What is known about the experience of CPAP for OSA from the users’ perspective? A systematic integrative literature review

Abstract

Introduction: The estimated economic, social and personal cost of untreated obstructive sleep apnoea (OSA) is high. Night time continuous positive airway pressure (CPAP) is a recommended, cost effective and popular treatment. The predicted global increase in obesity will lead to increasing prevalence of OSA. Exploring management of CPAP from the user perspective is crucial to successful administration of this therapy. The objective was synthesis of the international evidence base regarding users’ experience of night time continuous positive airway pressure therapy for obstructive sleep apnoea. Materials and methods: A systematic integrative literature review was conducted and quality assessment criteria applied. Results: From 538 identified papers, 22 met inclusion criteria. Thematic analysis identified four themes: (1) evidence regarding experience of CPAP and issues of research design; (2) CPAP influenced by users’ views and beliefs; (3) CPAP investigated using a language of difficulty; and (4) spouse and family impact on CPAP use. Overall, research relating to user experience of CPAP is limited. Understanding is incomplete because of problems of study design, for example the use of pre-determined checklists and survey questions. The problem oriented terminology adopted by most studies is also likely to set up the expectation that users will encounter difficulties with CPAP. There is evidence that personality and attitude impact expectations about CPAP prior to and during use, whilst engagement of spouse, family and colleagues also influence experience. Conclusion: This comprehensive integrative review identified limited evidence about experiencing CPAP from the users’ perspective. Current research is constrained by researchers’ concern with non-compliance. Typically experiences of CPAP are not defined by the user, but from an ‘expert’ healthcare perspective, using language that defines CPAP as problematic. Family and social support is a significant, but underexplored, element of experiencing CPAP and warrants further investigation. Research that more comprehensively involves CPAP users is required to determine how patients manage this therapy successfully.