How many hours per night is enough? A systematic integrative review to identify optimal hours of CPAP therapy use for sleep apnoea

Abstract

Objective: This study aimed to synthesise current evidence about the optimal hours of use of CPAP for OSA to offer an evidence-based approach to using this therapy. Method: A systematic integrative literature review was conducted with quality assessment criteria applied. Results: 10 of 4693 studies met inclusion criteria. Thematic analysis identified three themes: 1) more is better, but anything is better than nothing; 2) six hours is optimal; 3) the percentage of total sleep time/individualised optimal hours are the best way to determine ‘compliance’ and efficacy. Hours per night in the context of total sleep time may offer a more individualised indicator of compliance than four hours per night for every user. Conclusion: Overall, this review identified limited evidence about optimal hours of CPAP use for OSA. The previously employed four hours of use as the threshold for determining compliance warrants review in the context of total sleep time per night. Additionally, patients can be encouraged that any CPAP is better than none and increasing use should yield clinical improvement. We argue that optimal hours of use are an individualised definition and that previous ideas around universally applicable optimal hours be discarded in favour of a focus on improving clinical indicators and CPAP use as a percentage of total sleep time.