Experiences of using positive airway pressure for treatment of obstructive sleep apnea: a systematic review and thematic synthesis

STUDY OBJECTIVES: Suboptimal use of positive airway pressure (PAP) to treat obstructive sleep apnea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. METHODS: PsycINFO, MEDLINE, CINAHL, and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analyzed were included. Papers were critically appraised using the CASP qualitative checklist to generate a "hierarchy of evidence." Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS: Twenty-five papers reporting on over 398 people's experiences were analyzed to generate four themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. CONCLUSIONS: The findings highlight the applicability of a biopsychosocial understanding to PAP use. This metasynthesis gave voice to user experiences, revealing barriers to PAP use at a healthcare service level across the world, and suggests ways services can address these barriers. PROSPERO registration number: CRD42020157767.