive apneas
13. In a pediatric patient younger than 12 years of age, the continuous positive airway pressure (CPAP) can be increased by 1 cm H2O if unambiguous snoring is observed for at least 1 minute. True or false?
14. It is the responsibility of a sleep technologist performing a titration study to be sure that the study has no artifact. In addition, the technologist is also responsible for:
A. Assisting the patient for the best outcome
B. Acting as the eyes and ears of the physician and recording and commenting on important events that occur during the night
C. Ensuring the best pressure is identified for the best outcome for the patient
D. All of the above
15. A respiratory event–related arousal (RERA) could be scored if there is a 10-second period of signal flattening followed by an arousal or if there is increased effort measured by inductance plethysmography. True or false?
16. The American Academy of Sleep Medicine (AASM) Guidelines recommend waiting ______________ between changes in positive airway pressure (PAP) settings.
A. A minimum of 2 minutes
B. A minimum of 5 minutes
C. A minimum of 10 minutes
D. Until five respiratory disturbances are seen
17. In changing from continuous (CPAP) to bilevel (BPAP) positive airway pressure, the expiratory positive airway pressure (EPAP) should be set at the pressure that resolved the obstructive events and the inspiratory positive airway pressure (IPAP) should be at least ______________ cm H2O higher.
A. 3
B. 4
C. 5
D. 6
18. According to the American Academy of Sleep Medicine (AASM) Guidelines for an adequate PAP titration, the respiratory disturbance index (RDI) may be above 10 events per hour if it is reduced by 75% from baseline. True or false?
19. Auto-titrating positive airway pressure (APAP) therapy is indicated for all of the following EXCEPT:

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