Which of the following best describes how bi-level pressures should be adjusted for a patient with obstructive sleep apnea (OSA)?

The adjustment of bi-level pressures for a patient with obstructive sleep apnea (OSA) hinges on optimizing the therapeutic effects of the positive airway pressure settings. By increasing the inspiratory positive airway pressure (IPAP), one can enhance tidal volume and minute ventilation, which are crucial in addressing hypopneas, snoring, and oxygen desaturation events typically seen in patients with OSA.

Increasing IPAP helps to ensure that the air delivered during inhalation is sufficient enough to prevent the airway from collapsing, particularly in cases where the airway obstruction leads to episodes of shallow breathing or significant reductions in airflow. This can be critical in eliminating hypopneas, which are characterized by a substantial reduction in airflow, as well as in reducing snoring and the resultant oxygen desaturation that may occur during sleep.

In contrast, adjustments to the expiratory positive airway pressure (EPAP) aim to maintain airway patency during exhalation and may not be primarily focused on treating hypopneas or oxygenation issues directly. Thus, the strategy of increasing IPAP is a targeted approach to improving the overall efficacy of bi-level therapy in patients with OSA.