Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea
Abstract Background Continuous Positive Airway Pressure (CPAP) telemonitoring is increasingly important in managing obstructive sleep apnea (OSA). The Apnea-Hypopnea Index reported by CPAP devices (AHIflow) is used as a key indicator of treatment effectiveness. However, discrepancies in AHIflow calc...
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BMC
2025-07-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-025-03324-4 |
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| author | Celia Vidal Jean-Pierre Mallet Sarah Skinner Raphael Gilson Olivier Gaubert Arnaud Prigent Frédéric Gagnadoux Arnaud Bourdin Nicolas Molinari Dany Jaffuel |
| author_facet | Celia Vidal Jean-Pierre Mallet Sarah Skinner Raphael Gilson Olivier Gaubert Arnaud Prigent Frédéric Gagnadoux Arnaud Bourdin Nicolas Molinari Dany Jaffuel |
| author_sort | Celia Vidal |
| collection | DOAJ |
| description | Abstract Background Continuous Positive Airway Pressure (CPAP) telemonitoring is increasingly important in managing obstructive sleep apnea (OSA). The Apnea-Hypopnea Index reported by CPAP devices (AHIflow) is used as a key indicator of treatment effectiveness. However, discrepancies in AHIflow 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 AHIflow calculation may influence the number of patients presenting an AHIflow 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 AHIflow influence the percentage of alert cases. Methods We conducted a retrospective analysis of 13,764 CPAP-treated OSA patients monitored on October 2, 2023. AHIflow 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 AHIflow alert threshold of ≥ 10 events/h. Results We identified significant disparities in AHIflow 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%. Conclusions Our proof-of-concept study highlights inconsistencies in AHIflow calculations among CPAP manufacturers, raising concerns about patient care. Establishing standardized AHIflow calculation criteria is essential to ensuring accurate monitoring and optimal patient safety. |
| format | Article |
| id | doaj-art-f35a5b730678439db3f8c8ff9b8c7b11 |
| institution | Kabale University |
| issn | 1465-993X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj-art-f35a5b730678439db3f8c8ff9b8c7b112025-08-20T03:46:27ZengBMCRespiratory Research1465-993X2025-07-012611710.1186/s12931-025-03324-4Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apneaCelia Vidal0Jean-Pierre Mallet1Sarah Skinner2Raphael Gilson3Olivier Gaubert4Arnaud Prigent5Frédéric Gagnadoux6Arnaud Bourdin7Nicolas Molinari8Dany Jaffuel9IDESP, INSERM, PreMEdical INRIA, Montpellier University, CHU MontpellierGroupe AdèneCHU MontpellierGroupe AdèneGroupe AdèneGroupe Medical de Pneumologie, Polyclinique Saint-LaurentDepartment of Respiratory and Sleep Medicine, University Hospital of AngersGroupe AdèneIDESP, INSERM, PreMEdical INRIA, Montpellier University, CHU MontpellierGroupe AdèneAbstract Background Continuous Positive Airway Pressure (CPAP) telemonitoring is increasingly important in managing obstructive sleep apnea (OSA). The Apnea-Hypopnea Index reported by CPAP devices (AHIflow) is used as a key indicator of treatment effectiveness. However, discrepancies in AHIflow 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 AHIflow calculation may influence the number of patients presenting an AHIflow 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 AHIflow influence the percentage of alert cases. Methods We conducted a retrospective analysis of 13,764 CPAP-treated OSA patients monitored on October 2, 2023. AHIflow 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 AHIflow alert threshold of ≥ 10 events/h. Results We identified significant disparities in AHIflow 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%. Conclusions Our proof-of-concept study highlights inconsistencies in AHIflow calculations among CPAP manufacturers, raising concerns about patient care. Establishing standardized AHIflow calculation criteria is essential to ensuring accurate monitoring and optimal patient safety.https://doi.org/10.1186/s12931-025-03324-4CPAPAHIflowTelemonitoring |
| spellingShingle | Celia Vidal Jean-Pierre Mallet Sarah Skinner Raphael Gilson Olivier Gaubert Arnaud Prigent Frédéric Gagnadoux Arnaud Bourdin Nicolas Molinari Dany Jaffuel Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea Respiratory Research CPAP AHIflow Telemonitoring |
| title | Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea |
| title_full | Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea |
| title_fullStr | Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea |
| title_full_unstemmed | Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea |
| title_short | Concerns arising from the calculation of the apnea-hypopnea index during CPAP-telemonitoring of patients with obstructive sleep apnea |
| title_sort | concerns arising from the calculation of the apnea hypopnea index during cpap telemonitoring of patients with obstructive sleep apnea |
| topic | CPAP AHIflow Telemonitoring |
| url | https://doi.org/10.1186/s12931-025-03324-4 |
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