PSG Fall Exam 3

PSG Fall Exam 3 Which of the following need to be documented during a PSG? Answers: current medications current use of oxygen oxygen liter flow all of the above - ✔✔all of the above the most common method to monit ...

PSG Fall Exam 3 Which of the following need to be documented during a PSG? Answers: current medications current use of oxygen oxygen liter flow all of the above - ✔✔all of the above the most common method to monitor blood oxygen saturation during polysomnography is by using_______ - ✔✔pulse oximetry A 49 year old male has a respiratory disturbance index of 27 events per hour and a past medical history of hypertension. His BMI is 29kg/m2. He tries CPAP therapy for 2 months but reports he could not wear it. is he suitable candidate for oral appliance therapy - ✔✔yes, oral appliances are indicated for patients with moderate OSA who are unable or unwilling to use CPAP Adjustments should be made in ____ mm increments starting after the first 30 minutes of recording if the AHI is > 10. - ✔✔1 An oral appliance should ideally be fitted by a/an: - ✔✔sleep - trained dentist What are 2 ways to monitor CO2 in the sleep lab? - ✔✔End-tidal CO2 and transcutaneous CO2 Patients with high AHIs are not good candidates for oral appliance therapy. - ✔✔true Hypoxia is considered a medical emergency. - ✔✔true There are _____ primary types of oral appliances. - ✔✔2 Which of the following is the correct definition for hypercapnia? - ✔✔higher than normal CO2 in the blood Which of these conditions is not likely to contribute to episodes of hypoventilation and/or hypoxemia? partial or complete upper airway obstruction chronic obstructive pulmonary disease obesity diabetes - ✔✔diabetes At least _____ minutes of total sleep time at baseline should be recorded at the patient's currently titrated position during an oral applicance titration. - ✔✔30 MAD - ✔✔Mandibular Advancement device The syndrome resulting from prolonged severe episodes of hypoxemia during sleep and associated with an increase in PaCO2 that worsens during sleep is: - ✔✔obesity-hypoventilation Supplemental Oxygen Supplemental oxygen should be administered based on sleep center protocols to attain an appropriate titration for each individual patient. Significant variation from the protocol should be documented with appropriate rationale. AASM Clinical Guidelines recommend the use of supplemental O2 during PAP titration when awake supine SpO2 on room air is less than [1] for [2] minutes or longer. - ✔✔1. 88% 2. 5min Ms. Doe is seen in the sleep center for shortness of breath on exertion and nocturnal desaturation from an overnight oxygen saturation test. She has been observed to snore and to "hold her breath" during sleep. Polysomnography demonstrated no evidence of obstructive apneas, and only a few mild hypopneas (<5 per hour of sleep) are noted. Her baseline SaO2 is 91% and drops to an average of 88% on falling asleep and further to 78% during REM sleep. What is the appropriate treatment? - ✔✔A trial of nocturnal oxygen saturation via nasal cannula is indicated. Oxygen therapy is started at 1L/min. You can score hypoventilation in an adult patient without the use of CO2 monitoring. - ✔✔false in adults, hypoventilation during sleep is scored if there is either A. an increase in the PCO2 measurement to a value greater than [1] for > [2] minutes OR B. A > [3] mmHG increase in PCO2 measurement during sleep to a value exceeding [4] for > [5] minutes - ✔✔1. 55 mmHg 2. 10 min 3. 10 mmHg 4. 50 mmHg 5. 10 min Mr. Doe presents with loud snoring, excessive daytime sleepiness and frequent dyspneic episodes, especially upon awakening. Home overnight oximetry demonstrates an SaO2 nadir of 80% and 72% of the night was spent below 90%. Polysomnography shows repeated obstructive and mixed apneas and obstructive hypopneas. Baseline SaO2 is 96%, but falls to 79% during episodes of apneas. What the appropriate treatment - ✔✔After 2 hours of baseline testing, patient is started on CPAP therapy and titrated appropriately. Supplemental oxygen should be introduced into the PAP device at the device tubing connection using a T connector, not at the PAP mask. The recommended minimum starting rate for adult and pediatric patients is [1] L/min. Titrate O2 in 1 L/min increments with an interval of no less than [2] minutes until SpO2 is between 88% and 94%. Supplemental O2 levels can sometimes be reduced in patients on BPAP when IPAP level is increased. - ✔✔1. 