Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment

In the paper

“In these non-RCT cohorts, oronasal interfaces were least often chosen by participants for long-term treatment compared with nasal and intra-nasal interfaces.249,250”

What the sources say

• Disputed

  Table 2 (Patients’ characteristics; page not specified in our copy) reports that oronasal masks were used by 26.2% of patients, versus 11.4% for nasal pillows and 62.4% for nasal masks. Oronasal interfaces were therefore not the least-used type in this observational cohort. The paper reports interface use, not which interface participants chose for long-term treatment. (LLM, conf=0.90)

  Checked by a reasoning model — may be wrong.

  cites [249] Borel JC, Tamisier R, Dias-Domingos S, et al. Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One. 2013;8(5):e64382 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [250] Beecroft J, Zanon S, Lukic D, Hanly P Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest. 2003;124(6):2200–2208 source

In the paper

“current evidence suggests a continuous dose-response relationship between hours of use and therapeutic response.22,23”

What the sources say

• Partly supported

  The Discussion passage (page not provided) reports a dose-response relationship for many, but not all, behavioral measures: it was clear for posttreatment ESS scores but absent for MWT sleep latency. Thus the paper supports a relationship between hours of CPAP use and some therapeutic outcomes, but not a continuous relationship across therapeutic response generally. (LLM, conf=0.87)

  cites [22] Antic NA, Catcheside P, Buchan C, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34(1):111–119 sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion (page not specified in our copy) reports continuous gains in objective and subjective sleepiness with longer nightly CPAP use. It also says functional status appears to gain no further benefit beyond seven hours, so a continuous dose-response relationship does not apply to every therapeutic outcome studied. (LLM, conf=0.86)

  cites [23] Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30(6):711–719 sourceExperimental — accuracy not yet measured

In the paper

“meta-analyses demonstrated clinically significant reductions in the risk ratio for mortality of 0.2 (95% CI: 0.1 to 0.5) and 0.4 (95% CI: 0.2 to 0.7) for heart failure 142,146 and no heart failure participants, 137,139,143,144,147 respectively”

What the sources say

• ?Not checked — no full text of the sourcecites [142] Kasai T, Narui K, Dohi T, et al. Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure. Chest. 2008;133(3):690–696 source
• Partly supported

  The Mortality section (p. 1629) reports fewer deaths among treated heart-failure patients with obstructive sleep apnea than among untreated patients, so this study supplies relevant mortality data. It is an observational study, not a subgroup meta-analysis, and it reports no risk ratio of 0.2 (95% CI 0.1–0.5); its treated-versus-untreated mortality difference was not statistically significant (p = 0.07). (LLM, conf=0.86)

  cites [146] Wang H, Parker JD, Newton GE, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol. 2007;49(15):1625–1631 sourceExperimental — accuracy not yet measured

In the paper

“The first study 167 demonstrated an incremental cost-effectiveness ratio (ICER) of CDN$15,915 per quality-adjusted life year (QALY) with CPAP therapy”

What the sources say

• Partly supported

  The Results report an ICER of $15,915 per QALY gained for CPAP compared with no treatment over a lifetime horizon. The paper specifies that its values are in 2008 U.S. dollars, not Canadian dollars, so the CDN$ designation is unsupported. (LLM, conf=0.94)

  cites [167] Pietzsch JB, Garner A, Cipriano LE, Linehan JH An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep. 2011;34(6):695–709 sourceExperimental — accuracy not yet measured

In the paper

“A meta-analysis combining 2 RCTs measuring sleep-related QOL with FOSQ, 175,176 2 RCTs measuring sleep-related QOL with SAQLI, 178,182 and one RCT 180 measuring both FOSQ and SAQLI demonstrated no clinically significant difference in sleep-related QOL when comparing PAP initiation using home APAP versus an in-laboratory titration”

What the sources say

• Partly supported

  The Three-Month Assessment (p. 2) identifies this as an RCT that measured sleep-related quality of life with FOSQ, and the Results (p. 3) report no statistical difference between home and laboratory titration. The paper measured SF-36, not SAQLI, alongside FOSQ. It reports its own trial, not the cited meta-analysis or a test of clinical significance. (LLM, conf=0.88)

  cites [175] Cross MD, Vennelle M, Engleman HM, et al. Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome. Sleep. 2006;29(11):1451–1455 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [176] Kuna ST, Gurubhagavatula I, Maislin G, et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183(9):1238–1244 source
• ?Not checked — no full text of the sourcecites [178] Mulgrew AT, Fox N, Ayas NT, Ryan CF Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med. 2007;146(3):157–166 source
• ?Not checked — no full text of the sourcecites [182] Hui DS, Ng SS, Tam WWS Home-based approach is non-inferior to hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome. Am J Respir Crit Care Med. 2018;197(9):1233–1234 source
• Supported

  The Analytic Strategy section identifies FOSQ and SAQLI as the trial’s sleep-specific quality-of-life measures. The Discussion reports no between-group differences in patient-reported functional outcomes. This paper supports the cited role as one RCT contributing evidence to the meta-analysis; it does not itself report the meta-analysis. (LLM, conf=0.91)

  cites [180] Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep. 2012;35(6):757–767 source

In the paper

“Despite the greater cost-effectiveness of homebased APAP initiation, 175,177,179 out-of-pocket costs to patients may be lower with either split or whole-night in-laboratory PAP titration due to payor coverage policies in certain instances.”

What the sources say

• Supported

  The citation follows the clause about the greater cost-effectiveness of home-based titration, not the subsequent statement about patients’ out-of-pocket costs. The Discussion (p. 4) reports equal quality of care at lower cost per patient, with Table 4 listing $91.3 for home titration versus $142.2 for hospital titration. The Cost Analysis (p. 2) explicitly excludes patients’ out-of-pocket expenses, so this paper does not establish the subsequent statement about payer coverage. (LLM, conf=0.88)

  cites [175] Cross MD, Vennelle M, Engleman HM, et al. Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome. Sleep. 2006;29(11):1451–1455 source
• Supported

  The citations are attached to the statement that home-based APAP initiation is more cost-effective, not to the subsequent statement about patients’ out-of-pocket costs. The Costs section reports lower direct costs for home APAP titration than for either laboratory method, and the Discussion describes home APAP titration as cost-effective compared with manual titration. (LLM, conf=0.92)

  cites [177] McArdle N, Singh B, Murphy M, et al. Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration. Thorax. 2010;65(7):606–611 source
• ?Not checked — no full text of the sourcecites [179] Planes C, D'Ortho MP, Foucher A, et al. Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP. Sleep. 2003;26(2):156–160 source

In the paper

“some RCTs that selectively recruited non-sleepy participants demonstrated no benefits in BP 63,86,106 or cardiovascular risk reduction 106,108 with CPAP.”

