Therapy Pressure, Leak
& Residual Events
Reference for every metric CPAPDex reads from a PAP machine’s nightly therapy log — definitions, formulas, expected ranges, and the evidence base behind each. Most headline numbers are device-scored events the machine’s firmware produced (ingested as ground truth, not recomputed), augmented by direct channel statistics and a few flow-derived and oximetry-lane metrics CPAPDex computes itself. Companion to the analyzer output; not a substitute for your prescribing clinician’s review.
Hours of delivered therapy for the night — the denominator behind every per-hour event index. Mask-on is delivered pressure > 0; brief gaps under ~5 min are not counted as off.
| Usage (hr) | Read |
|---|---|
| < 4 | Below compliance |
| 4–6 | Minimum compliance |
| 6–7 | Good |
| > 7 | Excellent |
Percentage of nights in the trailing 30 days with at least 4 hours of use — the adherence figure insurers and clinicians track.
| Compliance | Read |
|---|---|
| < 50% | Poor |
| 50–70% | Below CMS threshold |
| 70–85% | Adequate |
| > 85% | Excellent |
Minutes from recording start to the first stable delivered pressure — how long the mask sat unused before therapy began.
| Latency (min) | Read |
|---|---|
| < 30 | Normal |
| 30–60 | Delayed |
| > 60 | Prolonged |
The median delivered pressure across mask-on time — the typical pressure the airway needed.
| Median (cmH₂O) | Read |
|---|---|
| < 8 | Low (typical mild OSA) |
| 8–12 | Moderate |
| 12–16 | High |
| > 16 | Very high |
The pressure exceeded only 5% of the night — the standard summary of an APAP machine’s pressure demand.
| P95 (cmH₂O) | Read |
|---|---|
| < 10 | Low demand |
| 10–14 | Moderate |
| 14–18 | High demand |
| > 18 | Near machine max |
Interquartile spread of delivered pressure — how much an auto-titrating machine moved through the night.
| IQR (cmH₂O) | Read |
|---|---|
| < 2 | Very stable |
| 2–4 | Normal APAP variability |
| 4–7 | Wide — positional? |
| > 7 | Excessive |
Median drop from inspiratory to expiratory pressure — how much the machine eases pressure on exhale for comfort.
P95 of the expiratory pressure — from a dedicated EPAP lane on bilevel machines, or derived from EPR-relieved expiratory pressure on CPAP/APAP.
Obstructive + central apneas + hypopneas per hour of use — the headline of how well therapy is controlling sleep-disordered breathing tonight.
| AHI (/hr) | Read |
|---|---|
| < 5 | Controlled |
| 5–10 | Mild residual |
| 10–20 | Moderate — investigate |
| > 20 | Severe — possible therapy failure |
Central apneas per hour of use. Elevated central events on CPAP can signal treatment-emergent central apnea (TECA) — which may call for a different therapy mode (e.g. ASV) rather than more pressure.
| CAI (/hr) | Read |
|---|---|
| < 1 | Normal |
| 1–5 | Borderline |
| 5–10 | Elevated — possible TECA |
| > 10 | High — clinician / ASV eval |
Obstructive apneas per hour. Persisting obstructive events suggest the delivered pressure may be inadequate.
| OAI (/hr) | Read |
|---|---|
| < 1 | Well controlled |
| 1–5 | Mild residual |
| > 5 | Pressure inadequate? |
Partial-airflow reductions per hour. Hypopneas dominate most residual AHI.
| HI (/hr) | Read |
|---|---|
| < 5 | Controlled |
| 5–10 | Mild residual |
| > 10 | Significant residual |
Arousals from increased respiratory effort that fall short of an apnea/hypopnea, per hour. Estimated from flow-limitation shape; not all machines report it.
Share of therapy time scored as Cheyne–Stokes respiration or periodic breathing (waxing–waning crescendo–decrescendo airflow), from the CSL annotation stream.
| PB % | Read |
|---|---|
| < 2% | Negligible |
| 2–10% | Present |
| > 10% | Marked — review (cardiac?) |
Mean of the machine’s flow-limitation index — a continuous 0–1 measure of inspiratory-flow flattening (a precursor to obstruction). Device-derived and less standardized across manufacturers.
Fraction of therapy time the flow-limitation index exceeded 0.3 — how much of the night the airway was meaningfully narrowed without yet triggering a scored event.
Share of therapy time the device’s snore index exceeded 0.2 — airway vibration on the pressure/flow signal. Persistent snore can indicate sub-optimal pressure.
Pearson correlation between snore index and delivered pressure — a CPAPDex composite probing whether more pressure is suppressing snore (negative) or failing to (flat/positive). Directional, internal.
Typical excess mask leak across the night. Low and steady is the goal.
| Median (L/min) | Read |
|---|---|
| < 5 | Minimal excess leak |
| 5–15 | Mild — monitor |
| 15–30 | Moderate |
| > 30 | Severe — mask refit |
Peak leak exceeded only 5% of the night — captures intermittent seal breaks a median can hide.
| P95 (L/min) | Read |
|---|---|
| < 15 | Good seal |
| 15–30 | Occasional breaks |
| > 30 | Frequent large leaks |
The single highest leak value of the night — worst-case seal break, useful context for brief data-quality dropouts.
