Summary Introduction Although obstructive sleep apnoea syndrome (OSAS) is usually a lifelong condition, little is known about compliance with nasal continuous positive airway pressure (nCPAP) over longer periods of follow up. Methods Long term acceptance of nCPAP was evaluated retrospectively using a survival analysis in 137 consecutive patients who started nCPAP therapy for OSAS between 1985 and 1993. Results During a mean follow-up of 9.2 ± 4.7 years, 30 patients died, 5 were lost of follow-up and 30 patients stopped their treatment most of them during the first 5 years. In compliant patients, the median value of daily nCPAP use was 7.5 hours. Kaplan Meier analysis showed that 82 % of patients were still using nCPAP at 5 years, 77 % at 10 years and 61 % at 15 years. Multivariate analysis showed that OSAS severity was an independent predictor of long-term nCPAP use. The rate of nCPAP acceptance at 10 years was 82 % in patients with an apnoea-hypopnoea index (AHI) ≥ 30 compared to 58% in patients with AHI < 30. Conclusion nCPAP is a suitable long-term therapy for OSAS, particularly in patients with more severe disease, with more than 80 % of patients continuing to be compliant with treatment at 10 years.