Table 7.1Randomized controlled trials of interventions to improve compliance with CPAP use: study characteristics

Study
PMID
InterventionsCPAP Pressure *, (type)Mean Age, yrMale, %Mean BMI, kg/m2Other Patient CharacteristicsCountry (enrollment years)Major quality issues
 Extra Support or Education
Chervin 1997294
9231954
Telephone callsnd (nd)5264ndEither new to CPAP (31%) or continuous CPAP users (69%)US (1995)Different follow-up durations between comparative groups.
Literature
Standard care
Damjanovic 2009174
19129293
Intensive supportAuto and manual (separate)577831Newly diagnosed OSAGermany (nd)Large dropout rate. Assumed non-compliance for dropout patients.
Standard support
Fletcher, 1991296
2024846
Telephone reinforcement about OSA and CPAP useManual (separate)52100Mean IBW = 158%New CPAP usersUS (nd)Inconsistent reporting; primarily relying on self-reported readings for CPAP use
Usual care
Hoy 1999297
10194151
Intensive educational programs and nursing supportManual (separate)589833New CPAP usersUK (nd)
Usual care
Hui 2000298
10807830
Augmented education and supportAuto (separate)459030Newly diagnosed OSAHong Kong (nd)More missing data on objective CPAP use in the intervention group than the control group due to technical problems.
Basic education and support
Wiese 2005299
15716221
Educational videotapend (nd)485338Newly diagnosed OSAUS (nd)More dropouts in the control group than intervention group. Assumed non-compliance for dropout patients.
No intervention
Lewis 2006300
16564210
Extra early supportAuto (separate?)518636New CPAP usersUK (nd)More dropouts in the control group than intervention group.
Usual care
Meurice 2007301
17157557
RP+RHManual (separate)58nd33New CPAP usersFrance (nd)Potential center effects were not controlled fro in the analyses.
RP+SH
SP+RH
SP+SH
Smith 2009303
18829212
Habit-promoting experimental audio intervention: CPAP everydayAuto (nd)635882% >30Newly diagnosed OSA and new CPAP usersUS (nd)Assumed non-compliance for dropout patients.
Placebo control audio- based intervention
 Telehealth or telemonitoring care
DeMolles 2004295
15258478
Telephone-linked communications for CPAPnd (nd)46nd38New CPAP usersUS (nd)How CPAP use data were collected was not described. “Usual care” was not described.
Usual care
Stepnowsky 2007304
17513285
Wireless telemonitoring clinical careAuto (nd)599832Newly diagnosed OSA and new CPAP usersUS (2004–06)Small sample size
Usual care
Taylor 2006305
16565867
Telemedicine supportnd (nd)4569ndNew CPAP usersUS (2002–03)Patients who had difficulties to use telemedicine support were excluded from the analyses.
Usual care
 Behavioral interventions
Richards 2007302
17552379
Cognitive behavioral therapyManual (nd)568630ndAustralia (2005)
Usual care
 Miscellaneous interventions
Bradshaw 2006288
17099012
Oral hypnotic agent (zolpidem), 10 mgnd (both)3810032New CPAP usersUS (2001–03)Patients in the standard care had more severe OSA based on AHI; not blinded.
Placebo pill
Standard care (no zolpidem or placebo pill)
Massie 2003306
12684301
Nasal pillowsManual (both)498236New CPAP usersUS (nd)
Nasal mask
 Different care models
Antic 2009307
19136368
Simplified nurse-led model of careAuto and manual (separate)507435ndAustralia (2004–06)Different CPAP titrations between groups by study design
Usual caremanual (nd)
Holmdahl 2009308
19179111
Simplified nurse-led model of careManual (nd)588535CPAP-treated patients with OSAS in a stable conditionSweden (nd)More patients dropped out in the control group. How CPAP use data were collected was not reported.
Usual care
Palmer 2004309
14725828
A home visit from a specialist nursend (nd)5586ndThe mean duration of CPAP therapy = 2.99 yrUK (2001)Baseline patient characteristics were unclear. Dropout and unusable CPAP use data were excluded form the analyses.
A visit to a consultant led clinic
*

Method for choosing CPAP Pressure: Manual (during sleep study); Auto (determined with AutoCPAP); Algorithm (by an algorithm); nd (no data reported); NA (not applicable, e.g. if AutoCPAP is the intervention). In parentheses: Split (CPAP introduced in a split night study); Separate (CPAP introduced on a separate full night than the diagnostic sleep study).

Method for choosing CPAP Pressure: Manual (during sleep study); Auto (determined with AutoCPAP); Algorithm (by an algorithm); nd (no data reported); NA (not applicable, e.g. if AutoCPAP is the intervention). In parentheses: Split (CPAP introduced in a split night study); Separate (CPAP introduced on a separate full night than the diagnostic sleep study).

Method for choosing CPAP Pressure: Manual (during sleep study); Auto (determined with AutoCPAP); Algorithm (by an algorithm); nd (no data reported); NA (not applicable, e.g. if AutoCPAP is the intervention). In parentheses: Split (CPAP introduced in a split night study); Separate (CPAP introduced on a separate full night than the diagnostic sleep study).

Method for choosing CPAP Pressure: Manual (during sleep study); Auto (determined with AutoCPAP); Algorithm (by an algorithm); nd (no data reported); NA (not applicable, e.g. if AutoCPAP is the intervention). In parentheses: Split (CPAP introduced in a split night study); Separate (CPAP introduced on a separate full night than the diagnostic sleep study).

From: Appendix D, Summary Tables

Cover of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Diagnosis and Treatment of Obstructive Sleep Apnea in Adults [Internet].
Comparative Effectiveness Reviews, No. 32.
Balk EM, Moorthy D, Obadan NO, et al.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.