Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 30: Disorders of Sleep

Test Bank

MULTIPLE CHOICE

1. What percent of the adult population is believed to have obstructive sleep apnea?
a. <1%
b. 2% to 4%
c. 5% to 10%
d. unknown

ANS: B
It is estimated that approximately 2% to 4% of the adult population has OSA.

DIF: Recall REF: p. 660 OBJ: 1

2. The definition of sleep apnea uses what criteria for defining an episode of apnea?
a. 5 seconds
b. 10 seconds
c. 15 seconds
d. 20 seconds

ANS: B
Sleep apnea can be defined as repeated episodes of complete cessation of airflow for 10
seconds or longer.

DIF: Recall REF: p. 660 OBJ: 2

3. Which of the following conditions are associated with central apnea?

1. congestive heart failure
2. primary central nervous system lesions
3. high-altitude hypoxemia
4. obesity
a. 1 and 4
b. 2 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

ANS: C
Primary central nervous system lesions, stroke, congestive heart failure, and high-altitude
hypoxemia can diminish respiratory control and cause central apnea events.

DIF: Recall REF: p. 660-661 OBJ: 2

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 Test bank 30-2

4. Central sleep apnea occurs more often than obstructive sleep apnea.
a. True
b. False

ANS: B
Central sleep apnea is not as common as obstructive sleep apnea.

DIF: Recall REF: p. 661 OBJ: 2

5. What term is used to describe a significant decrease in airflow during sleep but not a complete
cessation of breathing?
a. apnea
b. minor apnea
c. hypopnea
d. dyspnea

ANS: C
Hypopnea is a significant decrease in airflow without complete cessation of airflow.

DIF: Recall REF: p. 661 OBJ: 2

6. What are the criteria to define hypopnea?

a. 20% decrease in airflow and 4% oxygen desaturation
b. 20% decrease in airflow and 2% oxygen desaturation
c. 30% decrease in airflow and 4% oxygen desaturation
d. 30% decrease in airflow and 2% oxygen desaturation

ANS: C
Hypopnea is defined as a 30% decrease in airflow in conjunction with 4% oxygen
desaturation.

DIF: Recall REF: p. 661 OBJ: 2

7. What is the primary cause of obstructive sleep apnea?

a. small or unstable pharyngeal airway
b. deviated septum
c. unstable larynx
d. large tongue

ANS: A
The primary cause of obstructive sleep apnea is a small or unstable pharyngeal airway.

DIF: Recall REF: p. 662 OBJ: 3

8. All of the following conditions are associated with untreated obstructive sleep apnea, except:
a. systemic hypotension

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 Test bank 30-3

b. pulmonary hypertension
c. heart failure
d. myocardial infarction

ANS: A
Patients with untreated obstructive sleep apnea, compared with the general population, have
an increased risk of systemic and pulmonary hypertension, stroke, nocturnal arrhythmia, heart
failure, and myocardial infarction.

DIF: Application REF: p. 663 OBJ: 3

9. What is believed to be the cause of systemic hypertension in patients with sleep apnea?
a. hypervolemia
b. increased sympathetic tone
c. elevated CO2
d. tachycardia

ANS: B
Over time, increased sympathetic tone may result in systemic and modest pulmonary
hypertension.

DIF: Recall REF: p. 663 OBJ: 3

10. Which of the following factors has been shown to positively correlate with obstructive sleep
apnea?
a. age
b. height
c. obesity of the upper body
d. blood pressure at rest

ANS: C
Obesity, especially of the upper body, has been found to correlate positively with the presence
of obstructive sleep apnea.

DIF: Recall REF: p. 663 OBJ: 3

11. What is the name of the respiratory pattern where a crescendo-decrescendo pattern of
hyperpnea alternates with periods of apnea?
a. Cheyne-Stokes
b. Kussmaul
c. agonal
d. Biot’s

ANS: A
Cheyne-Stokes respiration, which often occurs in patients with congestive heart failure or
stroke, is a severe type of periodic breathing characterized by a crescendo-decrescendo pattern
of hyperpnea alternating with apnea.

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 Test bank 30-4

DIF: Recall REF: p. 663 OBJ: 3

12. All of the following characteristics are typically associated with sleep apnea, except:
a. male patient
b. over the age of 40 years
c. hypotensive
d. loud snoring during sleep

ANS: C
Patients with sleep apnea more commonly are men (three times greater frequency than among
women), are older than 40 years, and have hypertension (Box 30-2).

DIF: Application REF: p. 663 OBJ: 3

13. Which of the following complaints is frequently seen in a patient with obstructive sleep
apnea?
a. dizziness
b. chest pain
c. shortness of breath with exertion
d. excessive daytime sleepiness

ANS: D
Patients who have an increased frequency of awakenings and microarousals have more
daytime sleepiness and greater difficulty with daytime functioning than does the general
population.

