Table 5Clinical evidence summary: Non-invasive ventilation versus fixed level CPAP for improving usage of continuous positive airway pressure machines in adults with OSAHS-severe OSAHS

Outcomes

No of Participants

(studies)

Follow up

Quality of the evidence (GRADE)Relative effect (95% CI)Anticipated absolute effects
Risk with ControlRisk difference with NIV versus fixed CPAP (95% CI)

Machine usage (hours/night)

Follow-up 4 to 52 weeks

268

(4 studies)

⊕⊕⊝⊝

LOW11,

due to risk of bias,

control group risk not available4

The mean machine usage (hours/night) in the intervention groups was

0.14 higher

(0.17 lower to 0.45 higher)

Symptoms (Epworth Sleepiness Scale)

Scale from 0-24

Higher is worse

Follow-up 4 to 12 weeks

226

(4 studies)

⊕⊝⊝⊝

LOW11,

due to risk of bias,

control group risk not available4

The mean symptoms (epworth sleepiness scale) in the intervention groups was

0.49 lower

(1.46 lower to 0.48 higher)

Withdrawals (parallel group trials/first arm cross-over trials)

Follow-up 4 to 52 weeks

261

(3 studies)

⊕⊝⊝⊝

VERY LOW11,2

due to risk of bias, imprecision

RR 0.61

(0.33 to 1.15)

Moderate
138 per 1000

54 fewer per 1000

(from 92 fewer to 21 more)

Quality of life (Functional Outcome of Sleep Questionnaire)

Scale from 5-20

higher is better

Follow-up 8 weeks

151

(1 study)

⊕⊕⊝⊝

LOW11,2

due to risk of bias, imprecision

Mean in control group was

5.1

The mean quality of life (functional outcome of sleep questionnaire) in the intervention groups was

0.8 lower

(6.08 lower to 4.48 higher)

Quality of life (Sleep Association Quality of Life Index)

Scale 1-7

Higher is better

28

(1 study)

⊕⊕⊕⊝

MODERATE1

due to risk of bias

control group risk not available4

The mean quality of life (sleep association quality of life index) in the intervention groups was

0.4 higher

(0.34 lower to 1.14 higher)

Quality of life (SF-36 questionnaire) - Physical health

Scale from 0-100

Higher is better

151

(1 study)

⊕⊝⊝⊝

VERY LOW1,2

due to risk of bias, imprecision

Mean in control group was

1.2

The mean quality of life (sf-36 questionnaire) - physical health in the intervention groups was

0.6 higher

(2.21 lower to 3.41 higher)

Quality of life (SF-36 questionnaire) - Mental heath

Scale from 0-100

Higher is better

151

(1 study)

⊕⊕⊝⊝

LOW11,2

due to risk of bias, imprecision

Mean in control group was

4.6

The mean quality of life (sf-36 questionnaire) - mental health in the intervention groups was

2.9 lower

(7.09 lower to 1.29 higher)

Apnoea Hypopnoea Index (events/hr)

Lower is better

Follow-up 4 to 8weeks

179

(2 studies)

⊕⊝⊝⊝

VERY LOW1,2

due to risk of bias, imprecision

The mean AHI was

6.6 events/hour

The mean apnoea hypopnoea index (events/hr) in the intervention groups was

1.36 higher

(6.92 lower to 9.63 higher)

Patient preference - BiPAP/no preference or CPAP

88

(2 studies)

⊕⊝⊝⊝

VERY LOW1,2,3

due to risk of bias, inconsistency, imprecision

RR 0.88

(0.47 to 1.65)

Moderate
545 per 1000

65 fewer per 1000

(from 289 fewer to 354 more)

Tolerability outcomes - Dry mouth

Follow-up 4 to 52 weeks

151

(1 study)

⊕⊝⊝⊝

VERY LOW1,2

due to risk of bias, imprecision

RR 0.56

(0.15 to 2.17)

Moderate
75 per 1000

33 fewer per 1000

(from 64 fewer to 88 more)

Tolerability outcomes - Mask intolerance

Follow-up 4 to 52 weeks

151

(1 study)

⊕⊝⊝⊝

VERY LOW1,2

due to risk of bias, imprecision

RR 1.13

(0.45 to 2.85)

Moderate
100 per 1000

13 more per 1000

(from 55 fewer to 185 more)

Treatment comfort score

0-100 VAS

Follow-up 4 to 52 weeks

28

(1 study)

⊕⊕⊝⊝

LOW1,2

due to risk of bias

control group risk not available4

The mean treatment comfort score in the intervention groups was

9 higher

(3.54 lower to 21.54 higher)

1

Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias

2

Downgraded by one increment if the confidence interval crossed one MID and downgraded by two increments if the confidence interval crossed both MIDs. MID for machine usage (adherence)- 1 hour ; Established MIDs for SF-36 physical/mental- 2/3 ; FOSQ- 2 ; ESS −2.5; SAQLI – 2 3 SAQLI- established MID 2.. GRADE default MID (0.5XSD) used for all other continuous outcomes.

3

Downgraded by 1 or 2 increments for heterogeneity. Random effect analysis used.

4

Cochrane review used mean difference (SE) in the analysis, control group risk data not available.

From: Positive airway pressure therapy variants for OSAHS, OHS and COPD–OSAHS overlap syndrome

Cover of Positive airway pressure therapy variants for OSAHS, OHS and COPD–OSAHS overlap syndrome
Positive airway pressure therapy variants for OSAHS, OHS and COPD–OSAHS overlap syndrome: Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s: Evidence review F.
NICE Guideline, No. 202.
National Guideline Centre (UK).
Copyright © NICE 2021.

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