EVALUATION OF TREATMENT EFFICACY IN SLEEP-APNEA HYPOPNEA SYNDROME

The evaluation of treatment efficacy consists in evaluating their effi cacy to normalize sleep-related breathing disorders and neuropsycholog ical consequences and witness complaints, patients' compliance, and th e risk or side effects to benefits ratio. Polysomnographic studies are the gold standard for assessing the effects of treatments on nocturna l breathing and sleep characteristics, but the timing of control sleep studies must take into account the possible changes in treatment effi cacy with time. Determining the effective positive pressure level duri ng split nights or with a multifactorial regression model may be helpf ul but can result in an underestimation of the pressure setting. The u tility of unassisted home sleep recordings during CPAP therapy is limi ted by the number of signals recorded and the absence of sleep recordi ng. The evaluation of neuropsychological improvements has to be multif actorial to evaluate the subjective and objective effects of SAHS trea tments. The compliance to CPAP therapy must be evaluated by pressure c ounter or time counter measurements rather than on the reported use. C PAP observance can be reliably estimated after the first month of ther apy and is linked to improvement in diurnal symptoms. As for any disea se, SAHS treatment must be adapted to the individual characteristics o f the patient and of his or her disease. Therefore, the choice between weight loss, pharyngeal or maxillomandibular surgery, anterior mandib ular positioners or tongue retaining devices, nasal CPAP, BiPAP, and t racheostomy depends on the patient's complaints and morbidity risk fac tors and on the respective side effects to benefits ratio of these the rapeutic procedures.