Tolerance and intolerance to continuous positive airway pressure

Nasal continuous positive airway pressure (CPAP) is the most effective and widely used therapy for obstructive sleep apnea. As with any chronic therapy, long-term compliance has a significant impact on its effectiveness. Only about half of patients use CPAP for more than half the night on five or more nights per week. Approximately 4 hours of CPAP therapy per night appears to significantly improve daytime alertness and performance. Four hours of therapy also seems to improve sleep-disordered breathing for the remainder of the night. Patient education and close follow-up and intervention appear to improve long-term tolerance. Autotitration CPAP or bilevel positive airway pressure systems are no more effective or better tolerated than conventional CPAP therapy. They may be useful options if patients have been unable to tolerate conventional CPAP therapy.