{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:09:03Z","timestamp":1779455343026,"version":"3.53.1"},"reference-count":19,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Adherence to positive airway pressure (PAP) is often suboptimal, and current monitoring relies on device logs that, by design, cannot detect respiratory events outside the therapy window. This creates a physiological blind spot during periods of non-usage. This study aimed to demonstrate the clinical necessity of independent, continuous monitoring using a smartphone-based home sleep apnea test (S-HSAT) by validating treatment effectiveness on adherent nights and quantifying the untreated apnea burden caused by partial adherence. Methods: We prospectively monitored 63 obstructive sleep apnea (OSA) patients commencing PAP therapy. Nightly apnea\u2013hypopnea index (AHI) and usage time were recorded simultaneously by an S-HSAT (ApnoTrack) and the PAP device over a 30-day period. Nights were categorized by the duration discrepancy between S-HSAT and PAP (full-use, \u22645 min; intermediate-use, 5\u201330 min; partial-use, &gt;30 min) using physiologically and operationally derived thresholds. Results: Final analysis included 39 participants contributing 667 nights (24 participants excluded due to non-use of one or both devices). Full-use nights (46.2%) showed close agreement between S-HSAT and PAP mean AHI (2.8 \u00b1 4.3 vs. 2.5 \u00b1 2.0 events\/h; p = 0.13). On intermediate-use and partial-use nights (20.7% and 33.1%, respectively), substantial AHI discrepancies emerged (7.3 \u00b1 5.5 vs. 3.8 \u00b1 3.3 and 11.0 \u00b1 7.4 vs. 2.8 \u00b1 2.5 events\/h, respectively; both p &lt; 0.001). Conclusions: Independent S-HSAT monitoring quantified an untreated apnea burden that is invisible to PAP logs alone, while confirming therapeutic efficacy on well-adherent nights. These findings suggest that continuous independent monitoring may help bridge the gap between prescribed therapy and actual physiological outcomes in OSA care.<\/jats:p>","DOI":"10.3390\/medicina62061008","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:14:52Z","timestamp":1779452092000},"page":"1008","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuous Monitoring of Positive Airway Pressure Therapy with a Smartphone-Based Home Sleep Apnea Test"],"prefix":"10.3390","volume":"62","author":[{"given":"Sungjin","family":"Heo","sequence":"first","affiliation":[{"name":"Asleep Research Institute, Seoul 06159, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1819-0796","authenticated-orcid":false,"given":"Seunghun","family":"Kim","sequence":"additional","affiliation":[{"name":"Asleep Research Institute, Seoul 06159, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9207-7739","authenticated-orcid":false,"given":"Sungeun","family":"Moon","sequence":"additional","affiliation":[{"name":"Asleep Research Institute, Seoul 06159, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujin","family":"Lee","sequence":"additional","affiliation":[{"name":"Asleep Research Institute, Seoul 06159, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongheon","family":"Lee","sequence":"additional","affiliation":[{"name":"Asleep Research Institute, Seoul 06159, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8378-3332","authenticated-orcid":false,"given":"Joonki","family":"Hong","sequence":"additional","affiliation":[{"name":"Asleep Research Institute, Seoul 06159, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoo-Sam","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Jik","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1893-7868","authenticated-orcid":false,"given":"Jung Kyung","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Young","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Whun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Goomiro 173-Beongil, Bundang-gu, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","first-page":"e925","article-title":"Obstructive sleep apnea syndrome (OSAS). Review of the literature","volume":"17","year":"2012","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1164\/rccm.201504-0767ST","article-title":"An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities","volume":"191","author":"Mukherjee","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","article-title":"Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: An observational study","volume":"365","author":"Marin","year":"2005","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1152\/physrev.00043.2008","article-title":"Pathophysiology of sleep apnea","volume":"90","author":"Dempsey","year":"2010","journal-title":"Physiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41392-023-01496-3","article-title":"Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome","volume":"8","author":"Lv","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.5664\/jcsm.27497","article-title":"Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults","volume":"5","author":"Epstein","year":"2009","journal-title":"J. Clin. Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40463-016-0156-0","article-title":"Trends in CPAP adherence over twenty years of data collection: A flattened curve","volume":"45","author":"Rotenberg","year":"2016","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e60769","DOI":"10.2196\/60769","article-title":"Testing a Consumer Wearables Program to Promote the Use of Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea: Protocol for a Pilot Randomized Controlled Trial","volume":"13","author":"Mak","year":"2024","journal-title":"JMIR Res. Protoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1136\/thoraxjnl-2020-214544","article-title":"Night-to-night variability of respiratory events in obstructive sleep apnea: A systematic review and meta-analysis","volume":"75","author":"Roeder","year":"2020","journal-title":"Thorax"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1164\/rccm.201703-0582OC","article-title":"Effect of Telemedicine Education and Telemonitoring on Continuous Positive Airway Pressure Adherence. The Tele-OSA Randomized Trial","volume":"197","author":"Hwang","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1001\/jamaoto.2022.0244","article-title":"Evaluating Prediction Models of Sleep Apnea from Smartphone-Recorded Sleep Breathing Sounds","volume":"148","author":"Cho","year":"2022","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e44818","DOI":"10.2196\/44818","article-title":"Real-Time Detection of Sleep Apnea Based on Breathing Sounds and Prediction Reinforcement Using Home Noises: Algorithm Development and Validation","volume":"25","author":"Le","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1001\/jamaoto.2023.3490","article-title":"In-Home Smartphone-Based Prediction of Obstructive Sleep Apnea in Conjunction with Level 2 Home Polysomnography","volume":"150","author":"Han","year":"2024","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Jun, J.C., Unnikrishnan, D., Schneider, H., Kirkness, J., Schwartz, A.R., Smith, P.L., and Polotsky, V.Y. (2016). Effect of Acute Intermittent CPAP Depressurization during Sleep in Obese Patients. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0146606"},{"key":"ref_15","unstructured":"World Health Organization, Regional Office for the Western Pacific (2000). The Asia-Pacific Perspective: Redefining Obesity and Its Treatment, Health Communications Australia."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1093\/sleep\/30.6.711","article-title":"Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning","volume":"30","author":"Weaver","year":"2007","journal-title":"Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1001\/jama.2013.281250","article-title":"Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: The HIPARCO randomized clinical trial","volume":"310","author":"Capote","year":"2013","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.5664\/jcsm.8406","article-title":"Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea","volume":"16","author":"Epstein","year":"2020","journal-title":"J. Clin. Sleep Med."},{"key":"ref_19","first-page":"104","article-title":"Use of a non-intrusive under-mattress sleep analyzer in monitoring patients at home under Continuous Positive Airway Pressure","volume":"9","author":"Escourrou","year":"2023","journal-title":"ERJ Open Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1008\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:48:10Z","timestamp":1779454090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medicina62061008"],"URL":"https:\/\/doi.org\/10.3390\/medicina62061008","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}