Summary of findings 2. Supportive intervention versus control.
| Increased practical support and encouragement during follow‐up + CPAP compared to usual care + CPAP in adults with obstructive sleep apnoea | ||||||
| Patient or population: adults with obstructive sleep apnoea Setting: community Intervention: increased practical support and encouragement during follow‐up + CPAP Comparison: usual care + CPAP | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care + CPAP | Risk with Increased practical support and encouragement during follow‐up + CPAP | |||||
| 2.1 CPAP device usage (hours/night) | The mean CPAP device usage ranged from 1.75 to 4.9 hours/night | MD 0.70 hours/night higher (0.36 higher to 1.05 higher) | ‐ | 1426 (13 RCTs) | ⊕⊕⊕⊝ MODERATE 1 2 3 4 | |
| 2.2 CPAP device usage, sensitivity analysis: adherence in control group < four hours/night | The mean CPAP device usage, sensitivity analysis: adherence in control group < four hours/night ranged from 1.75 to 3.8 hours/night | MD 0.91 hours/night higher (0.57 higher to 1.25 higher) | ‐ | 735 (7 RCTs) | ⊕⊕⊕⊕ HIGH 3 4 5 | |
| 2.3 N deemed adherent (≥ four hours/night) | 601 per 1,000 | 717 per 1,000 (619 to 797) | OR 1.68 (1.08 to 2.60) | 376 (2 RCTs) | ⊕⊕⊝⊝ LOW 3 6 7 | |
| 2.4 Withdrawals | 136 per 1,000 | 167 per 1,000 (133 to 208) | OR 1.27 (0.97 to 1.66) | 1702 (11 RCTs) | ⊕⊕⊝⊝ LOW 3 8 | |
| 2.5.2 ESS: Comparison Endpoint or Change from Baseline Values ‐ ESS: Change from Baseline | The mean ESS ‐ Comparison Endpoint or Change from Baseline Values ‐ ESS: Change from Baseline ranged from ‐0.7 to ‐5.1 | MD 0.32 lower (1.19 lower to 0.56 higher) | ‐ | 470 (5 RCTs) | ⊕⊕⊝⊝ LOW 3 7 9 | |
| 2.7 Quality of lIfe: Comparison of Change from Baseline Values | The mean Quality of lIfe: Comparison of Change from Baseline Values was 0 | SMD 0.22 higher (0.01 lower to 0.45 higher) | ‐ | 294 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 3 9 10 11 | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CPAP: Continuous positive airways pressure; CI: Confidence interval; ESS: Epworth Sleepiness Scale; FOSQ: Functional Outcomes of Sleep Questionnaire; GRADE: Grades of Recommendation, Assessment, Development and Evaluation; MD: mean difference; OR: Odds ratio; RCT: randomised controlled trial; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Overall risk of bias for this comparison was 'High' for 8/13 and 'some concerns' for the remaining 5/13. In those with high risk, risk derived from randomisation (1), missing outcome data (6), protocol deviation (1) and selective reporting (2). The combined weight of the studies with high risk is 51.2%. Therefore, risk of bias for this comparison was downgraded by 1 level to 'serious.'
2 Direction of effect had some variability (one study, weight = 6.8%, favoured control), while remaining studies favoured experimental arms. Magnitude of effect varied across studies and CIs had fair overlap. Heterogeneity P = 0.05, I2 = 42%. Heterogeneity explained: attributable to single study with opposite direction of effect (Mendelson 2014). See sensitivity analysis with this study excluded (Analysis 2.13).
3 Studies retrieved and analysed for this review directly compare the population, interventions and outcomes of interest, as predefined, in our review protocol.
4 Performed optimal information size (OIS) (sample size) calculation, as per GRADE Handbook recommendations, which indicated OIS criterion was met for this outcome. Confidence interval does not include null and includes potential for important benefit.
5 Overall risk of bias for this comparison was 'High' for 3/7 and 'some concerns' for the remaining 4/7. In those with high risk, risk derived from missing outcome data (1) and selective reporting (2). The combined weight of the studies with high risk is 14.2%.
6 Overall risk of bias for this comparison was 'High' for 1/2 and 'some concerns' for the remaining 1/2. Hisk risk derived from missing outcome data. The weight of high risk study is 24.8%. Therefore, risk of bias for this comparison was downgraded by 1 level to 'serious.'
7 OIS (sample size) calculation, as per GRADE Handbook recommendations, which indicated OIS criterion not met for this outcome. Therefore, Imprecision for this comparison was downgraded by 1 level to 'serious.'
8 Performed OIS (sample size) calculation, as per GRADE Handbook recommendations, which indicated OIS criterion not met for this outcome. Additionally, CI includes null and potential for important difference in withdrawals. Therefore, Imprecision for this comparison was downgraded by 2 levels to 'very serious.'
9 Overallrisk of bias for this outcome is 'high' for all, or nearly all, included studies because, for all or nearly all studies assessed for this outcome, the following were true: a) outcome assessors (whether participant or investigator) were aware of the intervention received by study participants, b) the outcome assessment could have been influenced by knowledge of the intervention received (because each involves some judgement by the assessor, whether participant or investigator) and c) we have no further information that would permit further adjudication of the likelihood that outcome assessment was influenced by knowledge of the intervention received. Therefore, risk of bias for this comparison was downgraded by 1 level to 'serious.'
10 OIS likely insufficient.Therefore, Imprecision for this comparison was downgraded by 1 level to 'serious.'
11 Our review included a comprehensive search for published reports conducted. All (or nearly all) studies, including all small studies, for this comparison found a benefit for the intervention. Thus, due to suspicion for publication bias, this outcome was downgraded by one level.
12 Overall risk of bias for this comparison was 'High' for 7/12 and 'some concerns' for the remaining 5/12. In those with high risk, risk derived from randomisation (1), missing outcome data (5), protocol deviation (1) and selective reporting (2). The combined weight of the studies with high risk is 46.1%.