Fraction of the night above ResMed’s 24 L/min large-leak threshold — the trust gauge for everything else. A high value means the residual AHI should be read with heavy skepticism.
| Large Leak % | Read |
|---|---|
| < 1% | Negligible |
| 1–5% | Minor |
| 5–15% | Significant — AHI unreliable |
| > 15% | Severe — data invalid |
Standard deviation of leak divided by its mean — a CPAPDex composite for seal stability rather than level. A steady moderate leak scores better than an erratic one.
Median breaths per minute reported by the machine. Normal adult sleeping rate is ~12–18.
| Resp (/min) | Read |
|---|---|
| 12–18 | Typical resting |
| > 20 | Elevated — arousal / central instability |
Interquartile spread of breathing rate — a steadiness measure. A wide range can reflect periodic breathing or fragmented sleep.
Median estimated volume per breath. The machine estimates this from flow — a relative trend indicator, not calibrated spirometry.
Median air moved per minute (tidal volume × respiratory rate) — useful for spotting hypoventilation trends across nights.
Coefficient of variation of minute ventilation — a CPAPDex composite flagging unstable breathing (e.g. periodic-breathing crescendos) even when the median looks normal.
Total breaths CPAPDex detected from the raw flow waveform — the basis for the flow-derived rate and a data-completeness check.
Breaths per minute from CPAPDex’s own flow detection — an independent cross-check against the machine’s reported respiratory rate. Close agreement validates both.
| vs device RR | Read |
|---|---|
| within ±1 | Detectors agree |
| > ±2 | Inspect flow quality |
Ratio of inspiratory to expiratory flow time per breath. Shifts can reflect airway resistance or expiratory effort; method-dependent.
Self-gated AASM 3% desaturation events per hour — an independent corroboration of residual events from the oxygen side.
| ODI (/hr) | Read |
|---|---|
| < 5 | Normal on therapy |
| 5–15 | Mild residual desaturation |
| > 15 | Significant — corroborate AHI |
Share of valid oximetry samples below 90% saturation — the standard cumulative-hypoxemia burden. Near zero on effective therapy.
| T90 | Read |
|---|---|
| < 1% | Negligible |
| 1–5% | Mild burden |
| > 5% | Significant hypoxemia |
The lowest valid SpO₂ reading after self-gating — the worst oxygen point that survived artifact rejection.
| Nadir | Read |
|---|---|
| ≥ 90% | Reassuring |
| 85–89% | Mild dips |
| < 85% | Significant desaturation |
Average valid oxygen saturation across the night — the baseline oxygenation therapy is sustaining.
| Mean SpO₂ | Read |
|---|---|
| ≥ 94% | Normal |
| 90–93% | Mildly low |
| < 90% | Low — review |
Median heart rate from the oximeter (physiologically plausible in-band values) — context for the oxygen trace, not a substitute for the cardiac nodes.
Spread of the in-band pulse rate — a coarse variability indicator; wide swings can accompany arousals or residual events.
BRP (25 Hz raw flow), PLD (~0.5 Hz pressure / leak / RR / TV / MV / snore / flow-limitation), SA2 (1 Hz SpO₂ / pulse when an oximeter is attached), and the EVE / CSL annotation streams that carry firmware-scored events. Nothing else in the suite reads EDF.CPAPDex decodes the EDF header (labels, sample rates, physical scaling) and each signal’s records, then parses the EVE/CSL annotation TALs into classed events with absolute timestamps. Physical units are validated on decode.
The EDF start date/time maps to a floating wall-clock anchor per the Clock Contract (read back with UTC getters so displayed time is viewer-timezone-independent). A night can contain multiple sessions separated by an off-mask gap — CPAPDex stitches them while preserving the gap.
On the SA2 lane, CPAPDex applies the same self-gate as OxyDex before counting desaturations — rejecting perfusion-collapse and edge artifacts so a squeeze-artifact dip never inflates the ODI. Missing samples surface as gaps, never fabricated.
Validation refers to the scoring convention or threshold’s standing in guidelines/literature, and does not imply validation of the CPAPDex implementation against attended polysomnography.
