Vidal Celia, Mallet Jean-Pierre, Skinner Sarah, Gilson Raphael, Gaubert Olivier, Prigent Arnaud, Gagnadoux Frédéric, Bourdin Arnaud, Molinari Nicolas, Jaffuel Dany
IDESP, INSERM, PreMEdical INRIA, Montpellier University, CHU Montpellier, Montpellier, France.
Groupe Adène, Montpellier, France.
Respir Res. 2025 Jul 12;26(1):244. doi: 10.1186/s12931-025-03324-4.
Continuous Positive Airway Pressure (CPAP) telemonitoring is increasingly important in managing obstructive sleep apnea (OSA). The Apnea-Hypopnea Index reported by CPAP devices (AHI) is used as a key indicator of treatment effectiveness. However, discrepancies in AHI calculation rules between manufacturers may affect clinical decision-making. No prior studies have investigated whether manufacturers' choices to exclude certain apnea-hypopnea events from the AHI calculation may influence the number of patients presenting an AHI alert. The aim of this proof-of-concept study was not to compare the manufacturers with each other, but to evaluate, for each manufacturer, how the different possible ways of calculating AHI influence the percentage of alert cases.
We conducted a retrospective analysis of 13,764 CPAP-treated OSA patients monitored on October 2, 2023. AHI calculations were evaluated according to manufacturer-specific rules. When possible, we assessed the impact of excluding central hypopneas, events during major leaks, and/or ramp periods on the percentage of patients crossing the consensual AHI alert threshold of ≥ 10 events/h.
We identified significant disparities in AHI calculations between manufacturers, which lead to significant differences in the number of patients flagged as being in an alert state. Excluding central hypopneas reduced the number of alert cases by 50%, while excluding apneas/hypopneas during major leaks or ramp periods reduced alerts by 20%.
Our proof-of-concept study highlights inconsistencies in AHI calculations among CPAP manufacturers, raising concerns about patient care. Establishing standardized AHI calculation criteria is essential to ensuring accurate monitoring and optimal patient safety.
持续气道正压通气（CPAP）远程监测在阻塞性睡眠呼吸暂停（OSA）管理中日益重要。CPAP设备报告的呼吸暂停低通气指数（AHI）被用作治疗效果的关键指标。然而，不同制造商之间AHI计算规则的差异可能会影响临床决策。此前尚无研究调查制造商在AHI计算中选择排除某些呼吸暂停低通气事件是否会影响出现AHI警报的患者数量。本概念验证研究的目的不是比较各制造商，而是评估每个制造商不同的AHI计算方式如何影响警报病例的百分比。
我们对2023年10月2日接受CPAP治疗的13764例OSA患者进行了回顾性分析。根据各制造商的特定规则评估AHI计算。在可能的情况下，我们评估了排除中枢性低通气、严重漏气期间的事件和/或升压期对超过共识性AHI警报阈值≥10次事件/小时的患者百分比的影响。
我们发现各制造商之间的AHI计算存在显著差异，这导致被标记为处于警报状态的患者数量存在显著差异。排除中枢性低通气使警报病例数减少了50%，而排除严重漏气或升压期的呼吸暂停/低通气使警报减少了20%。
我们的概念验证研究突出了CPAP制造商之间AHI计算的不一致性，引发了对患者护理的担忧。建立标准化的AHI计算标准对于确保准确监测和优化患者安全至关重要。
