Sleep Board Review Test 1

18. Which of the following patients should not be treated with an autotitrating PAP device for obstructive sleep apnea (OSA)?

a. 51 yo man with OSA with an apnea hypopnea index of 45/hr, coronary artery disease, diabetes mellitus

b. 45 yo woman with OSA with an apnea hypopnea index of 31/hr, SPO2 nadir of 78%, morbid obesity

c. 62 yo man with OSA with an apnea hypopnea index of 42/hr, COPD, hypothyroidism

d. 41 yo woman with OSA with an apnea hypopnea index of 30/hr, restless legs syndrome, anemia

e. 64 yo man with OSA with an apnea hypopnea index of 40/hr, depression

Answer: c. 62 yo man with OSA with an apnea hypopnea index of 42/hr, COPD, hypothyroidism

In the 2002 AASM Practice Parameter on the use of autotitrating PAP machines, it is recommended to not use auto-titrating devices for titration or treatment in patients with the following diseases: COPD, CHF, and nocturnal arterial hpoxemia due to conditions other than OSA (such as obesity hypoventilation syndrome. In addition, patients who do not snore (due to palatal surgery or naturally) should not undergo titration or treatment with APAP devices that rely upon sound or vibration.

Reference:

Littner, ML for the AASM. Practice Parameters for the Use of Auto-Titrating Continuous Positive Airway Pressure Devices for Titrating Pressures and Treating Adult Patients with Obstructive Sleep Apnea Syndrome. Sleep 2002;25:143-147.

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