What the sources say

• ?Not checked — no full text of the sourcecites [63] Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med. 2001;134(11):1015–1023 source
• ?Not checked — no full text of the sourcecites [86] Robinson GV, Smith DM, Langford BA, Davies RJ, Stradling JR Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J. 2006;27(6):1229–1235 source
• Partly supported

  The COMMENT conclusion reports no statistically significant reduction in incident hypertension or cardiovascular events with CPAP in patients without daytime sleepiness, supporting the cardiovascular portion of the claim. The trial’s reported outcome was new-onset hypertension, not a demonstrated absence of benefit in blood-pressure levels; the authors also caution that limited power may have prevented detection of a difference. (LLM, conf=0.82)

  cites [106] Barbe F, Duran-Cantolla J, Sanchez-de-la-Torre M, et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;307(20):2161–2168 sourceExperimental — accuracy not yet measured

In the paper

“Despite the lack of improvement in fasting glucose levels, there have been several trials in those without diabetes suggesting CPAP therapy for comorbid OSA may reduce insulin resistance.[170][171][172]”

What the sources say

• Supported

  The Discussion reports that this controlled trial enrolled patients with sleep apnea and impaired glucose tolerance but not overt type 2 diabetes. It found no significant improvement across the full sample, but did find improved insulin resistance in a severe-sleep-apnea subgroup; the paper also describes two earlier studies in patients without diabetes that found improvements in insulin sensitivity. Those qualified findings support the citing sentence’s cautious wording, “may reduce.” (LLM, conf=0.89)

  cites [170] Weinstock TG, Wang X, Rueschman M, et al. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. Sleep. 2012;35(5):617–625 source
• Supported

  The Results report that, in participants with prediabetes and OSA, two weeks of CPAP significantly improved insulin sensitivity compared with placebo, while fasting glucose showed no significant difference between groups. This paper supplies one of the trials supporting the citing sentence; the other citations need not be established by this source alone. (LLM, conf=0.93)

  cites [171] Pamidi S, Wroblewski K, Stepien M, et al. Eight hours of nightly continuous positive airway pressure treatment of obstructive sleep apnea improves glucose metabolism in patients with prediabetes. A randomized controlled trial. Am J Respir Crit Care Med. 2015;192(1):96–105 source
• Supported

  The Discussion (page not available) reports that one week of effective nCPAP significantly increased insulin sensitivity in otherwise healthy males with moderate-to-severe OSA. The study therefore supports the cited sentence as one of the trials suggesting that CPAP may reduce insulin resistance in people without diabetes. (LLM, conf=0.92)

  cites [172] Lam JC, Lam B, Yao TJ, et al. A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. Eur Respir J. 2010;35(1):138–145 source

In the paper

“Two RCTs 175,180 demonstrated no clinically significant difference in general QOL as assessed by the SF-36 mental component summary, physical component summary, and vitality scores when comparing home APAP versus an in-laboratory titration”

What the sources say

• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [175] Cross MD, Vennelle M, Engleman HM, et al. Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome. Sleep. 2006;29(11):1451–1455 sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [180] Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep. 2012;35(6):757–767 sourceExperimental — accuracy not yet measured

In the paper

“A total of 5 studies reported differences in side effects between APAP and CPAP.186,193,194,198,208”

What the sources say

• ?Not checked — no full text of the sourcecites [186] Hukins C Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial. Sleep. 2004;27(8):1512–1517 source
• ?Not checked — no full text of the sourcecites [193] Nussbaumer Y, Bloch KE, Genser T, Thurnheer R Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea. Chest. 2006;129(3):638–643 source
• ?Not checked — no full text of the sourcecites [194] Randerath WJ, Schraeder O, Galetke W, Feldmeyer F, Ruhle KH Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med. 2001;163(3 Pt 1):652–657 source
• Supported

  The Objective compliance section reports significantly higher dry mouth/nose and gum-pain side-effect scores with fixed-CPAP than with auto-CPAP, as well as more pressure discomfort. This supports citing the study as one that reported differences in side effects; the count of five studies comes from the citing paper’s grouping of references, not from this individual study. (LLM, conf=0.93)

  cites [198] To KW, Chan WC, Choo KL, Lam WK, Wong KK, Hui DS A randomized cross-over study of auto-continuous positive airway pressure versus fixed-continuous positive airway pressure in patients with obstructive sleep apnoea. Respirology. 2008;13(1):79–86 source
• ?Not checked — no full text of the sourcecites [208] Massie CA, Hart RW Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest. 2003;123(4):1112–1118 source

In the paper

“In addition, a meta-analysis of 6 of these studies demonstrated no clinically significant difference in percent of nights PAP was used.186,189,191,192,206,208”

What the sources say

• ?Not checked — no full text of the sourcecites [186] Hukins C Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial. Sleep. 2004;27(8):1512–1517 source
• ?Not checked — no full text of the sourcecites [189] Marrone O, Resta O, Salvaggio A, Giliberti T, Stefano A, Insalaco G Preference for fixed or automatic CPAP in patients with obstructive sleep apnea syndrome. Sleep Med. 2004;5(3):247–251 source
• ?Not checked — no full text of the sourcecites [191] Nolan GM, Doherty LS, Mc Nicholas WT Auto-adjusting versus fixed positive pressure therapy in mild to moderate obstructive sleep apnoea. Sleep. 2007;30(2):189–194 source
• ?Not checked — no full text of the sourcecites [192] Noseda A, Kempenaers C, Kerkhofs M, Braun S, Linkowski P, Jann E Constant vs auto-continuous positive airway pressure in patients with sleep apnea hypopnea syndrome and a high variability in pressure requirement. Chest. 2004;126(1):31–37 source
• Supported

