A patient hands over a single-page “compliance report” pulled from ResMed AirView, Philips Care Orchestrator, or BMC iCode. The report has twenty-plus fields: hours-of-use, days-used, median pressure, 95th-percentile pressure, AHI, leak, mask-off events, central apneas, flow-limitation index. Half the fields look duplicative. A few are mislabelled compared to the clinical terms the physician learned. And the thresholds separating “therapy adequate” from “therapy needs follow-up” are not printed on the report — they live in the reader’s head, or not at all.
This article walks every major field on the three dominant cloud-report formats and assigns each a clinical meaning, a defensible threshold, and an action trigger. Then it compares the Indian sleep-lab report format (where in-lab PSG data is reported) with the home-monitoring cloud report (where therapy-under-PAP data is reported), because they are not the same document and are often confused when a patient brings both to a consultation.
The three cloud platforms at a glance
ResMed AirView is the cloud back-end for AirSense 10, AirSense 11, AirCurve family, and S9 legacy devices. Reports are generated server-side from data uploaded via the built-in cellular modem or SD card. The canonical patient-facing summary is the “Therapy Report.”
Philips Care Orchestrator (formerly EncoreAnywhere) serves DreamStation, DreamStation 2, and System One legacy devices. Philips’ equivalent summary is the “Compliance Report” or “Therapy Progress Report.”
BMC iCode is the cloud platform for BMC’s RESmart family and OEM variants sold under other labels. Report generation is via SD card or BMC’s app; cellular connectivity is less prevalent in the Indian BMC install base.
All three formats share the same core fields but with different names and occasionally different definitions. The sections below use field-by-field mapping.
Usage — hours used per night, days used per month
What it shows. Average hours of mask-on time per night across a selected window (usually 30 days or since last review). Also: days with ≥ 4 hours, days with any use, longest consecutive run.
Adequate-therapy threshold. ≥ 4 hours per night on ≥ 70% of nights in a 30-night window. This is the classical CMS (US) adherence criterion and has become the global reference, including in Indian insurance and corporate-plan coverage decisions. (AASM Practice Guidelines)
When to act. If average hours-of-use is < 3 hours/night or < 50% of nights have ≥ 4 hours, the first investigation is cause of non-adherence: mask fit, pressure tolerance, aerophagia, claustrophobia, nasal congestion, partner’s sleep schedule, work shift pattern. Fixing the cause is more important than any downstream AHI interpretation, because the AHI-on-therapy number is meaningless if the patient isn’t wearing the mask through the night.
Brand name differences. ResMed reports “Days used” and “Days with ≥ 4 hours” separately. Philips reports “Percent days used” and “Percent days ≥ 4 hours.” BMC iCode typically reports only total usage hours and a simple compliance-percent figure.
AHI — the headline residual event rate
What it shows. Apnea-hypopnea events per hour of machine-on time. Critical: this is not sleep time. The denominator is the clock-time the machine was running, whether the patient was actually asleep or lying awake with the mask on.
Adequate-therapy threshold. Residual AHI on PAP should be < 5 events/hour. Most well-treated patients run < 2. An AHI consistently > 5 on therapy means the prescription is under-titrated, the patient has treatment-emergent CSA, or there is a significant leak issue corrupting the flow signal.
When to act. Trend matters more than a single value. A stable AHI of 3 over months is fine. An AHI that drifts from 2 to 7 over three months, with no mask or lifestyle change, needs investigation.
Algorithm differences across brands. ResMed tends to under-report AHI relative to Philips on the same patient because ResMed’s hypopnea threshold is more conservative. BMC numbers vary across firmware versions. A cross-brand AHI comparison must be adjusted for algorithm differences — usually by 20–40%.
Central apnea index — ClearAirway / central events / CSR
What it shows. The subset of apneas the device classified as central (airway open, no flow). ResMed labels these “ClearAirway” apneas, detected by the Forced Oscillation Technique (FOT) cardiac-pulse probe. Philips uses a cardiac-pulse-through-airway inference. BMC’s central detection is less transparent.
Adequate-therapy threshold. Central apnea index (CAI) < 5, with ratio of centrals to total events < 50%. Isolated centrals are normal and not pathological; their concentration is what matters.
When to act. CAI > 5 with ratio > 50% suggests treatment-emergent central sleep apnea (CompSAS). Persistent over 30–90 days of stable therapy and it’s time to consider ASV or BiPAP-ST. Transient — say, for one week after a pressure increase — may resolve as the patient acclimatises.
Cheyne-Stokes respiration (CSR). ResMed AirView reports a separate “CSR” field (minutes of detected Cheyne-Stokes pattern). Non-trivial CSR, especially in a patient with known or suspected heart failure, is a clinical flag. (AASM Practice Guidelines)
Pressure percentiles — median, 90th, 95th, peak
What it shows. Pressure distribution on the given night / across the window. Median (50th) is the typical operating pressure. 95th is the “tight envelope” — the pressure below which the device operated 95% of the time. Peak is the single-point maximum.
Adequate-therapy pattern. Median and 95th percentile should be within a few cmH₂O of each other if the patient is on fixed CPAP. On APAP, a 3–5 cmH₂O gap between median and 95th is typical and reflects the device reacting to REM-supine episodes. A gap of 8+ cmH₂O suggests the APAP is frequently hitting the upper limit — either the range is too narrow or there’s an unusual event pattern.
When to act. If 95th-percentile pressure is drifting upward over months on a previously stable patient (say, from 10 to 14 cmH₂O), something is changing — weight gain, worsening nasal patency, alcohol use, leak-driven algorithm over-compensation. Investigate before just accepting the higher pressure as “the new prescription.”
