Cochrane · systematic review · CD003531
Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea
Kennedy, B, Lasserson, TJ, Wozniak, DR, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
AirwaysAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
32
current version
GRADE rated
25
No studies
7
Included studies
NR
No studies 7 · 21.9%Ungraded 0 · 0%Very low 4 · 12.5%Low 14 · 43.8%Moderate 5 · 15.6%High 2 · 6.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Auto‐CPAP compared to fixed CPAP for sleep apnoea in adults
Population: adults with a diagnosis of OSA
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Average machine usage (hours per night) Median Auto‐CPAP vs fixed CPAP | no estimate extracted | 31 studies · 1452 participants | Moderate Downgraded: risk of bias |
Number of participants using machine for 4 or more hours per night Auto‐CPAP vs fixed CPAP | OR 1.16 [0.75, 1.81] | 2 studies · 346 participants | Low Downgraded: risk of bias, imprecision |
Symptoms Auto‐CPAP vs fixed CPAP | no estimate extracted | 25 studies · 1285 participants | Moderate Downgraded: risk of bias |
Withdrawals (parallel group trials/first arm cross‐over trials) Median Auto‐CPAP vs fixed CPAP | OR 0.9 [0.64, 1.27] | 13 studies · 1275 participants | Moderate Downgraded: imprecision |
Quality of life Auto‐CPAP vs fixed CPAP | no estimate extracted | 3 studies · 352 participants | Low Downgraded: risk of bias, imprecision |
AHI measured by number of events/hr Median Auto‐CPAP vs fixed CPAP | no estimate extracted | 26 studies · 1256 participants | High |
Blood pressure (mmHg) Auto‐CPAP vs fixed CPAP | no estimate extracted | 2 studies · 353 participants | Moderate Downgraded: imprecision |
Adverse events (machine tolerability outcomes) Auto‐CPAP vs fixed CPAP | no estimate extracted | 9 studies · 574 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Bi‐PAP compared to fixed CPAP for sleep apnoea in adults
Population: adults with a diagnosis of sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Machine usage (hours/night) Bi‐PAP vs fixed CPAP | no estimate extracted | 4 studies · 268 participants | Low Downgraded: risk of bias, imprecision |
Machine usage assessed by number of participants using machine for 4 or more hours per night ‐ not measured Bi‐PAP vs fixed CPAP | no estimate extracted | NR | No studies |
Symptoms Bi‐PAP vs fixed CPAP | no estimate extracted | 4 studies · 226 participants | Low Downgraded: risk of bias, imprecision |
Withdrawals (parallel group trials/first arm cross‐over trials) Bi‐PAP vs fixed CPAP | OR 0.55 [0.26, 1.17] | 3 studies · 261 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life Bi‐PAP vs fixed CPAP | no estimate extracted | 1 study · 151 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
AHI Bi‐PAP vs fixed CPAP | no estimate extracted | 2 studies · 179 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Blood pressure ‐ not measured Bi‐PAP vs fixed CPAP | no estimate extracted | NR | No studies |
Adverse events (machine tolerability outcomes) Bi‐PAP vs fixed CPAP | no estimate extracted | 5 studies · 239 participants | Very low Downgraded: risk of bias, imprecision |
CPAP with expiratory pressure relief compared to fixed CPAP for adults with obstructive sleep apnoea
Population: adults with a diagnosis of sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Machine usage assessed by hours/night CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | 9 studies · 609 participants | Low Downgraded: risk of bias |
Machine usage assessed by number of participants using machine for 4 or more hours per night ‐ not measured CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | NR | No studies |
Symptoms CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | 6 studies · 515 participants | Moderate Downgraded: risk of bias |
Withdrawals (parallel group trials/first arm cross‐over trials) CPAP with expiratory pressure relief vs fixed CPAP | OR 0.86 [0.48, 1.55] | 2 studies · 298 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | 1 study · 74 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
AHI measured by number of events/hr CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | 5 studies · 342 participants | High |
Blood pressure ‐ not measured CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | NR | No studies |
Adverse events (machine tolerability outcomes) CPAP with expiratory pressure relief vs fixed CPAP | no estimate extracted | 6 studies · 577 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Heated humidification + fixed CPAP compared to fixed CPAP alone in adults with obstructive sleep apnoea
Population: adults with a diagnosis of sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Machine usage assessed by hours per night Heated humidification + fixed CPAP vs fixed CPAP alone | no estimate extracted | 6 studies · 277 participants | Low Downgraded: risk of bias |
Machine usage assessed by number of participants using machine for 4 or more hours per night ‐ not measured Heated humidification + fixed CPAP vs fixed CPAP alone | no estimate extracted | NR | No studies |
Symptoms Heated humidification + fixed CPAP vs fixed CPAP alone | no estimate extracted | 4 studies · 184 participants | Low Downgraded: risk of bias, imprecision |
Withdrawals (parallel group trials/first arm cross‐over trials) Heated humidification + fixed CPAP vs fixed CPAP alone | OR 1 [0.45, 2.24] | 3 studies · 316 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Heated humidification + fixed CPAP vs fixed CPAP alone | no estimate extracted | NR | No studies |
AHI measured by number of events/hr Heated humidification + fixed CPAP vs fixed CPAP alone | no estimate extracted | 1 study · 44 participants | Low Downgraded: risk of bias, imprecision |
Blood pressure ‐ not measured Heated humidification + fixed CPAP vs fixed CPAP alone | no estimate extracted | NR | No studies |
Adverse events (machine tolerability outcomes) assessed as number of participants experiencing a blocked nose Heated humidification + fixed CPAP vs fixed CPAP alone | OR 0.32 [0.16, 0.63] | 2 studies · 147 participants | Low Downgraded: risk of bias, imprecision |