0606 Evaluating the Clinical Reliability of Positive Airway Pressure Reported AHI When Compared to Cardiopulmonary Coupling Reported AHI on PAP

Abstract Introduction Positive Airway Pressure (PAP) therapy download reports are currently used as the standard of care to assess sleep apnea treatment success. They give insights into usage, leak and residual apnea hypopnea index (AHI-flow). Recent evidence suggests there may be utility in measuring sleep and respiratory health with home sleep testing systems for patients receiving PAP therapy. This study compares residual AHI derived from PAP devices (AHI-flow), and AHI from cardiopulmonary coupling (AHI-cpc) on nights while using PAP therapy. In particular, it examines patients for whom CPAP would have been noted to be effective, and how often more detailed follow-up testing may indicate an ongoing problem. Methods As a standard of care, most patients in our clinical program have a home sleep testing system (CardioPulmonary Coupling by Sleep Image) and sleep is tracked across time to mitigate pathology and optimize sleep health. In this cohort we reviewed retrospective remote physiological monitoring (RPM) data from ResMed PAP devices and home sleep testing with cardiopulmonary coupling (CPC) on nights that PAP was utilized, analyzed in multinight longitudinal fashion. Results A total of 465 patients met inclusion criteria of same night sleep testing with CPC and PAP use >4 hours on the same night. A total 24,939 nights had matching PAP and CPC data (median 22 nights per participant). The mean AHI-flow from PAP therapy was 2.4 events/hour (median, 1.5 events/hour) and the AHI-cpc was 12.1 events/hour (median, 10.1 events/hour). 22,338 nights had AHI-flow reported to be below 5 events/hr. Amongst nights with PAP-derived AHI-flow < 5 events per hour (what would have been considered treatment success ), 85 % of nights had AHI3%-cpc ≥ 5 events per hour, 47.7% of nights had AHI3%-cpc ≥10 events per hour, 28.3% nights had ≥ 5 minutes with SpO2 below 90% and 10.6% of nights had ≥ 5 minutes with SpO2 below 88%. Conclusion PAP therapy download report may be useful to assess usage and leak, but does have the potential to underestimate residual apnea burden. Relying on a single PAP-based metric to verify treatment efficacy (AHI-flow < 5/hr) has the potential to miss meaningful residual disease. Support (if any)