Implementation of long-term noninvasive positive airway pressure therapy in patients with COPD: a systematic review and meta-analysis of acceptance and adherence

Clinical Snapshot

Key Findings

• P Value: p=0.03 for acceptance difference between OSA vs CHRF; p<0.01 for daily use difference

• Effect Size: 86% acceptance rate (14% decline/discontinuation rate)

• Primary Outcome: PAP therapy acceptance and adherence rates in COPD patients

• Nnt Or Sensitivity: Six out of seven patients (86%) successfully use PAP therapy

• Confidence Interval: 95% CI 10-19% for decline/discontinuation

Clinical Application

High acceptance rate (86%) suggests PAP therapy is feasible in most COPD patients, with median daily use of 6.3 hours meeting clinical thresholds Relevant to Australian respiratory physicians and sleep specialists. PAP devices covered under PBS for OSA and CHRF. Results support current RACGP and Thoracic Society guidelines for PAP therapy in appropriate COPD patients COPD patients with obstructive sleep apnoea or chronic hypercapnic respiratory failure requiring PAP therapy

Abstract

BACKGROUND: Long-term noninvasive positive airway pressure (PAP) therapy is an effective, albeit complex, intervention for obstructive sleep apnoea (OSA) and/or chronic hypercapnic respiratory failure (CHRF) in patients with chronic obstructive pulmonary disease (COPD). PAP uptake and use is often reported in studies designed for other purposes. Systematic review methods were used to summarise acceptance of and adherence with PAP therapy. METHODS: A systematic search for studies that reported the proportion of patients that either declined or accepted PAP therapy and/or objective use of newly prescribed PAP therapy in patients with COPD was conducted according to a predefined protocol (PROSPERO CRD42021259262). Meta-analysis and meta-regression techniques were used to establish summary effect estimates and explore heterogeneity. RESULTS: On average, PAP therapy was declined or discontinued by 14% (95% CI 10-19) of participants, often within 6 weeks of initiation among studies reporting repeated measures. The pooled median adherence was 6.3 h·day-1 (95% CI 5.9-6.6). While meta-regression found higher acceptance (p=0.03) and shorter use per day (p<0.01) for the indication of OSA versus CHRF, this explained only some heterogeneity in the summary effect estimates. Summary of study-level variables associated with acceptance or adherence highlighted limitations in the available literature. CONCLUSIONS: An anticipated six out of seven patients with COPD newly prescribed PAP therapy will be successful using therapy; however, heterogeneity was substantial among studies, and only partly explained by indication for use. Prospective studies to explore barriers to use and detailed reporting of acceptance and adherence in studies on PAP therapy in patients with COPD are needed.

References

1. 1.Laratta, C. R., Moore, L., Kirkland, S. W., Essel, N. O. M., Campbell, S. M., Jen, R., MacLean, J. E., Pendharkar, S. R., & Rowe, B. H. (2026). Implementation of long-term noninvasive positive airway pressure therapy in patients with COPD: a systematic review and meta-analysis of acceptance and adherence. European Respiratory Review, 35(140), Article 0231-2025. https://doi.org/10.1183/16000617.0231-2025