  Table 2 (Home Use) reports days used as 98.3% with auto-adjusting CPAP and 96.2% with conventional CPAP. The Discussion states there was no difference in use between the two periods. This paper supplies one of the cited study comparisons; the meta-analysis is the citing authors’ synthesis, not a claim that this paper conducted it. (LLM, conf=0.86)

  cites [206] Teschler H, Wessendorf TE, Farhat AA, Konietzko N, Berthon-Jones M Two months auto-adjusting versus conventional nCPAP for obstructive sleep apnoea syndrome. Eur Respir J. 2000;15(6):990–995 source
• ?Not checked — no full text of the sourcecites [208] Massie CA, Hart RW Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest. 2003;123(4):1112–1118 source

In the paper

“A meta-analysis of 3 RCTs 214,221,229 demonstrated that the mean estimate of the impact of an education intervention on obtaining PAP usage > 4 h/night was clinically significant, with an odds ratio of 1.2 (95% CI: 0.8 to 1.9)”

What the sources say

• ?Not checked — no full text of the sourcecites [214] Aloia MS, Smith K, Arnedt JT, et al. Brief behavioral therapies reduce early positive airway pressure discontinuation rates in sleep apnea syndrome: preliminary findings. Behav Sleep Med. 2007;5(2):89–104 source
• ?Not checked — no full text of the sourcecites [221] Wang W, He G, Wang M, Liu L, Tang H Effects of patient education and progressive muscle relaxation alone or combined on adherence to continuous positive airway pressure treatment in obstructive sleep apnea patients. Sleep Breath. 2012;16(4):1049–1057 source
• Supported

  The citation identifies this paper as one of the RCTs included in the citing authors’ meta-analysis, not as the source of the pooled odds ratio. The Discussion identifies it as a randomised trial of an educational video, and Table 4 reports CPAP use above four hours per night. (LLM, conf=0.88)

  cites [229] Guralnick AS, Balachandran JS, Szutenbach S, et al. Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial. Thorax. 2017;72(12):1132–1139 source

In the paper

“The study using BPAP with a modified pressure profile as a rescue therapy in participants nonadherent to CPAP after ≥ 2 weeks demonstrated a clinically significant increase in the point estimate adherence of 0.8 h/night (95% CI: -0.03 to 1.6 h/night) in the BPAP compared to the CPAP group, although the precision was very low.209”

What the sources say

• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [209] Ballard RD, Gay PC, Strollo PJ Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med. 2007;3(7):706–712 sourceExperimental — accuracy not yet measured

In the paper

“Neither study 209,210 demonstrated a clinically significant difference in QOL between BPAP and CPAP as assessed by the FOSQ”

What the sources say

• Partly supported

  The Phase 2 and Discussion passages report FOSQ measurements in the CPAP and BiFlex groups, but do not establish whether the between-group difference was clinically significant. The Discussion says FOSQ scores increased significantly only within the BiFlex group and explicitly cautions that standard bilevel PAP was not studied. Thus this paper cannot support the claim as stated for BPAP versus CPAP; the other cited study is outside this verdict. (LLM, conf=0.83)

  cites [209] Ballard RD, Gay PC, Strollo PJ Interventions to improve compliance in sleep apnea patients previously non-compliant with continuous positive airway pressure. J Clin Sleep Med. 2007;3(7):706–712 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [210] Gay PC, Herold DL, Olson EJ A randomized, double-blind clinical trial comparing continuous positive airway pressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome. Sleep. 2003;26(7):864–869 source

In the paper

“In this study, no clinically significant increase in QOL was observed with the telemonitoring guided intervention (see supplemental material, Table S10).232”

What the sources say

• Partly supported

  The Methods (Measures; page unavailable) identify the Functional Outcomes of Sleep Questionnaire as the study’s quality-of-life measure. The Results (Outcomes, Table 6; page unavailable) report no statistically significant difference between telemonitored and usual care groups on that measure. The paper does not assess whether the change was clinically significant, so its statistical finding does not fully support that wording. (LLM, conf=0.82)

  cites [232] Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. J Med Internet Res. 2007;9(2):e14 sourceExperimental — accuracy not yet measured

In the paper

“A total of 5 RCTs were identified that evaluated the use of remote monitoring of PAP variables to trigger early interventions versus no such system as an adjunct to PAP therapy for the treatment of adults with OSA.228,[232][233][234][235]”

What the sources say

• Supported

  This paper is one of the RCTs identified in the citing sentence, not a source for the total count of five. Its Abstract (Design, Patients, and Interventions) describes adults with OSA randomized to standard PAP care or PAP with remote monitoring of adherence, air leak, and residual AHI, with telephone contact when the monitored data showed problems. (LLM, conf=0.92)

  cites [228] Fox N, Hirsch-Allen AJ, Goodfellow E, et al. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep. 2012;35(4):477–481 source
• Supported

  The Methods (Design) identify this paper as a randomized trial comparing telemonitored clinical care with usual clinical care in newly diagnosed OSA patients. The Methods (TCC Parameters and Thresholds; Clinical Pathways) describe remote review of PAP data and corrective action when parameters fell outside normal ranges. This paper supports its identification as one of the cited trials; it does not itself establish the citing paper’s total of five trials. (LLM, conf=0.91)

  cites [232] Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. J Med Internet Res. 2007;9(2):e14 source
• ?Not checked — no full text of the sourcecites [233] Hoet F, Libert W, Sanida C, Van den Broecke S, Bruyneel AV, Bruyneel M Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial. Sleep Med. 2017;39 77–83 source

In the paper

“Despite this, 63% of those in the telemonitoring arm placed a high or very high value on the usefulness of the telemonitoring assessment.235”

What the sources say

• Partly supported

  The Results and Discussion (page unavailable) say that patients in the telemonitoring arm generally valued the programme positively, including its usefulness. Our copy does not give the claimed 63% or the “high or very high” rating; Table 3’s data rows are absent from the indexed text. (LLM, conf=0.82)

  cites [235] Turino C, de Batlle J, Woehrle H, et al. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J. 2017;49(2): sourceExperimental — accuracy not yet measured

In the paper

“A total of 7 RCTs investigated the use of modified pressure profile PAP to improve clinical outcomes and reduce side effects.188,[236][237][238][239][240][241]”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [188] Kushida CA, Berry RB, Blau A, et al. Positive airway pressure initiation: a randomized controlled trial to assess the impact of therapy mode and titration process on efficacy, adherence, and outcomes. Sleep. 2011;34(8):1083–1092
• Supported