DIF: Recall REF: p. 664 OBJ: 3

14. Which of the following physical exam findings is associated with obstructive sleep apnea?
a. large tonsils
b. microcephaly
c. macroglossia
d. deviated nasal septum

ANS: A
Although tonsillar hypertrophy is common in children with sleep apnea, it is seldom found in
adults. Large palatine tonsils may increase the risk of airway closure during sleep.

DIF: Recall REF: p. 664 OBJ: 3

15. All of the following are parameters used to confirm the metabolic syndrome associated with
obstructive sleep apnea, except:
a. low triglycerides
b. insulin resistance
c. hypertension
d. impaired glucose intolerance

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 Test bank 30-5

ANS: A
The metabolic syndrome includes three of the following: waist circumference greater than 102
cm, hypertension, impaired glucose tolerance, insulin resistance, and elevated triglyceride
levels.

DIF: Application REF: p. 664 OBJ: 3

16. All of the following parameters are typically monitored with a polysomnogram, except:
a. SaO2
b. electroencephalogram (EEG)
c. breathing effort
d. exhaled PCO2

ANS: D
In a laboratory sleep study, several physiologic signals are recorded to determine whether
airway closure occurs during sleep and to what extent the closure disturbs sleep continuity and
cardiopulmonary function. An electroencephalogram (EEG), electrooculogram (EOG), and
chin electromyogram (EMG) are obtained for assessment of sleep stage and documentation of
sleep disruption due to sleep-related breathing disturbance. Airflow (measured at nose and
mouth), ventilatory effort (using inductive plethysmography or piezo belts), cardiac rhythm
(with a modified lead II electrocardiogram), and oxygen saturation (measured with pulse
oximetry) are included in the standard testing montage.

DIF: Application REF: p. 664 OBJ: 4

17. What value for the apnea–hypopnea index (AHI) is consistent with moderate obstructive sleep
apnea?
a. 5 to 15
b. 15 to 30
c. above 30
d. below 5

ANS: B
The AASM has operationally defined the severity of obstructive sleep apnea as follows: mild,
AHI 5 to 15; moderate, AHI 15 to 30; and severe, AHI greater than 30.

DIF: Recall REF: p. 665 OBJ: 4

18. Which of the following behavioral interventions is least useful for the treatment of sleep
apnea?
a. weight loss
b. avoidance of alcohol
c. avoidance of sedatives
d. avoidance of daytime naps

ANS: D

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 Test bank 30-6

Several behavioral interventions can be beneficial, including weight loss in obese patients;
avoidance of alcohol, sedatives, and hypnotics; and avoidance of sleep deprivation.

DIF: Recall REF: p. 665 OBJ: 5

19. Why should the patient with obstructive sleep apnea not use alcohol?
a. Alcohol decreases the arousal threshold.
b. Alcohol increases upper airway muscle tone.
c. Alcohol increases the arousal threshold.
d. Alcohol reduces the cardiovascular compensatory mechanisms.

ANS: A
Alcohol decreases the arousal threshold and as a result can increase the duration of apnea.
Alcohol also reduces upper airway muscle tone, causing the airway to be more compliant and
thus more prone to complete or partial closure.

DIF: Recall REF: p. 666 OBJ: 5

20. Which of the following medical therapies is considered first-line treatment for obstructive
sleep apnea (OSA)?
a. continuous positive airway pressure (CPAP)
b. surgery
c. oxygen therapy
d. antibiotics

ANS: A
CPAP therapy was introduced for management of OSA in 1981. It has become the first-line
medical therapy for OSA.

DIF: Recall REF: p. 667 OBJ: 6

21. What is the amount of CPAP that is typically required to abolish upper airway obstruction in
patients with OSA?
a. 3 to 5 cm H2O
b. 10 to 20 cm H2O
c. 2.5 to 7.5 cm H2O
d. 7.5 to 12.5 cm H2O

ANS: D
For most patients, obstruction of the upper airway is abolished by CPAP pressures between
7.5 and 12.5 cm H2O.

DIF: Recall REF: p. 667 OBJ: 6

22. How does CPAP improve breathing in the patient with OSA?
a. stimulation of the phrenic nerve
b. pneumatic splinting of the upper airway

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 Test bank 30-7

c. stimulation of upper airway muscles

d. repositioning of the epiglottis

ANS: B
CPAP therapy is believed to work by splinting the upper airway open, thus raising the
intraluminal pressure of the upper airway above a critical transmural pressure of the pharynx
and hypopharynx that is associated with airway closure.

