Self-adjusted continuous positive continuous pressure and treatment of obstructive respiratory sleep disorders.

Self-adjusted Continuous Positive Airway Pressure or auto-CPAP machines hav e been engineered to automatically adjust the pressure to maintain the uppe r airway patency. They can be used for titration or long-term home therapy. They have been developed to improve efficiency and compliance of CPAP trea tment and the cost-effectiveness of titration and also to decrease the long waiting lists for manual titration. For the treatment, it is believed, but not demonstrated that compliance may be increased by lowering the optimal pressure. Most machines are piloted by an algorithm based on detection of v arious combination of respiratory events such as apnoeas, hypopnoeas, snori ng, inspiratory flow limitation or impedance. Severals short-term studies h ave shown that autoCPAP reduces the indices of respiratory events and micro arousals. In general optimal CPAP determined automatically are identical or lower than evaluated manually by experienced technicians. However the long -term benefits of auto-CPAP on compliance have not been determined and requ ire further controlled clinical studies taking account not only compliance, but also sleep quality, quality of life, alertness and cognition for each autoCPAP! The cost-effectiveness of autotitration versus conventional titra tion remains also to be established.