  The study description (p. 1) identifies this paper as a randomized trial comparing modified-pressure C-Flex with CPAP and measuring sleepiness, vigilance, quality of life, and treatment comfort. Materials and Methods (p. 2) also describes a questionnaire assessing treatment side effects. The citation identifies one of the seven RCTs; it does not attribute the count of seven to this paper or claim that C-Flex succeeded in reducing side effects. (LLM, conf=0.91)

  cites [236] Bakker J, Campbell A, Neill A Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep. 2010;33(4):523–529 source
• Supported

  The Methods describe a randomized, single-blind crossover trial comparing APAP with two modified pressure-profile modes, C-Flex and A-Flex. It assessed sleepiness, sleep quality, quality of life, and treatment-related symptoms, so this paper fits as one of the cited RCTs; it does not itself establish the citing document’s total of seven. (LLM, conf=0.88)

  cites [237] Chihara Y, Tsuboi T, Hitomi T, et al. Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP. Sleep. 2013;36(2):229–236 source

In the paper

“A meta-analysis of 5 RCTs 188,236-239 demonstrated no clinically significant difference in self-reported sleepiness between participants on modified pressure profile PAP compared to standard PAP (see supplemental material, Figure S86).”

What the sources say

• ?Not checked — no full text of the sourcecites [188] Kushida CA, Berry RB, Blau A, et al. Positive airway pressure initiation: a randomized controlled trial to assess the impact of therapy mode and titration process on efficacy, adherence, and outcomes. Sleep. 2011;34(8):1083–1092 source
• Partly supported

  The Results (p. 4) report no significant difference between C-Flex and CPAP on post-treatment questionnaires, which assessed subjective sleepiness. This paper is one RCT, not the five-trial meta-analysis, and it does not establish the pooled finding or whether the pooled difference was clinically significant. (LLM, conf=0.86)

  cites [236] Bakker J, Campbell A, Neill A Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep. 2010;33(4):523–529 sourceExperimental — accuracy not yet measured
• Supported

  The Methods describe a randomized trial comparing standard APAP with modified-pressure C-Flex and A-Flex PAP, with self-reported sleepiness measured by the Epworth Sleepiness Scale. The Results report no statistically significant difference in ESS changes among the three groups. This paper supports its role as one of the cited RCTs; it does not itself report the citing authors’ five-trial meta-analysis or assess clinical significance. (LLM, conf=0.86)

  cites [237] Chihara Y, Tsuboi T, Hitomi T, et al. Flexible positive airway pressure improves treatment adherence compared with auto-adjusting PAP. Sleep. 2013;36(2):229–236 source
• ?Not checked — no full text of the sourcecites [238] Marshall NS, Neill AM, Campbell AJ Randomised trial of compliance with flexible (C-Flex) and standard continuous positive airway pressure for severe obstructive sleep apnea. Sleep Breath. 2008;12(4):393–396 source
• ?Not checked — no full text of the sourcecites [239] Pepin JL, Muir JF, Gentina T, et al. Pressure reduction during exhalation in sleep apnea patients treated by continuous positive airway pressure. Chest. 2009;136(2):490–497 source

In the paper

“Patient satisfaction with telemonitoring guided adherence interventions was assessed in two of the reviewed studies, with discrepant findings.232,235”

What the sources say

• Supported

  The Methods > Measures section (page not provided) says patient satisfaction was assessed by questionnaire. The Results > Patient Satisfaction section (page not provided) reports that both the telemonitored and usual-care groups were highly satisfied, with no difference between them. This confirms the cited paper as one of the studies assessing satisfaction; the comparison across two studies is not attributed to this paper alone. (LLM, conf=0.89)

  cites [232] Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. J Med Internet Res. 2007;9(2):e14 source
• Supported

  The Results report that this study assessed patient satisfaction at three months and found significantly lower overall satisfaction with telemedicine than with standard care. This supports the paper’s role as one of the two studies cited; the other study’s finding is not attributed to this source alone. (LLM, conf=0.90)

  cites [235] Turino C, de Batlle J, Woehrle H, et al. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J. 2017;49(2): source

In the paper

“The meta-analysis demonstrated no clinically significant difference in self-reported sleepiness between the interfaces as assessed with the ESS (see supplemental material, Figure S98).”

What the sources say

• Partly supported

  The Randomised Trial section confirms that this paper compared nose and face masks and measured sleepiness with the Epworth score. It reports a lower score with the nose mask (8.2 versus 9.8, p<0.01). This paper is one trial, not a meta-analysis of two RCTs, and it does not establish the claimed pooled result or assess whether the difference was clinically significant. (LLM, conf=0.86)

  cites [244] Mortimore IL, Whittle AT, Douglas NJ Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax. 1998;53(4):290–292 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [248] Rowland S, Aiyappan V, Hennessy C, et al. Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med. 2018;14(1):101–108 source

In the paper

“The efficacy of oronasal compared with nasal interfaces for improving adherence was evaluated in meta-analyses of 3 cross-over RCTs of 3 to 4 weeks duration, 244,245,248 which demonstrated a clinically significant improvement in adherence of 0.6 h/night (95% CI: -0.2 to 1.3 h/night) with nasal interface compared with oronasal interface (see supplemental material, Figure S96).”

• Also stated in: § Adherence · boosted

  “The meta-analyses demonstrated clinically significant improvements in adherence in adults with OSA with nasal interfaces compared to oronasal interfaces.”

What the sources say

• Partly supported

  The Abstract and RANDOMISED TRIAL section report higher nightly CPAP use with a nose mask than with a face mask in this four-week crossover trial. This paper reports a mean difference of 1.0 h/night (95% CI 0.3 to 1.8), not the cited pooled estimate of 0.6 h/night (95% CI −0.2 to 1.3) from three RCTs. Page numbers are not provided in the supplied passages. (LLM, conf=0.88)

  cites [244] Mortimore IL, Whittle AT, Douglas NJ Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax. 1998;53(4):290–292 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [245] Ebben MR, Narizhnaya M, Segal AZ, Barone D, Krieger AC A randomised controlled trial on the effect of mask choice on residual respiratory events with continuous positive airway pressure treatment. Sleep Med. 2014;15(6):619–624 source
• ?Not checked — no full text of the sourcecites [248] Rowland S, Aiyappan V, Hennessy C, et al. Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med. 2018;14(1):101–108 source

In the paper

“This also demonstrated a clinically significant difference in adherence of 0.7 h/night (95% CI: 0.2 to 1.2 h/night) in favor of nasal interfaces (see supplemental material, Figure S97).”

