(The following scenario and associated questions are representative of the types of questions found on the new Certification In Clinical Sleep Health (CCSH) examination.)
Please refer to the simulated PAP download below to choose the BEST answer the questions.
A 15-year-old male returns to the sleep clinic for a 5-week follow-up and review of PAP download data. He was previously diagnosed with obstructive sleep apnea and started on APAP at 5-10 cm H20 using a nasal interface. The patient continues to have complaints of episodes of extreme sleepiness and continuing weight gain. A sleep diary for the two weeks prior to the appointment indicates average bedtime of 10:30 pm, wake time of 7:00 am, with an average of 8.5 hours of sleep per night.
Original Sleep Complaints, Medical Issues and Clinical Findings
• Daytime fatigue with periodic episodes of extreme sleepiness
• Episodes of overeating and weight gain of 25 lbs. over past 3 months
• Snoring and witnessed apnea
• Intermittent behavioral changes and symptoms of aggression
• Increased sexual drive
• ESS 19
• BP 140/90
• BMI 32
• Overnight oximetry – multiple desaturations with low of 86%
Original PSG results
• Sleep efficiency = 92%
• Sleep latency = 12 min
• REM latency = 95 min
• AHI pre-PAP = 38 AI = 42
• AHI on PAP = 6.0 AI = 11
• Low SpO2 = 70% during supine REM
Current Download Data
• Average pressure = 8.5 cm H20
• Compliance usage days = 79%
• Average use/day = 7.8 hrs
• Average leak = 15 L/in
• AHI = 4
• CA = 0
Refer to the above scenario to answer the following questions:
1. Based on the download data, what adjustment should be made to the patient’s PAP?
a. Change patient to oronasal interface
b. Increase APAP to 5-12 cm H2O
c. No adjustment is necessary
d. Switch to bi-level PAP
2. The BEST first action to help clarify the reason for the patient’s continued daytime sleepiness would be:
a. Repeat overnight oximetry.
b. Repeat PSG followed by MSLT.
c. Repeat 2 week actigraphy.
d. Type II portable monitor.
3. In addition to sleep apnea, this patient MOST LIKELY has:
a. Catathrenia.
b. Kleine-Levin Syndrome.
c. Narcolepsy.
d. Sleep-related Eating Disorder.
4. What would be the MOST LIKELY cause of the disparity between the low oxygen saturation value on the overnight oximetry and the PSG?
a. Malfunctioning oximeter on overnight oximetry
b. Intentional interface leak during titration
c. Absence of REM sleep on PSG
d. Increased amount of supine sleep during PSG
Refer to the above scenario to answer the following questions:
1. Based on the download data, what adjustment should be made to the patient’s PAP?
a. Change patient to oronasal interface
b. Increase APAP to 5-12 cm H2O
c. No adjustment is necessary
d. Switch to bi-level PAP
Key: C
2. The BEST first action to help clarify the reason for the patient’s continued daytime sleepiness would be:
a. Repeat overnight oximetry.
b. Repeat PSG followed by MSLT.
c. Repeat 2 week actigraphy.
d. Type II portable monitor.
Key: B
3. In addition to sleep apnea, this patient MOST LIKELY has:
a. Catathrenia.
b. Kleine-Levin Syndrome.
c. Narcolepsy.
d. Sleep-related Eating Disorder.
Key: B
4. What would be the MOST LIKELY cause of the disparity between the low oxygen saturation value on the overnight oximetry and the PSG?
a. Malfunctioning oximeter on overnight oximetry
b. Intentional interface leak during titration
c. Absence of REM sleep on PSG
d. Increased amount of supine sleep during PSG
Key: D
