| Outcomes | No of Participants (studies) Follow up | Quality of the evidence (GRADE) | Relative effect (95 % CI) | Anticipated absolute effects | |
|---|---|---|---|---|---|
| Risk with Control | Risk difference with Increased practical support and encouragement during follow-up + CPAP versus usual care + CPAP (95% CI) | ||||
|
CPAP Device Usage (hours/night) Higher is better |
1501 (14 studies) |
⊕⊝⊝⊝ due to risk of bias, inconsistency, imprecision |
The mean CPAP device usage (hours/night) in the control group was 3.6 |
The mean CPAP device usage (hours/night) in the intervention groups was 0.83 higher (0.45 to 1.22 higher) | |
|
Days PAP used >4 hours at 12 months Higher is better |
23 (1 study) |
⊕⊕⊝⊝ LOW2 due to imprecision | The mean days pap used >4 hours in the control group was 282 days |
The mean days pap used >4 hours at 12 months in the intervention groups was 11 lower (75.76 lower to 53.76 higher) | |
|
Days PAP used >4 hours at 3 months Higher is better |
294 (2 studies) 3 months |
⊕⊕⊕⊕ HIGH | The mean days pap used >4 hours in the control group was 65.8 days |
The mean days pap used >4 hours at 3 months in the intervention groups was 8.06 higher (1.80 to 14.33 higher) | |
|
Mean adherence all days (min per day) at 12 months Higher is better |
23 (1 study) |
⊕⊕⊕⊝ MODERATE2 due to imprecision |
The mean adherence all days (min per day) at 12 months in the control group was 307 |
The mean adherence all days (min per day) at 12 months in the intervention groups was 45 higher (20.99 lower to 110.99 higher) | |
|
CPAP use min/night Higher is better |
327 (1 study) |
⊕⊕⊕⊕ HIGH |
The mean CPAP use min/night in the control groups was 307 |
The mean CPAP use min/night in the intervention groups was 20 higher (1.51 lower to 41.51 higher) | |
| N deemed adherent (≥ four hours/night) |
376 (2 studies) |
⊕⊝⊝⊝ due to risk of bias, imprecision, indirectness | RR 1.19 (1.03 to 1.37) | Moderate | |
| 635 per 1000 |
121 more per 1000 (from 19 more to 235 more) | ||||
| Withdrawals |
1702 (11 studies) |
⊕⊝⊝⊝ due to risk of bias, imprecision, indirectness | RR 1.22 (0.97 to 1.52) | Moderate | |
| 118 per 1000 |
26 more per 1000 (from 4 fewer to 61 more) | ||||
|
Epworth Sleepiness Scale - Comparison Endpoint or Change from Baseline Values - ESS: Endpoint Scores Scale from 0-24 Lower is better |
1527 (15 studies) |
⊕⊕⊝⊝ due to risk of bias, inconsistency |
The mean epworth sleepiness scale - in the control groups was 3.16 |
The mean epworth sleepiness scale - comparison endpoint or change from baseline values - ESS: endpoint scores in the intervention groups was 0.28 lower (0.73 lower to 0.16 higher) | |
|
Quality of Life: Comparison of Values at Endpoint - QoL: FOSQ – Endpoint Scale from 5-20 Higher is better |
109 (3 studies) |
⊕⊕⊝⊝ due to risk of bias, indirectness |
The mean quality of life: FOSQ - in the control groups was 16.1 |
The mean quality of life: comparison of values at endpoint - QOL: FOSQ - endpoint in the intervention groups was 0.55 higher (0.81 lower to 1.9 higher) | |
|
Quality of Life: Comparison of Values at Endpoint - QoL: SAQLI – Endpoint Higher is better |
240 (1 study) |
⊕⊕⊝⊝ due to risk of bias, indirectness |
The mean quality of life: SAQLI in the control groups was 4.6 |
The mean quality of life: comparison of values at endpoint - QOL: SAQLI - endpoint in the intervention groups was 0.5 higher (0.09 lower to 1.09 higher) | |
|
Quality of Life: Comparison of Values at Endpoint - QoL: SF-36 (PH) – Endpoint Scale from 0-100 Higher is better |
334 (3 studies) |
⊕⊝⊝⊝ due to risk of bias, indirectness, imprecision | The mean quality of life: sf-36 (ph) - in the control groups was 46 |
The mean quality of life: comparison of values at endpoint - QOL: sf-36 (ph) - endpoint in the intervention groups was 1.09 higher (0.34 lower to 2.52 higher) | |
|
Quality of Life: Comparison of Change from Baseline Values - QoL: FOSQ - Change from Baseline Higher is better |
39 (1 study) |
⊕⊝⊝⊝ due to risk of bias, indirectness, imprecision |
The mean quality of life: FOSQ - in the control groups was 1.1 |
The mean quality of life: comparison of change from baseline values - QOL: FOSQ - change from baseline in the intervention groups was 0.8 higher (1.25 lower to 2.85 higher) | |
|
Quality of Life: Comparison of Change from Baseline Values - QoL: SF-36 (PH) - Change from Baseline Higher is better |
82 (1 study) |
⊕⊝⊝⊝ due to risk of bias, indirectness, imprecision | The mean quality of life: sf-36 (ph) - in the control groups was 2.9 |
The mean quality of life: comparison of change from baseline values - QOL: sf-36 (ph) - change from baseline in the intervention groups was 0.3 higher (3.1 lower to 3.7 higher) | |
|
Quality of Life: Comparison of Change from Baseline Values - QoL: FOSQ-10 - Change from Baseline Higher is better |
173 (1 study) |
⊕⊝⊝⊝ due to risk of bias, indirectness, imprecision |
The mean quality of life: fosq-10 - in the control groups was −14.2 |
The mean quality of life: comparison of change from baseline values - QOL: fosq-10 - change from baseline in the intervention groups was 3.3 higher (0.1 to 6.5 higher) | |
| diastolic blood pressure |
55 (1 study) |
⊕⊕⊕⊝ MODERATE2 due imprecision | The mean diastolic blood pressure in the control groups was 82.8 |
The mean diastolic blood pressure in the intervention groups was 4.4 lower (9.82 lower to 1.02 higher) | |
| systolic blood pressure |
55 (1 study) |
⊕⊕⊕⊝ MODERATE,2 due imprecision | The mean systolic blood pressure in the control groups was 138.8 |
The mean systolic blood pressure in the intervention groups was 9.3 lower (17.57 to 1.03 lower) | |
|
AHI on treatment - Comparison of Values at Endpoint Lower is better |
411 (5 studies) |
⊕⊝⊝⊝ due to risk of bias, inconsistency, imprecision |
The mean ahi on treatment performed in control group was 4.2 |
The mean ahi on treatment performed in the intervention groups was 0.80 higher (0.66 lower to 2.25 higher) | |
| Mortality (critical outcome) | Not reported | ||||
Downgraded by 1 increment if the majority of the evidence was at high risk of bias and downgraded by 2 increments if the majority of the evidence was at very high risk of bias
Downgraded by one increment if the confidence interval crossed one MID and downgraded by two increments if the confidence interval crossed both MIDs. MID for machine usage (adherence)- 1 hour; Established MIDs for SF-36 physical/mental- 2/3 ; FOSQ- 2 ; ESS −2.5;SAQLI – 2. GRADE default MID (0.5XSD) used for all other continuous outcomes.
Downgraded by 1 or 2 increments for heterogeneity,unexplained by subgroup analysis. Random effect analysis used.
Downgraded by 1 or 2 increments because the majority of the evidence included an indirect or very indirect population respectively
Not sleepy in both groups
From: Adherence
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