What the sources say

• Partly supported

  The Discussion and Conclusions report that nasal-mask users were more adherent than oronasal-mask users in this prospective cohort. The paper is not a meta-analysis of three nonrandomized studies and does not report the attributed pooled difference of 0.7 h/night or its 95% CI of 0.2–1.2 h/night. (LLM, conf=0.87)

  cites [249] Borel JC, Tamisier R, Dias-Domingos S, et al. Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One. 2013;8(5):e64382 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [250] Beecroft J, Zanon S, Lukic D, Hanly P Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest. 2003;124(6):2200–2208 source
• ?Not checked — no full text of the sourcecites [251] Bachour A, Vitikainen P, Virkkula P, Maasilta P CPAP interface: satisfaction and side effects. Sleep Breath. 2013;17(2):667–672 source

In the paper

“One study 236 reporting global QOL using SF-36 MCS, PCS, and vitality scores found no significant difference in any of these measures.”

What the sources say

• Partly supported

  The Materials and Methods (p. 2) specify SF-36's eight subscales as outcomes, and the Results (p. 4) report no significant posttreatment questionnaire-score differences between C-Flex and CPAP; the table on p. 5 includes vitality. Our copy does not report SF-36 MCS or PCS scores, so it does not establish the claim for those two measures. (LLM, conf=0.88)

  cites [236] Bakker J, Campbell A, Neill A Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep. 2010;33(4):523–529 sourceExperimental — accuracy not yet measured

In the paper

“In a multivariate analysis, PAP nonadherence in this cohort was independently associated with use of the oronasal interface.249”

What the sources say

• Supported

  The section ‘Factors Associated with Risk of CPAP Non-adherence in Multivariate Analysis’ states that interface type—oronasal mask compared with nasal mask—was associated with a higher risk of non-adherence in the multivariable model. The Discussion describes interface type as independently associated with that risk. (LLM, conf=0.94)

  cites [249] Borel JC, Tamisier R, Dias-Domingos S, et al. Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One. 2013;8(5):e64382 source

In the paper

“In one cross-over RCT, 244 19 of 20 participants rated the nasal interface as more comfortable.”

What the sources say

• Supported

  The Randomised Trial section describes 20 patients assigned to four weeks each of nose-mask and face-mask CPAP. The Abstract reports that 19 of 20 rated nose masks more comfortable. (LLM, conf=0.95)

  cites [244] Mortimore IL, Whittle AT, Douglas NJ Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax. 1998;53(4):290–292 source

In the paper

“In the non-RCTs, oral interfaces were associated with significantly more upper airway dryness and”

What the sources say

• Partly supported

  The Figure 3 caption (section labeled Conclusions; page unavailable) reports significantly more dry mouth with oronasal than nasal masks (p<0.0001), consistent with one part of the claim in this observational study. It does not establish the comparison for oral-only interfaces, and no passage found reports rainout or condensation. (LLM, conf=0.85)

  cites [249] Borel JC, Tamisier R, Dias-Domingos S, et al. Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One. 2013;8(5):e64382 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [250] Beecroft J, Zanon S, Lukic D, Hanly P Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest. 2003;124(6):2200–2208 source

In the paper

“A total of 9 RCTs were identified that evaluated the use of PAP with humidification versus PAP without humidification to improve one or more of the following outcomes: adherence to PAP therapy, sleepiness, QOL, or PAP-related side effects including nasal discharge, nasal congestion, dry nose, epistaxis, and dry mouth/throat.[258][259][260][261][262][263][264][265][266]”

What the sources say

• ?Not checked — no full text of the sourcecites [258] Mador MJ, Krauza M, Pervez A, Pierce D, Braun M Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure. Chest. 2005;128(4):2151–2158 source
• ?Not checked — no full text of the sourcecites [259] Massie CA, Hart RW, Peralez K, Richards GN Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest. 1999;116(2):403–408 source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [260] Neill AM, Wai HS, Bannan SP, Beasley CR, Weatherall M, Campbell AJ Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J. 2003;22(2):258–262 source

In the paper

“However, this study reported no clinically significant differences in cough or sinus infection.260”

What the sources say

• Partly supported

  Table 3 reports identical sinus-infection frequencies in the two treatment arms (14% each) and a nonsignificant difference in cough (31% versus 24%; p=0.48). The Discussion says individual symptom differences did not reach statistical significance, but it does not establish that a clinically meaningful difference in cough was absent. (LLM, conf=0.82)

  cites [260] Neill AM, Wai HS, Bannan SP, Beasley CR, Weatherall M, Campbell AJ Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J. 2003;22(2):258–262 sourceExperimental — accuracy not yet measured

In the paper

“Recent data suggest that the blood pressure reduction reported with APAP may not be as robust with CPAP”

What the sources say

• ?Not checked — no full text of the sourcecites [156] Patruno V, Aiolfi S, Costantino G, et al. Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest. 2007;131(5):1393–1399 source
• Supported

  The Discussion reports that fixed-pressure CPAP reduced 24-hour diastolic blood pressure more than auto-adjusting CPAP, although the trial found no significant difference in its primary outcome, office systolic blood pressure. The Conclusions and perspectives section repeats both findings. Together, they support the claim’s cautious wording that APAP’s blood-pressure effect may be less robust. (LLM, conf=0.90)

  cites [157] Pepin JL, Tamisier R, Baguet JP, et al. Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial. Thorax. 2016;71(8):726–733 source

In the paper

“Clinically significant reductions in daytime SBP and DBP of -2.8 mmHg (95% CI: -4.3 to -1.2 mmHg) and -2.0 mmHg (95% CI: -3.0 to -0.9 mmHg), respectively were observed”

In the paper

“nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity”

In the paper

“PAP therapy was also associated with clinically significant reductions in 24-hour SBP and DBP of -2.5 mmHg [95% CI: -4.3 to -0.8 mmHg] and -2.2 mmHg [95% CI: -3.4 to -1.0 mmHg] with PAP therapy, respectively”

In the paper

“clinically significant reductions in nighttime SBP and DBP (-3.3 mmHg [95% CI: -6.1 to -0.4 mmHg] and -2.2 mmHg [95% CI: -4.4 to 0.0 mmHg], respectively), daytime DBP (-1.1 mmHg [95% CI: -3.4 to +1.1 mmHg]), and 24-h SBP and DBP, (-2.2 mmHg [95% CI: -5.1 to +0.8 mmHg], and -2.1 mmHg [95% CI: -4.1 to 0.0 mmHg], respectively) with CPAP therapy but not a clinically significant reduction in daytime S”

In the paper

“In addition, the initiation of PAP in the home demonstrated equivalent effects on patient outcomes when compared to an in-laboratory titration approach.”