1l/min 2. 15 min According to AAST Technical Guideline for monitoring end-tidal CO2, what are some reasons an occulsion can occur when monitoring end-tidal CO2? - ✔✔1. A crimp in the sample line to the patient. 2. A no longer functioning moisture trap. 3. A crimp in the scavenger port line located on the back of the device. 4. A break or disconnect in the internal tubing that moves the patient airflow sample through the testing components. What is maxillomandibular advancement? - ✔✔Treatment that involves cutting and advancing the upper and lower jaw bones; enlarging and stabilizing the posterior airway. What are 3 indications for oral appliance therapy? - ✔✔Mild to moderate OSA Snoring CPAP Intolerance A 44 year old male has a respiratory disturbance index of 27 events per hour. A majority of his respiratory events consist of Cheyne-Stokes respiration. oral appliance therapy ???? - ✔✔no, cheyne strokes respiration is a contraindication for oral appliance therapy The patient's baseline SpO2 is below the wake limits on the lab's protocol. The medical director orders supplemental O2 at 2L/min. During the night, the patients TCO2 levels increase by 12 mmHg and the respiratory rate decreases to 6 breaths per minute. What should the technician do? 1. decrease the O2 flow rate and contact the physician 2.recalibrate the transcutaneous CO2 monitor 3.this outcome is desirable and the technician should continue monitoring 4.add bilevel PAP with a back up rate - ✔✔decrease the O2 flow rate and contact the physician CO2 monitoring, using either end-tidal or transcutaneous sensors, is mandatory in children for the scoring of: Answers: A. Apnea B. Hypopnea C. Central events D. Hypoventilation - ✔✔hypoventilation Which of the following is an indication for oral appliance therapy? A. patients with primary snoring or mild obstructive sleep apnea who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep position change B patients with severe central apnea c. patients with moderate to severe obstructive sleep apnea who are not candidates for tonsillectomy and adenoidectomy, craniofacial operations or tracheostomy d. all of the above - ✔✔patients with primary snoring or mild obstructive sleep apnea who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep position change What is a normal CO2 value in mmHg? - ✔✔35-45 mmHg The PCO2 is a measurement of what? - ✔✔the amount of carbon dioxide in the blood Supplemental oxygen cannot be used during an OAT titration. - ✔✔false During a pediatric sleep study, you are using transcutanous monitoring on your patient to evaluate their CO2 levels. The sensor is placed on the patient's upper chest, after 4 hours the patient and caregiver are complaining of a burning sensation at the sensor site. What should you do as the technologist? - ✔✔move the transcutanous every 4 hours or Move the monitor to a different location. During a CPAP titration, the patient is at 10 cm/H2O and their SPO2 values range between 80- 85% for 10 minutes despite the absence of respiratory events. What is the best action for the technologist to take? - ✔✔initiate supplemental O2 and follow protocol TRD - ✔✔tongue retaining device CPAP and oral appliances can be used together for treatment of OSA. - ✔✔true What are some symptoms a patient may have when experiencing hypoxia? (list at least 3) - ✔✔Dramatic Change in Skin Color to Blue or Cherry Red, Feeling Disoriented and Confused, Coughing, Rapid Heartbeat, Shortness of Breath, Slow Heart Rate, Sweating, Wheezing What are 3 contraindication's to oral devices? - ✔✔central Sleep Apnea TMJ No teeth What is the primary source of oxygen available to you in a freestanding sleep center? - ✔✔oxygen concentrators