Talking Sleep Understanding Residual AHI: What Sleep Doctors Need to Know
Jan 10, 2025
Imran Iftikhar, associate professor and sleep physician who led the CPAP meta-analysis. Tavi Ioachimescu, sleep medicine researcher who coordinated industry–clinician discussions. Robert Thomas, Harvard sleep researcher focused on PAP waveforms and management. They discuss CPAP algorithm accuracy, device brand differences, when to inspect raw waveforms, and approaches for unstable breathing and high loop gain.
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Look At Waveforms For Low AHIs
- Check waveforms when residual AHI is in the mid–low single digits or if the patient remains symptomatic.
- Use OSCAR or device software to visually confirm events before changing therapy.
CPAP AHI Often Discords With PSG
- CPAP-reported AHI (REI) often shows discordance with PSG AHI due to different sensing and denominators.
- Imran Iftikhar's meta-analysis found wide percentage errors across manufacturers, signaling limited accuracy.
Fix Leak And Position Before Drugs
- Address mask leak and body position first when you see unstable breathing on downloads.
- Consider estazolamide, oxygen, or dead space only after confirming instability is not leak- or sleep-quality-driven.