Since its first description in 1981, considerable advances have been made in systems used to deliver positive airway pressure for the treatment of patients with obstructive sleep-disordered breathing (OSDB).<sup>101 Sullivan C.E., Issa F.G., Berthon-Jones M. , e al. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares Lancet 1981 ;  1 : 862-865  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The present generation of machines uses microprocessors and are small, quiet, and easily portable to facilitate their use while traveling. The software in many of the newer generation machines allows for the objective assessment of patient compliance by monitoring both the total time on and time at the prescribed pressure. Positive pressure can be delivered at a fixed pressure throughout the breathing cycle, as in the case of continuous positive airway pressure (CPAP), at two different fixed pressures in response to inspiration and expiration, as in bilevel pressure, or at a variable positive pressure in response to changes in airflow or snoring sounds, as is the case in autotitrating systems.<sup>98 Strollo P.J., Rogers R.M. Obstructive sleep apnea N Engl J Med 1996 ;  334 : 99-104  [cross-ref]

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Most machines can be run on European or North American electrical current, and off alternate power sources such as a car battery. The nasal and oronasal interfaces that are available incorporate a variety of materials and designs. The newer masks provide patients with improved fit and comfort. Positive airway pressure remains the initial medical treatment of choice for the sleep apnea/hypopnea syndromes.<sup>98 Strollo P.J., Rogers R.M. Obstructive sleep apnea N Engl J Med 1996 ;  334 : 99-104  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> It has essentially eliminated the need for emergency tracheostomy in patients with obstructive sleep apnea (OSA).

In this article we discuss the utility of positive airway pressure in OSDB—its mechanism of action, benefits, and complications. We review the important topic of compliance and discuss current approaches to improve the long-term use of this highly effective treatment modality. Finally, we will offer our perspective on the future of positive airway pressure therapy for OSDB.