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One of the purported advantages of autotitrating CPAP is that a lower mean overnight pressure may be delivered to the patient. This can be beneficial in terms of pressure tolerance and side-effects. However, Luo and colleagues found in their Chinese population that pressures derived from the auto-titration were consistently greater that those determined by manual titration.[76] As identified by the authors, this may reflect the greater sensitivity of the flow sensor within the autotitrating CPAP device detecting and responding to flow limitation compared with the thermistor used during the manual titration. This study and that of Damiani et?al. highlight the need for long-term studies to evaluate whether clinically important outcome differences exist between SCR7 in vivo different devices and approaches to titration.[75] Although highly efficacious, CPAP therapy is not tolerated or accepted as long-term treatment by a significant number of patients with OSA. With this in mind, Anandam et?al. undertook a large observational study of 570 patients with severe OSA (apnoea-hypopnoea index ��30/h) followed up for a median period of over 5 years.[77] All patients initially received CPAP, although only 177 continued on this therapy over the study period. Another 72 patients were switched to a mandibular advancement splint (MAS), and 212 declined intervention. A control group of 208 individuals Mianserin HCl with an apnoea-hypopnoea index Entinostat order the similarity in outcomes between the two therapies likely arise from higher compliance with MAS offsetting its lower efficacy. To date, a major limitation with MAS has been the inability to objectively monitor compliance. However, this will change with the recent development of microsensor technology permitting chips to be embedded within these devices, enabling more accurate usage monitoring.[80] Although OSA is a common finding in the majority of patients with obesity hypoventilation syndrome, CPAP is not universally successful in improving sleep-disordered breathing in this population. Salord et?al.