In the paper

“Clinically significant reductions in daytime SBP and DBP of -2.8 mmHg (95% CI: -4.3 to -1.2 mmHg) and -2.0 mmHg (95% CI: -3.0 to -0.9 mmHg), respectively were observed”

In the paper

“clinically significant reductions in nighttime SBP and DBP (-3.3 mmHg [95% CI: -6.1 to -0.4 mmHg] and -2.2 mmHg [95% CI: -4.4 to 0.0 mmHg], respectively), daytime DBP (-1.1 mmHg [95% CI: -3.4 to +1.1 mmHg]), and 24-h SBP and DBP, (-2.2 mmHg [95% CI: -5.1 to +0.8 mmHg], and -2.1 mmHg [95% CI: -4.1 to 0.0 mmHg], respectively) with CPAP therapy but not a clinically significant reduction in daytime S”

In the paper

“PAP therapy was also associated with a clinically significant reduction in 24-hour SBP and DBP of -1.5 mmHg (95% CI: -2.3 to -0.7 mmHg) and -1.6 mmHg (95% CI: -2.2 to -0.9 mmHg), respectively”

In the paper

“Furthermore, data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions.”

In the paper

“heated humidification compared to no humidification reduces some continuous PAP-related side effects”

In the paper

“but not a clinically significant reduction in daytime SBP”

In the paper

“In contrast, a meta-analysis of 7 RCTs 63,64,69,70,82,85,91 using the MSLT to assess objective sleepiness demonstrated no clinically significant difference in sleep latency with the use of PAP”

In the paper

“nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity”

In the paper

“Meta-analyses of RCTs reporting on QOL using the SF-36 physical component summary score, 63,64,71,76,78,83,87,90,116,150,151 the mental component summary score, 36,63,64,71,76,78,83,87,90,116,150,151 and the vitality score 36,64,71,78,83,87,150,151 demonstrated no clinically significant improvement in QOL using PAP.”

In the paper

“Clinically significant reductions in daytime SBP and DBP of -2.7 mmHg [95% CI: -4.9 to -0.5 mmHg], and -2.4 mmHg [95% CI: -3.9 to -0.9] respectively, were observed”

In the paper

“A meta-analysis of 11 RCTs 34,61,65,66,74,78,82,84,90,92,93 demonstrated a clinically significant mean difference in OSA severity of -23 events/h (95% CI: -29 to -18 events/h) with PAP”

In the paper

“Meta-analyses demonstrated the mean estimate of the effect of PAP therapy were clinically significant reductions in nighttime SBP and DBP (-3.3 mmHg [95% CI: -6.1 to -0.4 mmHg] and -2.2 mmHg [95% CI: -4.4 to 0.0 mmHg], respectively)”

In the paper

“PAP therapy was also associated with a clinically significant reduction in 24-hour SBP and DBP of -1.5 mmHg (95% CI: -2.3 to -0.7 mmHg) and -1.6 mmHg (95% CI: -2.2 to -0.9 mmHg), respectively”

In the paper

“The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.”

In the paper

“Meta-analyses demonstrated clinically significant reductions in nighttime SBP and DBP of -3.9 mmHg [95% CI: -6.5 to -1.4 mmHg] and -3.0 mmHg [95% CI: -5.3 to -0.8 mmHg], respectively”

In the paper

“PAP therapy was also associated with clinically significant reductions in 24-hour SBP and DBP of -2.5 mmHg [95% CI: -4.3 to -0.8 mmHg] and -2.2 mmHg [95% CI: -3.4 to -1.0 mmHg] with PAP therapy, respectively”

In the paper

“meta-analysis demonstrated that PAP therapy was associated with a clinically significant reduction in nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP) of -4.2 mmHg (95% CI: -6.0 to -2.5 mmHg), and -2.3 mmHg (95% CI: -3.7 to -0.9 mmHg), respectively”

In the paper

“Meta-analyses demonstrated the mean estimate of the effect of PAP therapy were clinically significant reductions in nighttime SBP and DBP (-3.3 mmHg [95% CI: -6.1 to -0.4 mmHg] and -2.2 mmHg [95% CI: -4.4 to 0.0 mmHg], respectively)”

In the paper

“pressure profile PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.”

In the paper

“meta-analysis demonstrated that PAP therapy was associated with a clinically significant reduction in nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP) of -4.2 mmHg (95% CI: -6.0 to -2.5 mmHg), and -2.3 mmHg (95% CI: -3.7 to -0.9 mmHg), respectively”

In the paper

“The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.”

In the paper

“A meta-analysis of 7 RCTs using the MWT or OSLER sleep latency to assess objective wakefulness demonstrated a clinically significant SMD in objective sleepiness of 0.5 (95% CI: 0.2 to 0.8) with the use of PAP 65,71,73,76,77,81,89”

In the paper

“A metaanalysis of 8 RCTs 34,63,65,72,[82][83][84]90 reporting on FOSQ and 5 RCTs 36,78,81,87,89 reporting on SAQLI demonstrated a clinically significant SMD of 0.3 (95% CI: 0.1 to 0.5).”

