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. 2019 Dec 2;2019(12):CD003531. doi: 10.1002/14651858.CD003531.pub4

West 2006.

Methods Randomised, parallel group trial. Identical machines used. Withdrawals described
Participants N = 98 participants (N considered for this review: 65 (55 M/10 F). Mean age: 47; ESS: 16.
Inclusion criteria: 18 to 75 years of age; ESS > 9; proven OSA (PSG); 10 dips/hr in arterial O2 saturation; CPAP‐naive
Exclusion criteria: respiratory failure requiring urgent treatment; unable to give written consent
Participants were not excluded on the basis of comorbidities
Interventions Auto‐CPAP versus algorithm established fixed CPAP
Additional treatment group not considered for this review: 1 week auto‐titration followed by fixed pressure at the level of 95th centile pressure from the auto‐CPAP week data.
Study duration: 24 weeks
Outcomes

  1. Machine usage (average hours used)

  2. Symptoms (ESS)

  3. Quality of life (SF‐36 and SAQLI)

  4. Treatment pressure

  5. AHI

  6. Withdrawals
Funding & conflicts of interest statements Quote: "ResMed UK provided part financial support for the purchase of CPAP machines for the study but was not involved in its design or analysis. D Jones was supported in part by a Helen Bearpark Scholarship from the Australasian Sleep Association and by the Sleep Apnoea Trust Association (UK). None of the authors has any conflict of interest."
Notes —
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computer generated schedule (MINIM)
Allocation concealment (selection bias) Low risk Quote: "...investigators carrying out the assessment studies were blind to their group allocation."
Blinding of participants and personnel (performance bias) 
 Machine usage, symptoms, quality of life, withdrawal, adverse effects Low risk Quote: "The patients and the investigators carrying out the assessment studies were blind to their group allocation."
Blinding of participants and personnel (performance bias) 
 AHI, blood pressure, treatment pressure Low risk These outcomes unlikely to be affected by awareness of treatment group.
Blinding of outcome assessment (detection bias) 
 Machine usage, symptoms, quality of life, withdrawal, adverse effects Low risk Quote: "...the investigators carrying out the assessment studies were blind to their group allocation."
Blinding of outcome assessment (detection bias) 
 AHI, blood pressure, treatment pressure Low risk These outcomes unlikely to be affected by awareness of treatment group.
Incomplete outcome data (attrition bias) 
 All outcomes High risk Nine participants lost to follow‐up or excluded from the analysis: Quote: "No data were entered for those who did not attend."
Selective reporting (reporting bias) Low risk All outcomes reported
Other bias Low risk No concerns identified