Carballo Nancy J, Alessi Cathy A, Martin Jennifer L, Mitchell Michael N, Hays Ron D, Col Nananda, Patterson Emily S, Jouldjian Stella, Josephson Karen, Fung Constance H
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles.
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles.
Clin Ther. 2016 Nov;38(11):2407-2415. doi: 10.1016/j.clinthera.2016.09.008. Epub 2016 Oct 15.
Obstructive sleep apnea is a prevalent sleep disorder among older adults. Oral appliances are increasingly prescribed as therapy for obstructive sleep apnea. Adherence to oral appliance therapy is highly variable. Based on value-expectancy theory and other social-psychological theories, adherence to oral appliance therapy may be influenced by patients' perceived effectiveness of the therapy, self-efficacy, and availability of social support. We examined these perceptions among older adults with obstructive sleep apnea who were prescribed oral appliance therapy.
We mailed surveys to all patients aged ≥65 years who had been prescribed oral appliance therapy for obstructive sleep apnea over the prior 36 months at a Veterans Affairs medical center. We examined frequencies of responses to items that assessed perceived effectiveness, self-efficacy, and social support for nightly use of oral appliances from friends, family, or health care staff.
Thirty-nine individuals responded (response rate, 30%; mean [SD] age 71.4 [SD 6.3] years; 97% male). Thirty-six percent of the respondents perceived regular use of oral appliance therapy to be effective in managing obstructive sleep apnea; 39% agreed that they felt confident about using oral appliances regularly; 41% felt supported by people in their life in using oral appliance therapy; and 38% agreed that health care staff would help them to use their oral appliance regularly. These rates represented less than half of respondents despite the finding that 65% of patients believed that they would use their oral appliance regularly.
Although oral appliance therapy is increasingly prescribed for obstructive sleep apnea, only about one third of older adults prescribed it perceived it to be an effective treatment, were confident about oral appliance use, and/or believed that they would receive needed support. Future research is needed to better understand older adults' perceptions so that interventions can be designed to improve the effectiveness of oral appliances, their self-efficacy for using oral appliances, and their social support for this therapy, which may, in turn, improve oral appliance therapy adherence.
阻塞性睡眠呼吸暂停是老年人中一种常见的睡眠障碍。口腔矫治器越来越多地被用作阻塞性睡眠呼吸暂停的治疗方法。对口腔矫治器治疗的依从性差异很大。基于价值期望理论和其他社会心理学理论，对口腔矫治器治疗的依从性可能会受到患者对治疗效果的感知、自我效能感以及社会支持的可用性的影响。我们研究了接受口腔矫治器治疗的老年阻塞性睡眠呼吸暂停患者的这些认知情况。
我们向一家退伍军人事务医疗中心在过去36个月内被开了用于阻塞性睡眠呼吸暂停的口腔矫治器治疗的所有65岁及以上患者邮寄了调查问卷。我们检查了对评估夜间使用口腔矫治器的感知效果、自我效能感以及来自朋友、家人或医护人员的社会支持的项目的回答频率。
39人回复（回复率30%；平均[标准差]年龄71.4[标准差6.3]岁；97%为男性）。36%的受访者认为经常使用口腔矫治器治疗对控制阻塞性睡眠呼吸暂停有效；39%的人同意他们对经常使用口腔矫治器有信心；41%的人觉得生活中的人支持他们使用口腔矫治器治疗；38%的人同意医护人员会帮助他们定期使用口腔矫治器。尽管65%的患者认为他们会定期使用口腔矫治器，但这些比例均不到受访者的一半。
尽管越来越多地为阻塞性睡眠呼吸暂停患者开口腔矫治器治疗，但只有约三分之一接受该治疗的老年人认为它是一种有效的治疗方法，对使用口腔矫治器有信心，和/或认为他们会得到所需的支持。需要进一步研究以更好地了解老年人的认知，从而设计干预措施来提高口腔矫治器的有效性、他们使用口腔矫治器的自我效能感以及他们对这种治疗的社会支持，这反过来可能会提高对口腔矫治器治疗的依从性。