In the paper

“Clinically significant reductions in daytime SBP and DBP of -2.7 mmHg [95% CI: -4.9 to -0.5 mmHg], and -2.4 mmHg [95% CI: -3.9 to -0.9] respectively, were observed”

In the paper

“A meta-analysis of 38 RCTs 34,106,112,[114][115][116]150,153 demonstrated a clinically significant reduction in self-reported sleepiness of -2.4 points in the ESS score (95% CI: -2.8 to -1.9 points) in participants on PAP compared to controls”

In the paper

“Meta-analyses demonstrated clinically significant reductions in nighttime SBP and DBP of -3.9 mmHg [95% CI: -6.5 to -1.4 mmHg] and -3.0 mmHg [95% CI: -5.3 to -0.8 mmHg], respectively”

In the paper

“clinically significant reductions in nighttime SBP and DBP (-3.3 mmHg [95% CI: -6.1 to -0.4 mmHg] and -2.2 mmHg [95% CI: -4.4 to 0.0 mmHg], respectively), daytime DBP (-1.1 mmHg [95% CI: -3.4 to +1.1 mmHg]), and 24-h SBP and DBP, (-2.2 mmHg [95% CI: -5.1 to +0.8 mmHg], and -2.1 mmHg [95% CI: -4.1 to 0.0 mmHg], respectively) with CPAP therapy but not a clinically significant reduction in daytime S”

In the paper

“a meta-analysis demonstrated a clinically significant reduction in 24-hour mean BP of -2.6 mmHg (95% CI: -3.9 to -1.4 mmHg) with PAP therapy”

In the paper

“Meta-analysis of 11 non-RCTs 133,134,136-141,143-145 demonstrated a clinically significant reduction in cardiovascular events with a risk ratio of 0.5 (95% CI: 0.3 to 0.7) with the use of PAP”

In the paper

“A meta-analysis of these studies did not demonstrate a significant reduction in hospitalizations associated with PAP therapy compared with control conditions”

In the paper

“meta-analyses demonstrated clinically significant reductions in the risk ratio for mortality of 0.2 (95% CI: 0.1 to 0.5) and 0.4 (95% CI: 0.2 to 0.7) for heart failure 142,146 and no heart failure participants, 137,139,143,144,147 respectively”

What the sources say

• ?Not checked — no full text of the sourcecites [137] Capodanno D, Milazzo G, Cumbo M, et al. Positive airway pressure in patients with coronary artery disease and obstructive sleep apnea syndrome. J Cardiovasc Med (Hagerstown). 2014;15(5):402–406 source
• ?Not checked — no full text of the sourcecites [139] Doherty LS, Kiely JL, Swan V, McNicholas WT Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest. 2005;127(6):2076–2084 source
• ?Not checked — no full text of the sourcecites [143] Marin JM, Carrizo SJ, Vicente E, Agusti AG Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–1053 source

In the paper

“The meta-analysis also did not demonstrate a clinically significant reduction in the rate of cardiovascular events occurring with the use of PAP”

In the paper

“Meta-analysis of all participants in these studies showed no clinically significant improvement in LVEF.”

In the paper

“meta-analysis demonstrated a clinically significant reduction in 24-hour mean BP of -2.2 mmHg [95%CI: -3.6 to -0.7 mmHg]”

In the paper

“another study 168 performed for the National Institute of Health and Clinical Excellence (NICE) in the United Kingdom demonstrated an ICER for CPAP therapy compared to dental devices or lifestyle advice that ranged from £4,413-£20,585 depending on the OSA severity.”

What the sources say

• ?Not checked — no full text of the sourcecites [168] Weatherly HL, Griffin SC, Mc Daid C, et al. An economic analysis of continuous positive airway pressure for the treatment of obstructive sleep apnea-hypopnea syndrome. Int J Technol Assess Health Care. 2009;25(1):26–34 source

In the paper

“All of the trials individually failed to demonstrate a clinically significant reduction in fasting glucose with PAP”

In the paper

“in general, PAP adherence was lower in the RCTs than in the nonrandomized studies.”

In the paper

“a meta-analysis of the 3 RCTs that were conducted in participants without heart failure demonstrated no clinically significant improvement in LVEF.”

In the paper

“A meta-analysis of these studies demonstrated a clinically significant reduction in risk with a risk ratio of 0.40 (95% CI: 0.24 to 0.69).”

In the paper

“The largest trial to date showed no clinically significant impact of CPAP therapy on secondary prevention in adults with established cardiovascular disease.”

What the sources say

• ?Not checked — no full text of the sourcecites [116] McEvoy RD, Antic NA, Heeley E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–931 source

In the paper

“Meta-analyses of RCTs did not demonstrate a clinically significant reduction in obstacles hit or percent obstacles hit using a driving simulator”

In the paper

“The metaanalysis did not demonstrate a clinically significant reduction in all-cause mortality with the use of PAP”

In the paper

“However, one study demonstrated a clinically significant reduction in 24-hour DBP of -1.4 mmHg [95% CI: -3.2 to 0.4 mmHg] with PAP therapy.”

What the sources say

• ?Not checked — no full text of the sourcecites [72] Faccenda JF, Mackay TW, Boon NA, Douglas NJ Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med. 2001;163(2):344–348 source

In the paper

“The largest trial to date showed no clinically significant impact of CPAP therapy on mortality in adults with established cardiovascular disease.”

What the sources say

• ?Not checked — no full text of the sourcecites [116] McEvoy RD, Antic NA, Heeley E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–931 source

In the paper

“The meta-analysis demonstrated no clinically significant difference in PAP adherence when comparing treatment initiation using home APAP versus in-laboratory titration”

In the paper

“Meta-analyses of the 10 non-randomized studies 118,119,121-123,125-128,132 comparing participants with OSA before and after CPAP treatment demonstrated a mean crash rate risk ratio of 0.3 (95% CI: 0.2 to 0.4) (see supplemental material, Figure S51), which was considered to be clinically significant.”

In the paper

“The meta-analysis demonstrated no clinically significant difference in residual OSA severity (see supplemental material, Figure S58) when PAP was initiated using home APAP compared to in-laboratory titration.”

In the paper

“Meta-analyses of the HADS anxiety scale and HADS depression scale scores demonstrated no clinically significant improvements in mood using CPAP”

In the paper

“Meta-analyses demonstrated no clinically significant reduction in daytime or nighttime SBP and DBP”

In the paper

“When limited to participants with heart failure, a meta-analysis of 5 RCTs demonstrated no clinically significant improvement in LVEF.”

In the paper

“The meta-analyses demonstrated no clinically significant differences between PAP and control groups in any of the domains of neurocognitive function tested, which included executive function, processing speed, attention and vigilance, memory, and intelligence.”

In the paper

“A meta-analysis of the four studies did not demonstrate a clinically significant improvement in HbA1c with PAP”

In the paper

“A total of 26 RCTs were identified that investigated the effects of ongoing treatment with APAP compared with fixed CPAP in reducing side effects and improving one or more of the following outcomes: AHI/RDI, adherence to PAP therapy, sleepiness, QOL, and neurocognitive function.156,179,”

What the sources say

• ?Not checked — no full text of the sourcecites [156] Patruno V, Aiolfi S, Costantino G, et al. Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea. Chest. 2007;131(5):1393–1399 source
• ?Not checked — no full text of the sourcecites [179] Planes C, D'Ortho MP, Foucher A, et al. Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP. Sleep. 2003;26(2):156–160 source

In the paper

“No studies were identified that reported on side effects of either strategy.”

