Do educational, supportive and/or behavioural interventions increase usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea?

Smith I, Nadig V, Lasserson TJ

Published Online:

July 8, 2009

Continuous positive airway pressure (CPAP) treats obstructive sleep apnoea (OSA) effectively in the majority of people. Despite its efficacy in ameliorating symptoms resulting from OSA, CPAP usage has been reported as 65-80%. This review critically appraises studies involving educational and behavioural interventions and supportive strategies aimed at improving CPAP usage. After reviewing the literature, we have found some evidence that educational interventions and cognitive behavioural therapy increased CPAP usage. Short course education did not have a statistically significant effect on CPAP usage.

Abstract (click to read)

Background:

Although effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) does not meet with universal acceptance by users. Educational, supportive and behavioural interventions may help people with obstructive sleep apnoea recognise the need for regular and continued use of continuous positive airway pressure.

Objectives:

To critically assess strategies that are educational, or supportive, or behavioural in encouraging people who have been prescribed or offered CPAP to use their machines.

Search strategy:

Searches were conducted on the Cochrane Airways Group Sleep Apnoea trials register. Searches are current to September 2008.

Selection criteria:

Randomised parallel group studies which assessed an intervention aimed to inform participants about CPAP or OSA, or to support them in using CPAP or to modify their behaviour in increasing their use of CPAP machines. Studies of any duration were considered.

Data collection and analysis:

Two authors assessed studies to determine their suitability for inclusion in the review. Data were extracted independently and entered in to Review Manager software.

Main results:

Seventeen studies met the review entry criteria (1070 participants). Support/encouragement offered on an ongoing basis led to increased average machine usage (0.59 hours/night (95% CI 0.26 to 0.92), although there was a significant degree of variation between the results of the studies. The effects of these interventions on the likelihood of study withdrawal, symptoms and quality of life were not statistically significant.

Short-course educational intervention was not more successful in improving average machine usage than usual care.

Cognitive behavioural therapy led to a significant improvement in average machine usage in two studies (2.92 hours/night (95% CI 1.93 to 3.92)), and a number needed to treat of 3 (95% CI 2 to 6) for one additional patient to achieve machine usage of six or more hours per night. Overall, In the control groups 85 people out of 100 had failed to comply with CPAP over 4 to 12 weeks, compared to 46 (95% CI 68 to 25) out of 100 for the cognitive behaviour groups.

Authors' conclusions:

There is some evidence that a supportive intervention which encourages people to continue to use their CPAP machines leads to greater levels of CPAP machine usage than control, although the variation across the studies introduces some uncertainty over how consistent this effect is. We could not find evidence that a short-term educational intervention led to improvements in usage. Cognitive behavioural therapy led to the largest increases in average machine usage, partly because more participants were prepared to try out the treatment. Studies generally recruited CPAP naive patients whose sleep apnoea was severe. Trials in patients who have struggled to persist with treatment are required, as there is currently little evidence in this population. This could make a valuable contribution to our understanding of the complex relationship between initial motivation, ongoing perception of benefit and long-term health benefits.

This record should be cited as:

Smith I, Nadig V, Lasserson TJ. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007736. DOI: 10.1002/14651858.CD007736

Assessed as up to date:

September 22, 2008

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Primary Review Group:

Airways Group

Health topics:

Neurology > Sleep disorders > Obstructive sleep apnoea

Lungs & airways > Sleep apnoea

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Do educational, supportive and/or behavioural interventions increase usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea?

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