Cochrane · systematic review · CD007736
Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea
Askland, K, Wright, L, Wozniak, DR, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
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
25
current version
GRADE rated
22
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 3 · 12%Very low 10 · 40%Low 5 · 20%Moderate 3 · 12%High 4 · 16%
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
Current version onlyEducational intervention versus control
Population: adults with obstructive sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
1.1 CPAP device usage (hours/night) Educational intervention vs control | no estimate extracted | 10 studies · 1128 participants | Very low Downgraded: risk of bias |
1.2 CPAP device usage (hours/night), sensitivity analysis: adherence in control group < four hours/night Educational intervention vs control | no estimate extracted | 6 studies · 698 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
1.3 N deemed adherent (≥ four hours/night) Educational intervention vs control | OR 2.58 [1.5, 4.44] | 7 studies · 1019 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
1.4 Withdrawal ‐ NO META‐ANALYSIS PERFORMED Educational intervention vs control | no estimate extracted | 9 studies · 1745 participants | Ungraded |
1.5 ESS ‐ Comparison of values at endpoint‐ NO META‐ANALYSIS PERFORMED Educational intervention vs control | no estimate extracted | 3 studies · 355 participants | Ungraded |
Supportive intervention versus control
Population: adults with obstructive sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
2.1 CPAP device usage (hours/night) Supportive intervention vs control | no estimate extracted | 13 studies · 1426 participants | Moderate Downgraded: risk of bias |
2.2 CPAP device usage, sensitivity analysis: adherence in control group < four hours/night Supportive intervention vs control | no estimate extracted | 7 studies · 735 participants | High |
2.3 N deemed adherent (≥ four hours/night) Supportive intervention vs control | OR 1.68 [1.08, 2.6] | 2 studies · 376 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
2.4 Withdrawals Supportive intervention vs control | OR 1.27 [0.97, 1.66] | 11 studies · 1702 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
2.5.2 ESS: Comparison Endpoint or Change from Baseline Values ‐ ESS: Change from Baseline Supportive intervention vs control | no estimate extracted | 5 studies · 470 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
2.7 Quality of lIfe: Comparison of Change from Baseline Values Supportive intervention vs control | no estimate extracted | 3 studies · 294 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Behavioural intervention versus control
Population: adults with obstructive sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
3.1 CPAP Device Usage (hours/night) Behavioural intervention vs control | no estimate extracted | 8 studies · 578 participants | High |
3.2 CPAP Device Usage, sensitivity analysis: adherence in control group < four hours/night Behavioural intervention vs control | no estimate extracted | 6 studies · 525 participants | Moderate |
3.3 N deemed adherent (≥ four hours/night) Behavioural intervention vs control | OR 1.7 [1.2, 2.41] | 6 studies · 549 participants | High |
3.4 Withdrawal Behavioural intervention vs control | OR 0.66 [0.44, 0.98] | 10 studies · 939 participants | High |
3.5 ESS (Endpoint scores) Behavioural intervention vs control | no estimate extracted | 5 studies · 271 participants | Low |
3.6 AHI on treatment ‐ Endpoint Behavioural intervention vs control | no estimate extracted | 2 studies · 89 participants | Very low |
3.7 Quality of Life ‐ Comparison of Values at Endpoint Behavioural intervention vs control | no estimate extracted | 3 studies · 228 participants | Moderate |
3.7.1 Quality of Life ‐ Comparison of Values at Endpoint ‐ QoL: FOSQ ‐ Endpoint Behavioural intervention vs control | no estimate extracted | 2 studies · 200 participants | Ungraded |
Mixed (BEH/EDU/SUP) intervention versus control
Population: adults with obstructive sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
4.1 CPAP Device Usage (hours/night) Mixed (BEH/EDU/SUP) intervention vs control | no estimate extracted | 11 studies · 4509 participants | Very low Downgraded: risk of bias |
4.2 CPAP Device Usage, sensitivity analysis: adherence in control group < four hours/night Mixed (BEH/EDU/SUP) intervention vs control | no estimate extracted | 2 studies · 343 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
4.3 N deemed adherent (≥ four hours/night) Mixed (BEH/EDU/SUP) intervention vs control | OR 1.71 [1.08, 2.72] | 9 studies · 4015 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
4.4 Withdrawal Mixed (BEH/EDU/SUP) intervention vs control | OR 0.61 [0.28, 1.3] | 11 studies · 4956 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
4.5 Quality of LIfe: Comparison of Change from Baseline Values Mixed (BEH/EDU/SUP) intervention vs control | no estimate extracted | 2 studies · 3012 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
4.7 Anxiety Symptom Rating ‐ Comparison of Values at Endpoint Mixed (BEH/EDU/SUP) intervention vs control | no estimate extracted | 3 studies · 333 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Increased practical support and encouragement for adults with sleep apnoea
Population: adults with sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Machine usage Hours per night | no estimate extracted | 13 studies · 803 participants | Low Downgraded: risk of bias, inconsistency |
N deemed adherent (≥ four hours/night) | OR 2.06 [1.22, 3.47] | 4 studies · 268 participants | Low Downgraded: risk of bias, imprecision |
Symptoms of sleepiness Epworth Scale: zero to 24 | no estimate extracted | 8 studies · 501 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life Functional Outcomes of Sleep Questionnaire | no estimate extracted | 2 studies · 70 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Sleep Apnoea Quality of Life Index (SAQLI) | no estimate extracted | 1 study · 108 participants | Low Downgraded: risk of bias, imprecision |
Withdrawals | OR 0.65 [0.44, 0.97] | 12 studies · 903 participants | Moderate Downgraded: risk of bias |
Educational interventions for adults with sleep apnoea
Population: adults with sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Machine usage Hours per night | no estimate extracted | 7 studies · 508 participants | Moderate Downgraded: risk of bias |
N deemed adherent (≥4 hours/night) | OR 1.8 [1.09, 2.95] | 3 studies · 285 participants | Low Downgraded: risk of bias, imprecision |
Symptoms of sleepiness Epworth Scale: 0 to 24 | no estimate extracted | 5 studies · 336 participants | Moderate Downgraded: risk of bias |
Quality of life: Sleep Apnoea Quality of Life Index (SAQLI) | no estimate extracted | 1 study · 89 participants | Very low Downgraded: risk of bias, imprecision |
Withdrawal | OR 0.67 [0.45, 0.98] | 8 studies · 683 participants | Low Downgraded: risk of bias, inconsistency |
Behavioural therapy for adults with sleep apnoea who are using CPAP
Population: adults with sleep apnoea
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Machine usage Hours per night | no estimate extracted | 6 studies · 584 participants | Low Downgraded: risk of bias, inconsistency |
N deemed adherent (≥4 hours/night) | OR 2.23 [1.45, 3.45] | 3 studies · 358 participants | Very low Downgraded: risk of bias, inconsistency |
Symptoms Epworth scores | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Functional Outcomes of Sleep Questionnaire | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision |
Withdrawal | OR 0.85 [0.57, 1.25] | 5 studies · 609 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |