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The effects of different pressure delivery interventions for improving use of continuous positive airway pressure in the treatment of obstructive sleep apnoea

Smith I, Lasserson TJ
Published Online: 
7 October 2009

Obstructive sleep apnoea (OSA) is caused by intermittent airway closure during sleep such that airflow stops despite continued efforts to breathe. Continuous positive airways pressure (CPAP) can be an effective treatment for this condition but requires regular use, and many people cannot tolerate it, or do not use it every night. Attempts to improve compliance with treatment have included changes to the mechanical devices used to deliver airway pressure, such as auto-CPAP, bi-level PAP, expiratory pressure relief and additional humidification. We examined the evidence for these different approaches. None led to large increases in hours of use, though when asked, most participants expressed a preference for the auto-CPAP machine rather than fixed pressure. When bi-level PAP and fixed CPAP were compared, initial patient acceptance was greater for bi-level PAP in one study, but long-term usage in those accepting treatment was similar for both devices. Expiratory pressure relief (C-flexTM) did not show improvement in hours of use and symptom scores. According to the evidence currently available, compliance with positive airway pressure therapy for OSA is similar, irrespective of the mode of delivery (e.g. fixed, auto-titrating or bi-level device).

This record should be cited as: 
Smith I, Lasserson TJ. Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003531. DOI: 10.1002/14651858.CD003531.pub3
Assessed as up to date: 
22 September 2008