Berry 2014.

Methods	Randomised, open‐label, parallel group, singe‐centre trial
Participants	N = 156 participants (145 M/11 F). Age: 59 years; BMI: 36 kg/m2; AHI: 28.5 ESS: 14.8 Inclusion criteria: AHI ≥ 10/hour; ESS ≥ 8; living within 200 miles of treatment centre; age > 18 years Exclusion criteria: previous CPAP therapy; shift work; unstable depression/psychosis; non‐adherence with medication; COPD; uncontrolled hypertension or restless legs syndrome; narcolepsy; supplemental oxygen use; congestive heart failure; nightly narcotic use; hypoventilation; neuromuscular weakness; regular sleep of < 4 hours per night; low baseline SaO2; central apnoea index > 5/hour
Interventions	Auto‐CPAP versus home PSG CPAP titration followed by fixed pressure CPAP treatment Study duration: 6 weeks
Outcomes	Machine usage (average hours used) AHI Symptoms (ESS) Quality of life (FOSQ) Treatment pressure Withdrawals
Funding & conflicts of interest statements	Quote: "This study was supported by a research grant from the Res Med Foundation and an unrestricted research grant from Philips Respironics. Both grants were made to the North Florida Foundation for Research and Education. The CPAP and APAP equipment were purchased by the VA as part of the routine clinical care of the patients. The PAP setups were performed by clinical PAP respiratory therapists as part of the patient’s usual care. A registered polysomnographic technologist (CPAP titrations) and study coordinator were paid by research funding. The principal investigators received no salary support from research funding. This work was also supported by resources provided by the North Florida/South Georgia Veterans Health System, Gainesville, FL. The contents of this paper do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. The authors have indicated no other financial conflicts of interest. The study was performed at the Malcom Randall VA Medical Center, Gainesville, FL."
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient details available to determine process
Allocation concealment (selection bias)	Low risk	Quote: "The method of randomization was by opening sequential envelopes prepared by the research service."
Blinding of participants and personnel (performance bias) Machine usage, symptoms, quality of life, withdrawal, adverse effects	High risk	Study had open‐label design which likely affects usage, symptoms, quality of life attrition outcomes.
Blinding of participants and personnel (performance bias) AHI, blood pressure, treatment pressure	Low risk	These outcomes unlikely to be affected by open‐label design.
Blinding of outcome assessment (detection bias) Machine usage, symptoms, quality of life, withdrawal, adverse effects	High risk	Impact of study design on outcome assessment related to nature of outcome. Usage, AHI and treatment pressure measured from technical readings. Symptoms, quality of life more likely affected by open‐label design.
Blinding of outcome assessment (detection bias) AHI, blood pressure, treatment pressure	Low risk	Treatment pressure and AHI unlikely to be affected by open‐label design.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Balanced but potentially meaningful dropout which was slightly higher in fixed CPAP group (19/78 versus 12/78). Participants not using machines at clinic visit assumed to be non‐users and assigned values of 0 for usage outcome. Likely to be greater impact on symptoms and quality of life outcomes.
Selective reporting (reporting bias)	Low risk	All prespecified outcomes presented according to details provided on trials registry record.
Other bias	Low risk	No concerns identified