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Adherence to CPAP in Randomized Controlled Trials in Obstructive Sleep Apnoea-A Meta-Analysis and Investigation of
Lara Benning1,2, Zoe Bousraou1,2, Matteo Bradicich1
1Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland.
Journal of Clinical Medicine
|May 13, 2026
Summary
Higher baseline apnea-hypopnea index (AHI) predicts better continuous positive airway pressure (CPAP) adherence in obstructive sleep apnea trials. Sleepiness and demographics did not significantly impact CPAP usage in these studies.
Area of Science:
- Sleep Medicine
- Respiratory Medicine
- Clinical Trials Methodology
Background:
- Continuous positive airway pressure (CPAP) is the primary treatment for obstructive sleep apnea (OSA).
- Inconsistent CPAP adherence in randomized controlled trials (RCTs) may underestimate its true efficacy.
- Identifying predictors of CPAP adherence is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To determine patient and study characteristics associated with CPAP adherence in RCTs.
- To investigate factors influencing CPAP usage duration in OSA patients within trial settings.
Main Methods:
- A comprehensive literature search of PubMed and existing meta-analyses was performed (1984-2024).
- A study-level meta-analysis of RCTs comparing CPAP with inactive controls in OSA patients was conducted.
- Meta-regressions and subgroup analyses were employed to identify predictors of CPAP adherence, with risk-of-bias assessed using the Cochrane RoB-2 tool.
Main Results:
- Across 136 RCTs (8827 patients), mean nocturnal CPAP use was 4.5 ± 1 hour.
- Higher baseline apnea-hypopnea index (AHI) was the strongest predictor of longer CPAP use (p < 0.001).
- Smaller, single-center trials showed higher nightly CPAP usage; age, BMI, sex, and sleepiness (ESS) were not significant predictors.
Conclusions:
- Elevated baseline AHI independently predicts greater CPAP adherence in OSA RCTs.
- Patient-reported sleepiness and demographic factors do not significantly influence CPAP adherence in trial settings.
- These findings highlight the importance of baseline disease severity in predicting treatment adherence for OSA.
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