Brand name differences. Philips reports “90th percentile pressure” by default; ResMed reports “95th percentile pressure.” The two numbers are close but not identical. Knowing which percentile you’re reading matters when comparing across brands.
Leak values — intentional vs mask leak
What it shows. Total leak in L/min (measured at the blower; derived from the difference between commanded pressure and the resulting blower motor load). Usually the report shows median leak and 95th-percentile leak.
Adequate-therapy threshold. Total leak 95th percentile < 24 L/min (ResMed’s published threshold) or < the equivalent Philips “large leak” flag. Note that every mask has an intentional leak designed for CO₂ clearance — typically 20–40 L/min at the prescribed pressure, published in the mask spec sheet. The device’s reported leak is total leak minus expected intentional leak; i.e., the unintentional part.
When to act. 95th-percentile leak > 24 L/min (ResMed) or equivalent red flag on Philips is a mask-fit problem. The AHI on such a night is not reliable because leak destabilises flow-shape detection. Fix the leak (re-fit mask, check cushion wear, investigate mouth leak) before trying to titrate the pressure up.
Brand name differences. ResMed has clean leak reporting. Philips has historically been less transparent, reporting “Large leak percentage” (percent of session time spent in the large-leak state) rather than absolute L/min. BMC varies by firmware.
Flow limitation index
What it shows. Rate of detected flow-limitation events per hour. These are sub-apnea, sub-hypopnea events — inspiratory flow flattening suggesting partial airway narrowing.
Adequate-therapy threshold. There is no widely accepted numeric threshold. A low value (< 0.1) is normal; persistent high values (> 0.3) suggest the patient has residual partial obstruction the APAP algorithm is aware of but isn’t fully resolving.
When to act. A low AHI with high flow-limitation index, in a patient who is still symptomatically tired, is suspicious for residual airway resistance or a UARS phenotype contribution. This is where the APAP’s upper pressure limit may need to be raised, or where the patient may benefit from an evaluation for oral-appliance combination therapy.
Mask-off events
What it shows. Number of times the device detected mask removal during a session, typically with timestamps.
Adequate-therapy pattern. Occasional mask-offs (0–1 per night) are normal. A frequent pattern (3+ per night, recurrently) suggests active mask removal during sleep — often for toilet trips, pressure intolerance, or unconscious face-rubbing. Investigate behavioural cause.
When to act. Frequent mask-offs in a patient reporting mid-night awakenings merit a look at mask type, pressure comfort, and bladder / prostate issues (common in older Indian male patients with BPH driving nocturia).
Average minutes / session statistics
What it shows. Minutes per session, sessions per day, start-time and stop-time statistics.
Adequate-therapy pattern. One session per night, consistent start-time, session length matching the patient’s total sleep time, is the profile of a stable user. Multiple short sessions with large gaps suggest the patient is taking the mask off mid-night.
”Adequate therapy” vs “needs follow-up” — the gestalt
A single-number summary of “is this patient adequately treated” is a bad idea — the fields interact. A reasonable gestalt:
- Adequate therapy. Usage > 4h/night on > 70% of nights, AHI < 5, 95th-percentile leak < threshold, 95th-percentile pressure stable over 30+ days, CAI < 5, no mask-off storm.
- Needs follow-up. Any one of: AHI consistently > 5, 95th-percentile leak > threshold, upward-trending 95th-percentile pressure, CAI ratio > 50%, usage < 4h/night.
- Immediate action. Sudden change in a previously stable profile — large overnight AHI spike, leak storm on a specific night sequence, central apnea emergence — especially in a patient with comorbidity.
Indian sleep-lab report vs home cloud report — a common confusion
Patients frequently carry two documents into a consultation and assume both describe the same thing. They do not.
Sleep-lab PSG report (from the diagnostic study). Records sleep architecture, baseline AHI (pre-therapy), desaturation burden, body-position breakdown, REM-index. Measured against AASM scoring rules with or without EEG depending on Type I vs Type III. This is the diagnostic document.
Home cloud report (from the CPAP). Records usage hours, residual AHI on therapy, pressure distribution, leak, and device-detected events. Calculated by the device’s proprietary algorithms against machine-on time (not sleep time). This is the therapy-monitoring document.
A patient asking “my lab report said AHI 42, my CPAP report says AHI 2 — which is correct?” is asking a confused question. Both are correct. The first is pre-therapy severity; the second is residual on therapy. The CPAP having dropped AHI from 42 to 2 means the therapy is working.
The two also use different denominators, different event-detection methods (EEG + effort + SpO₂ + flow vs. flow only), and different AHI definitions (AASM rule 1A vs. manufacturer-specific proprietary rule). They cannot be directly compared; they describe different phases of the same disease.
Clinical takeaway
The cloud report is a trend-monitoring instrument, not a diagnostic re-measurement. Read it by field, with thresholds in mind. Usage first, then AHI, then leak, then pressure trend, then centrals, then flow limitation. Don’t act on a single night’s outlier; act on sustained patterns over 2–4 weeks. And recognise that cross-brand comparisons of AHI and leak numbers are calibration-dependent — the numbers are not interchangeable.
HHZ’s editorial view: Indian CPAP dealers should be sending the cloud report (or its SD-card equivalent) to the treating physician quarterly, by default, not only on patient request. Most don’t. Patients should download the AirView / Care Orchestrator / iCode app themselves and review their own numbers weekly — the data is theirs and the pattern-recognition is learnable.
Consult your sleep physician when the report shows AHI > 5 persistently, upward-trending pressure, high leak, or central apnea emergence — these are the fields that change clinical management.
References: ResMed AirSense 11 Clinician’s Manual [CITATION]; Philips DreamStation 2 clinician guide [CITATION]; BMC RESmart user manual [CITATION]; CMS NCD for CPAP adherence [CITATION]; AASM scoring manual v3 [CITATION].