Introduction Advancements in OSA treatment monitoring now include nightly Remote Patient Monitoring (RPM), typically from PAP machines (PAP-RPM). Recognizing PAP-RPM’s limitations, we present practical examples of a superior approach implemented at REST Technologies using the REST-Tracker RPM (RT-RPM) system for capturing nightly OSA-metrics.

Methods The REST-Tracker employs a Ring-Oximeter with Cardiopulmonary Coupling (CPC) analysis through SleepImage™, an FDA-cleared cloud-computing system. It provides OSA metrics at two sensitivity levels (sAHI_3% and sAHI_4%) with longitudinal viewing and automated data surveillance for workflow optimization. Results From about 300 RT-RPM patients with OSA, managed by a variety of treatment methods, ranging from PAP, Inspire-HGNS, Oral-Appliance-Therapy to orthodontics, we present three cases, all on PAP in whom PAP data, available from ResMed Airview platform, demonstrating RT-RPM’s ability to capture treatment deficiencies not observed by PAP-RPM: Case 1: A 74-year-old male with OSA, using Inspire and PAP therapy, showed increased sAHI on RT-RPM (sAHI_3% 14.7/SD 5.7, sAHI_4% 8.4/SD 4.1) despite normal PAP-RPM data (pAHI 3.7/SD 2). Investigation revealed correlation with intermittent alcohol use, detected only through RT-RPM. Case 2: A 76-year-old female’s RT-RPM detected elevated sAHI (sAHI_3% 27.5/SD 12.9, sAHI_4% 16.4/SD 7.8) while PAP-RPM remained normal (pAHI 3.4/SD 1.8). Investigation revealed high-altitude vacation effects, leading to PAP pressure adjustments and oxygen supplementation. Case 3: A 78-year-old female with severe OSA on combination therapy showed normal PAP-RPM data (pAHI 0.8/SD 1.4) but elevated RT-RPM readings (sAHI_3% 26.2/SD 6.7, sAHI_4% 15.9/SD 5.9), matching persistent symptoms and necessitating treatment modifications.

Conclusion: These cases demonstrate PAP data’s inadequacy in identifying intermittent OSA exacerbations. Our group has demonstrated a clear distinction between the pAHI and sAHI sensitivities, reported in a separate abstract. Besides the significantly lower sensitivity in identifying residual OSA by the pAHI, PAP-RPM is limited to only providing OSA metrics while the patient is on therapy, whereas RT-RPM provides metrics regardless of therapy type or usage, giving a more significant indication of morbidity impact from OSA status. We conclude that relying solely on PAP data for OSA patient monitoring is not sufficient to be deemed a standard of care goal since better methods are now becoming available with advanced wearable technologies. Support (if any)