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36 Cards in this Set

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What is the purpose of Positive Airway Pressure (PAP)?
To deliver a continuous flow of air that increases pressure in the upper airway and prevent airway collapse
What are the three types of PAP?
Continuous Pressure (CPAP)
Bilevel PAP (BPAP)
Auto-Titrating (APAP)
What are the benefits of PAP?
1) Immediately effective, relatively non-invasive

2) Reduce complaints

3) Modifies consequences of OSA
What main problems are associate with PAP?
1) Mask discomfort
2) Patient acceptance (of lack of)
3) Aerophagia
4) Chest Discomfort
What is aerophagia?
the swallowing of air
What does PAP selection depend on?
1) Shape of face
2) Facial Hair
3) Patient ability to breathe through nose
4) patient preference
What are solutions for dryness due to PAP?
1) Humidification
2) Prevent Leaks
What are solution to claustrophobia due to PAP?
1) Less cumbersome interface
2) Desensitization
What are solution to aerophagia due to PAP?
1) Body positioning
2) Reduce mean airway pressure
What are solutions for rhinitis and nasal congestion?
1) Humidification
2) Nasal steroids or decongestants
What is a solution to air leaks?
Proper mask and headgear
What is the recommended starting CPAP pressure for adults (over the age of 12)?
4 cm
What is the recommended starting CPAP pressure for kids (under the age of 12)?
4 cm
What is the recommended maximum CPAP pressure for adults?
20 cm
What is the recommended maximum CPAP pressure for kids?
15 cm
How often, by how much, and until when should CPAP pressure be increased?
Every 5 minutes, by at least 1 cm till obstructive events are eliminated.
For a child, when should CPAP titration be increased?
After 1 obs apnea
After 1 obs hypopnea
After 3 RERAs or
1 minutes of loud unambiguous snoring
For an adult, when should CPAP titration be increased?
After 2 obs apneas
3 obs hypopneas
5 RERAs or
3 minutes of loud unambiguous snoring
What is the AHI criteria for a Split Night Protocol
AHI greater than or equal to 40 for 2 hours of PSG
How long should CPAP titration be carried out during a Split Night Protocol?
3 hours
When is bilevel PAP (BPAP) used?
1) When a high level of pressure is needed and the pt has trouble with fixed pressure

2) Hypoventilation is present
What is BPAP useful for treating?
1) Restrictive lung disease

2) Hypoventilation syndrome associated with daytime hypercapnia
What is IPAP?
Inspiratory Airway Pressure
What is EPAP?
Expiratory Airway Pressure
What is the goal of EPAP?
set lowest to prevent airway collapse during expiration
What is the goal of IPAP?
set higher to prevent airway collapse during inspiration
What is the recommended starting IPAP Pressure for kids and adults?
8 cm
What is the recommended starting EPAP pressure for kids and adults?
4 cm
What is the recommended maximum EPAP/IPAP pressure for kids?
20 cm
What is the recommended maximum EPAP/IPAP pressure for adults?
30 cm
What is the recommended minimum IPAP-EPAP differential for kids and adults?
4 cm
What is the recommended maximum IPAP-EPAP differential for kids and adults?
10 cm
When should IPAP be increased for kids?
After 1 obs hypopnea
3 RERAs or
1 minute of loud snoring
When IPAP be increased for adults?
After 3 obs hypopnes
5 RERAs or
3 minutes of loud snoring
What is the purpose of APAP?
APAP increases CPAP to eliminate airway obstruction then lowers overnight to keep CPAP at lowest possible level
What medical conditions is APAP not recommended for?
1) Congestive Heart Failure
2) Hypoventilation syndromes
3) Chronic lung disease
4) Absence of snoring