| Baseline/nCPAP Study ("Split Night" Sleep Study) |
 |
Submitted by Karen Allen, RPSGT
I. PURPOSE / INDICATIONS /
RATIONALE:
Diagnosis and initiation of therapy for
Obstructive Sleep Apnea (OSA) is usually conducted over at least
two nights of polysomnographic testing. The first night Seep Sudy
is to establish a reliable baseline. If the patient's
polysomnogram is positive for Obstructive Sleep Apnea, the second
night Seep Study is utilized to initiate and titrate nasal CPAP.
Some patients may meet life threatening or
severe criteria necessitating immediate intervention early enough
in their first night of polysomnographic study to begin
application and titration of therapeutic modalities appropriate
for their sleep disordered breathing abnormality. If any one or
more of the following occurs and is associated with Obstructive
Respiratory events, nCPAP should be initiated immediately:
1. Bradycardia of 40 beats per minute or less.
2. PVC couplets or bigeminy.
3. Sinus bradycardia (arrest) > 2.5 seconds.
4. 02 desaturation to 75% or below.
In the event that there is a delay between the
first and second night Sleep Study and the patient's sleep
recording has documented a minimum of 30 qualifying apneas
accompanied by desaturations of 4% or more of baseline and/or
arousals within the first 3 hours of LIGHTS OUT, nCPAP should be
initiated.
nCPAP should begin with a level of 4 cm H20
pressure and gradually increased by 2 cm/H20 pressure until
apneas and hypopneas have been alleviated. 15 cm H20 pressure is
the maximum nCPAP pressure established in this Sleep Lab. If the
patient's Sp02 remains below 90% and the respiratory obstructions
have been eliminated by recorded documentation, oxygen should be
initiated inline with nCPAP beginning with 1 liter per minute.
The oxygen should be judiciously increased until the patient's
Sa02 is 90% or better.
II. PROCEDURE:
1. After patient activity has recorded
sufficient evidence of Obstructive Sleep Apnea, as indicated by
preceding criteria, Document information and interrupt the Sleep
Recording.
2. Awaken and explain to patient that the sleep
study is being modified to include his/her sleep with the
assistance of nasal CPAP.
3. Begin procedure for nasal CPAP titration.
|
