Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP) devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO), which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA) via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI) was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3) and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3). Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring. 1. Introduction Obstructive sleep apnea (OSA) is a chronic medical condition requiring nightly application of therapy to effectively limit the number of apneas and hypopneas that would occur without intervention. The gold-standard treatment for OSA is continuous positive airway pressure therapy (PAP), which provides a pneumatic splint of the soft tissue in the upper airway [1]. PAP devices can measure and record airflow and pressure levels whenever the device is worn. They contain internal, proprietary (i.e., differing by manufacturer) algorithms that identify breathing disturbances and whether these disturbances are due to persistent obstructive or nonobstructive events. Thus, PAP devices can provide a measure of “residual” Apnea-Hypopnea Index (AHI) and its components, the Hypopnea Index (HI) and Apnea Index (AI). Although not equivalent to the indices measured by polysomnography or home sleep testing via Type III devices, the PAP terminology is nonetheless the same. American Academy of Sleep Medicine practice parameters and clinical guidelines recommend routine monitoring of adherence and efficacy data provided by PAP devices as an indication of treatment progress [2, 3]. Because residual AHI is primarily used
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