In the paper

“In the studies reviewed, participants with conditions that increased the risk of central sleep apnea (eg, congestive heart failure or opiate use), hypoventilation syndromes (eg, significant lung disease such as chronic obstructive pulmonary disease), neuromuscular disease, sleep-related oxygen requirements or the expectation of nocturnal arterial oxyhemoglobin desaturations, or a history of uvulop”

In the paper

“The cost reduction ranged from 25-84% in favor of treatment arms including APAP in the home.”

In the paper

“Of the four studies, only one showed a significant reduction in HbA1c.129”

What the sources say

• ?Not checked — no full text of the sourcecites [129] Martinez-Ceron E, Barquiel B, Bezos AM, et al. Effect of continuous positive airway pressure on glycemic control in patients with obstructive sleep apnea and type 2 diabetes. A randomized clinical trial. Am J Respir Crit Care Med. 2016;194(4):476–485 source

In the paper

“Only one randomized trial was identified that assessed patient preference of an ambulatory/home pathway versus an in-laboratory diagnostic and treatment pathway.178”

What the sources say

• ?Not checked — no full text of the sourcecites [178] Mulgrew AT, Fox N, Ayas NT, Ryan CF Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med. 2007;146(3):157–166 source

In the paper

“The meta-analysis demonstrated no clinically significant difference in self-reported sleepiness when PAP therapy was initiated using home APAP compared to an in-laboratory titration”

In the paper

“The meta-analysis of non-sleepy OSA participants, demonstrated a statistically but not clinically significant reduction in ESS.”

In the paper

“Patient preference for APAP compared with CPAP was assessed in a total of 9 RCTs.183,184,187,189,[191][192][193]198,199”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites 183,184,187,189,[191][192][193]198,199

In the paper

“Meta-analyses of these studies demonstrated no clinically significant differences in attention as measured by either mean reaction time or lapses on the PVT”

In the paper

“Furthermore, a meta-analysis of 2 RCTs demonstrated that the difference in the percent of nights PAP therapy was used > 4 hours with APAP versus CPAP was not clinically significant.185,193”

What the sources say

• ?Not checked — no full text of the sourcecites [185] Hudgel DW, Fung C A long-term randomized, cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep. 2000;23(5):645–648 source
• ?Not checked — no full text of the sourcecites [193] Nussbaumer Y, Bloch KE, Genser T, Thurnheer R Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea. Chest. 2006;129(3):638–643 source

In the paper

“A total of 5 RCTs compared the use of BPAP to CPAP to improve one or more of the following outcomes: AHI, adherence to PAP therapy, sleepiness, neurocognitive function, QOL, and reduction of side effects.[209][210][211][212][213]”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [209][210][211][212][213]

In the paper

“Side effect data were not sufficiently standardized to permit meta-analysis, but a description of side effect findings is provided.”

In the paper

“A meta-analysis of all 23 RCTs demonstrated no clinically significant difference in average hours of use in adults with OSA treated with APAP compared to CPAP.”

In the paper

“On the other hand, in one study more discomfort due to pressure variation with APAP was noted.194”

What the sources say

• ?Not checked — no full text of the sourcecites [194] Randerath WJ, Schraeder O, Galetke W, Feldmeyer F, Ruhle KH Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Respir Crit Care Med. 2001;163(3 Pt 1):652–657 source

In the paper

“Meta-analyses demonstrated no clinically significant differences in residual AHI between APAP and CPAP.”

In the paper

“Met-analyses of studies reporting ESS and combining studies reporting either the OSLER or MWT demonstrated no clinically significant mean differences in self-reported or objective sleepiness”

In the paper

“A total of 18 RCTs were identified that evaluated the use of some combination of an educational, behavioral, or troubleshooting intervention as an adjunct to initiation of PAP therapy compared to PAP therapy with standard of care alone on PAP adherence, sleepiness, and QOL.207,[214][215][216][217][218][219][220][221][222][223][224][225][226][227][228][229][230]”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites 207,[214][215][216][217][218][219][220][221][222][223][224][225][226][227][228][229][230]

In the paper

“There were insufficient data available to perform meta-analyses for QOL, neurocognitive function, or side effects; however, data from individual studies were reviewed.”

In the paper

“Metaanalysis of the 2 RCTs 210,213 did not demonstrate a clinically significant difference in residual AHI with treatment using BPAP compared to CPAP”

What the sources say

• ?Not checked — no full text of the sourcecites [210] Gay PC, Herold DL, Olson EJ A randomized, double-blind clinical trial comparing continuous positive airway pressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome. Sleep. 2003;26(7):864–869 source
• ?Not checked — no full text of the sourcecites [213] Blau A, Minx M, Peter JG, et al. Auto bi-level pressure relief-PAP is as effective as CPAP in OSA patients-a pilot study. Sleep Breath. 2012;16(3):773–779 source

In the paper

“However, the studies demonstrated that both BPAP and CPAP use improve self-reported sleepiness compared to before initiation of treatment.”

In the paper

“The metaanalysis demonstrated no clinically significant difference in adherence with BPAP compared with CPAP (see supplemental material, Figure S76) in the 4 studies that used BPAP as the first line therapy.[210][211][212][213]”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [210][211][212][213]

In the paper

“The mean difference in residual AHI between BPAP and CPAP was -2.2 events/h (95% CI: -5.1 to 0.7 events/h).”

In the paper

“The meta-analysis demonstrated no clinically significant difference in selfreported sleepiness in adults with OSA treated with BPAP compared to CPAP”

In the paper

“In addition, in one other available study, 213 there was no difference between BPAP and CPAP treatment in sleep quality as assessed by the Pittsburgh Sleep Quality Index”

What the sources say

• ?Not checked — no full text of the sourcecites [213] Blau A, Minx M, Peter JG, et al. Auto bi-level pressure relief-PAP is as effective as CPAP in OSA patients-a pilot study. Sleep Breath. 2012;16(3):773–779 source

In the paper

“However, improved adherence to BPAP was not observed in the available studies that predominantly recruited PAP naïve patients.”