DIF: Recall REF: p. 668 OBJ: 7

23. When diffentiating between central and obstructive sleep apnea, which of the following
“channels” or parameters would reflect vastly different results during an apneic episode or
event?
a. SPO2
b. heart rate
c. chest wall and abdominal effort
d. nasal airflow

ANS: C
In central sleep apnea, there is essentially no chest wall or abdominal effort detected during
episodes/events due to a problem with the signal from the brain, while such effort is present
and may increase in obstructive sleep apnea.

DIF: Analysis REF: p. 661-662 OBJ: 10

24. What is considered to be the major problem with the use of CPAP in patients with obstructive
sleep apnea?
a. patient compliance
b. frequent pneumothorax
c. cardiovascular complications
d. expense

ANS: A
Approximately 80% of patients accept CPAP, although long-term objective compliance is
frequently less than optimal.

DIF: Recall REF: p. 668 OBJ: 8

25. Available evidence has shown that bilevel pressure is associated with better patient
compliance than the conventional CPAP.
a. True
b. False

ANS: B
Although patient acceptance may be slightly better with bilevel pressure, the published data
have shown no difference in compliance between conventional CPAP and BiPAP.

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 Test bank 30-8

DIF: Recall REF: p. 669 OBJ: 9

26. In what way do BiPAP units differ from CPAP units?

a. BiPAP applies different pressure levels on inspiration and exhalation.
b. BiPAP units cost significantly more that CPAP units.
c. BiPAP operates on electricity.
d. BiPAP simulates spontaneous breathing.

ANS: A
Unlike conventional CPAP, BiPAP is titrated by increasing inspiratory positive airway
pressure (IPAP) and expiratory positive airway pressure (EPAP) separately in response to
apnea, hypopnea, and desaturation.

DIF: Recall REF: p. 669 OBJ: 9

27. What term is used to describe CPAP units that use a computer to adjust CPAP levels as
needed by the patient during sleep?
a. min-CPAP
b. max-CPAP
c. retro-CPAP
d. auto-CPAP

ANS: D
These devices are referred to as “auto-CPAP,” “intelligent CPAP,” or “smart CPAP.” These
devices use a computer algorithm for adjusting the level of CPAP in response to dynamic
changes in airflow, and/or vibration secondary to snoring.

DIF: Recall REF: p. 669 OBJ: 10

28. All of the following are common side effects of positive-pressure therapy, except:
a. dry nasal mucosa
b. claustrophobia
c. skin irritation
d. headache

ANS: D
These effects include feelings of claustrophobia, nasal congestion, rhinorrhea, skin irritation,
and nasal dryness (Figure 30-4).

DIF: Recall REF: p. 670 OBJ: 10

29. Oral devices may prove useful for cases of mild OSA.
a. True
b. False

ANS: B

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 Test bank 30-9

Patients who have mild sleep apnea and are unwilling to use CPAP may benefit from these
devices.

DIF: Recall REF: p. 670 OBJ: 11

30. Medications have proved ineffective for most patients with sleep apnea.
a. True
b. False

ANS: A
Medications have proven ineffective for most patients with sleep apnea.

DIF: Recall REF: p. 670 OBJ: 11

31. Uvulopalatopharyngoplasty has a success rate of less than 50%.

a. True
b. False

ANS: A
The success rate of UPPP is reported to be less than 50% overall.

DIF: Recall REF: p. 672 OBJ: 11

32. Which of the following are TRUE about obstructive sleep apnea (OSA)?

A. It is overdiagnosed in the United States.

B. It has an equivalent prevalence to asthma in the general population.
C. It has an equivalent prevalence to diabetes in the general population.
D. The spectrum of the disease includes sleep disruption related to increased airway
resistance.
a. 1 and 2 only
b. 2 and 3 only
c. 1, 2 and 4 only
d. 2, 3 and 4 only

ANS: D
Obstructive sleep apnea syndrome is a common clinical problem that continues to be
underdiagnosed. The prevalence is equivalent to that of asthma and diabetes in the general
population. The spectrum of the disease ranges from sleep disruption related to increased
airway resistance to profound daytime sleepiness in conjunction with severe
oxyhemoglobin desaturation, pulmonary hypertension, and right heart failure.

DIF: Recall REF: p. 660 OBJ: 1

33. All of the following are interventions used in the management of obstructive sleep apnea,
except:
a. group therapy

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Test bank 30-10

b. behavioral
c. medical
d. surgical

ANS: A
Management of OSA should be individualized but generally can be divided into three options:
behavioral, medical, and surgical interventions

DIF: Recall REF: p. 665 OBJ: 6

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.