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Residual AHI Measurement from PAP Devices Versus Home Polygraphy: A Method Comparison Study Using Real World Data.

Stephanie K Mansell, Sharon Augustt, Francesca Gowing

    Respiration; International Review of Thoracic Diseases
    |June 25, 2026
    PubMed
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    Positive airway pressure (PAP) device data often underestimates residual apnoea hypopnoea index (AHI) in obstructive sleep apnoea (OSA) patients compared to home polygraphy. Interface leak significantly worsens this underestimation, necessitating polygraphy for accurate treatment assessment.

    Area of Science:

    • Sleep Medicine
    • Respiratory Medicine
    • Medical Device Technology

    Background:

    • Positive airway pressure (PAP) therapy is a standard treatment for obstructive sleep apnoea (OSA).
    • Device-derived residual apnoea hypopnoea index (AHI) from PAP downloads is commonly used to monitor treatment effectiveness.
    • The real-world accuracy of PAP device-reported AHI compared to objective measurements remains under investigation.

    Purpose of the Study:

    • To evaluate the agreement between PAP device-derived AHI and AHI measured by home cardiorespiratory polygraphy (CRP).
    • To assess the diagnostic accuracy of PAP device data for detecting inadequate OSA treatment.
    • To examine the impact of interface leak on AHI underestimation by PAP devices.

    Main Methods:

    • Secondary analysis of the 3DPiPPIn randomised controlled trial involving adults with OSA (AHI ≥15 events/hr) naive to PAP therapy.

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  • Two-night home CRP was performed at three and six months post-initiation of PAP therapy.
  • Residual AHI was obtained from Löwenstein PAP devices; agreement assessed using Bland-Altman analysis, ICC, and weighted Kappa.

    • Main Results:

    • PAP device-derived AHI consistently underestimated CRP-derived AHI, with poor agreement (ICCs: 0.02 at 3 months, 0.16 at 6 months).
    • Diagnostic agreement for inadequate control (AHI ≥7 events/hr) was low (Kappa < 0.10 at both time points).
    • Higher interface leak was significantly associated with greater AHI underestimation by PAP devices (p < 0.0001).

    Conclusions:

    • PAP device downloads substantially underestimate residual AHI and show poor agreement with home CRP.
    • Device-derived AHI has significant limitations in real-world OSA management, especially with interface leak.
    • Confirmatory assessment with cardiorespiratory polygraphy is essential when treatment adequacy is uncertain.