0596 Pressure Support Does Not Lead to Increased Treatment Adherence versus CPAP: A Systematic Review and Meta-analysis

Abstract Introduction Modified continuous positive airway pressure (CPAP) modalities providing pressure support—bilevel PAP (BPAP) or expiratory pressure relief algorithms (EPRAs)—are routinely used for OSA treatment, despite little evidence of increased adherence and improved downstream outcomes. Therefore, we sought an answer to the following question: Does the use of pressure support increase treatment adherence in OSA patients? To answer this question, an updated, more comprehensive systematic review and meta-analysis of pressure support on adherence is needed. Methods MEDLINE, EMBASE, CENTRAL, Clinicaltrials.gov and major abstract repositories were searched for randomized and non-randomized control trials assessing the effect of pressure support (BPAP, EPRA or both) on adherence (primary outcome) vs. CPAP in adults with OSA and in those exhibiting CPAP intolerance (exploratory). Subgroup analyses and meta-regressions assessed potential causes of heterogeneity. Epworth Sleepiness Scale (ESS) changes from baseline, residual apnea-hypopnea index (AHI) and leak (secondary outcomes) were also analyzed when available. GRADE was used for certainty of evidence (CoE) rating. Results In twenty-one studies (N=1462 participants), pressure support did not affect adherence vs. CPAP (mean difference 95%CI: 0.21 -0.01, 0.44 h/night, P=0.06; heterogeneity=45%; CoE: very-low-to-moderate). BPAP had a larger effect amongst those exhibiting PAP intolerance (0.68 0.14, 1.23 h/night, P=0.01), but CoE was very-low. Longer follow-up duration was associated with decreasing adherence to pressure support vs. CPAP (-0.18 -0.36, -0.03 h/night per additional trimester beyond 3 months, P=0.03). There was no difference in ESS and residual AHI between interventions, but leak was reduced on pressure support (CoE: low-to-moderate). Conclusion Pressure support yields similar adherence and residual AHI to CPAP. Given increased research and development demands and device cost, its use in OSA cannot be recommended. Support (if any) None