Introduction Sleep disordered breathing is commonly treated with positive airway pressure (PAP) therapy. However, PAP therapy can result in mask leak, ineffective treatment, eye irritation, nasal congestion, pressure ulcers and poor concordance. Aims This systematic review and meta-analysis aimed to identify effectiveness of current treatment strategies for managing PAP therapy complications. Methods Five databases were searched using PRISMA and Cochrane guidelines.  Results 10,809 articles were screened with 36 articles included. Studies investigated: dressings, nasal spray/douche, chin straps, heated humidification and interfaces. No intervention either improved or detrimentally effected PAP concordance, Epworth Sleepiness Score (ESS), residual apnoea hypopnea index (AHI) or interface leak (Table 1). Reduction in AHI and ESS in nasal vs. oronasal interfaces was not clinically meaningful. Reduction in leak associated with humidification could be related to reduced mouth opening. 

Conclusion Study heterogeneity, particularly for outcome measures used, limited the review. Patient demographics were not reported making it difficult to apply findings to a broad clinical population. We highlight paucity of evidence supporting treatment strategies managing PAP therapy complications.