Introduction
To date, continuous positive airway pressure (CPAP) remains the
cornerstone of obstructive sleep apnoea treatment. CPAP data describing
residual sleep-disordered breathing events (ie, the CPAP-measured
apnoea–hypopnoea indices (AHI-CPAPflow)) is
difficult to interpret because it is an entirely different metric than
the polysomnography (PSG) measured AHI gold standard
(AHI-PSGgold). Moreover, manufacturer
definitions for apnoea and hypopnoea are not only different from those
recommended for PSG scoring, but also different between manufacturers.
In the context of CPAP initiation and widespread telemedicine at home to
facilitate sleep apnoea care, there is a need for concrete evidence that
AHI-CPAPflow can be used as a surrogate for
AHI-PSGgold.
Methods and analysis
No published systematic review and meta-analysis (SRMA) has compared
the accuracy of AHI-CPAPflow against
AHI-PSGgold and the primary objective of this
study is therefore to do so using published data. The secondary
objectives are to similarly evaluate other sleep disordered breathing
indices and to perform subgroup analyses focusing on the
inclusion/exclusion of central apnoea patients, body mass index levels,
CPAP device brands, pressure titration modes, use of a predetermined and
fixed pressure level or not, and the impact of a 4% PSG desaturation
criteria versus 3% PSG on accuracy. The Preferred Reporting Items for
SRMA protocols statement guided study design. Randomised controlled
trials and observational studies of adult patients (≥18 years old)
treated by a CPAP device will be included. The CPAP intervention and PSG
comparator must be performed synchronously. PSGs must be scored manually
and follow the American Academy of Sleep Medicine guidelines (2007 AASM
criteria or more recent). To assess the risk of bias in each study, the
Quality Assessment of Diagnostic Accuracy Studies 2 tool will be
used.
Ethics and dissemination
This protocol received ethics committee approval on 16 July 2020
(IRB_MTP_2020_07_2020000404) and results will be disseminated via
peer-reviewed publications.
PROSPERO/Trial registration numbers
CRD42020159914/NCT04526366; Pre-results
Apnoea–hypopnoea indices determined via continuous positive airway
pressure (AHI-CPAPflow) versus those determined by
polysomnography (AHI-PSGgold): a protocol for a systematic review
and meta-analysis