| Metric Category | Status | Basis |
|---|---|---|
| Residual AHI / CAI / OAI / HI / RERA / PB | ● Device-scored (ingested) | Machine firmware EVE/CSL scoring — AASM scoring conventions |
| Pressure, leak, EPR, RR, TV, MV, snore, SpO₂/pulse | ● Direct measurement | Direct PLD / SA2 channel statistics |
| 30-day compliance; Large Leak %; ODI / T90; flow-derived breath rate | ● Literature / standard | CMS NCD 240.4; ResMed 24 L/min spec; AASM oximetry |
| Flow limitation, Flow-Limited %, I:E ratio | ◐ Emerging | Device-derived / method-dependent |
| Leak CV; MinVent stability; Snore↔Pressure | ○ Experimental composite | CPAPDex internal composites; no independent validation |
| Tier | Meaning | Examples |
|---|---|---|
| Core | Headline therapy outcomes | Usage, Compliance, Residual AHI, Median P, Median/Large Leak |
| Advanced | Fuller therapy analysis | OAI/HI, EPR, P95/median leak, ventilation, ODI/T90 |
| Research | Exploratory / emerging / composites | RERA, EPAP95, Leak CV, MinVent stability, I:E |
| Metric / Rule | Primary Citation | Category |
|---|---|---|
| AHI / OAI / CAI / HI / RERA / CS-PB scoring | AASM Scoring Manual (Berry et al.) | AASM |
| OSA severity grades | ICSD-3 (AASM 2014) | AASM |
| 30-day compliance (≥4 h / ≥70%) | CMS NCD 240.4 | Adherence |
| ODI (3%) / T90 | AASM oximetry scoring | Oximetry |
| Treatment-emergent central apnea | Morgenthaler 2006 | Central apnea |
| EDF+ (BRP/PLD/SA2/EVE/CSL) | Kemp & Olivan 2003 | Format |
| 24 L/min large-leak threshold; EPR | ResMed AirSense spec (manufacturer) | Device spec |
| Flow limitation; I:E; flow-derived breath rate | Standard flow signal processing — CPAPDex impl. | Method |
| Leak CV; MinVent stability; Snore↔Pressure | CPAPDex internal — no external source | Internal |
| Rule / Formula | Source / Author | Year | Reference |
|---|---|---|---|
| Event scoring (apnea/hypopnea/RERA/CS) | AASM (Berry et al.) | v2.x | AASM Manual for the Scoring of Sleep |
| OSA severity classification | AASM | 2014 | ICSD-3 |
| PAP adherence (≥4 h / ≥70% / 90 d) | CMS | — | NCD 240.4 |
| Treatment-emergent / complex central apnea | Morgenthaler et al. | 2006 | Sleep. 29(9):1203–9 |
| EDF+ file format | Kemp & Olivan | 2003 | Clin Neurophysiol. 114(9):1755–61 |
| Large-leak threshold (24 L/min); EPR | ResMed (manufacturer) | — | AirSense / AirView clinical documentation |
- Events are scored by proprietary firmware, not a technologist
- Machine AHI tends to undercount vs attended PSG
- Hypopnea/RERA scoring varies by manufacturer and model
- Tidal volume / minute ventilation are flow estimates, not spirometry
- Above 24 L/min large leak, event scoring is unreliable
- Intentional vent leak is mask-dependent and removed before reporting
- SA2 oximetry metrics exist only when an oximeter is connected
- Leak CV, MinVent stability and Snore↔Pressure are internal composites
- Flow limitation / I:E are method-dependent
- Normative bands are general guidance, not device-calibrated
- Not FDA cleared or CE marked as a medical device
- Not for clinical diagnosis or self-directed therapy changes
- Pressure / mode changes are a prescribing clinician’s decision
- Personal, research, and wellness use only
| Method / Threshold | Primary Citation | Category |
|---|---|---|
| AHI / OAI / CAI / HI / RERA / Cheyne–Stokes scoring | Berry RB, Brooks R, Gamaldo CE, et al. The AASM Manual for the Scoring of Sleep and Associated Events. American Academy of Sleep Medicine; v2.x. aasm.org | AASM |
| OSA severity grades (AHI ≥30 severe) | American Academy of Sleep Medicine. International Classification of Sleep Disorders (ICSD-3). AASM; 2014. | AASM |
| PAP adherence (≥4 h on ≥70% nights / 90 d) | Centers for Medicare & Medicaid Services. National Coverage Determination 240.4 — CPAP Therapy for Obstructive Sleep Apnea. cms.gov | Adherence |
| Oxygen desaturation index (3%) & T90 | Berry RB et al. AASM Manual for the Scoring of Sleep and Associated Events (oximetry scoring rules). AASM. | Oximetry |
| Treatment-emergent / complex central apnea | Morgenthaler TI, Kagramanov V, Hanak V, Decker PA. Complex sleep apnea syndrome: is it a unique clinical syndrome? Sleep. 2006;29(9):1203–9. doi: 10.1093/sleep/29.9.1203 | Central apnea |
| EDF+ file format (BRP / PLD / SA2 / EVE / CSL) | Kemp B, Olivan J. European data format ‘plus’ (EDF+)… Clin Neurophysiol. 2003;114(9):1755–61. doi: 10.1016/S1388-2457(03)00123-8 | Format |
| Large-leak threshold (24 L/min); EPR behaviour | ResMed. AirSense / AirView clinical documentation — manufacturer specification (not a peer-reviewed threshold). | Device spec |
| Flow-limitation index; I:E ratio; flow-derived breath rate | Standard respiratory-flow signal processing — method-dependent; CPAPDex implementation. | Method |
| Leak CV; MinVent stability; Snore↔Pressure | CPAPDex internal composites — no external source. Directional only. | Internal |
Implementation · Validation · UI/UX
Literature synthesis · Reference formatting
Planicka M. CPAPDex: CPAP/PAP Therapy-Log Analysis Node. Version 1.0.0. 2026.