Saglam-Aydinatay B, Taner T
Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, Ankara 06100, Turkey,
Med Oral Patol Oral Cir Bucal. 2018 Jan 1;23(1):e72-e77. doi: 10.4317/medoral.22158.
Despite the advances in the treatment of obstructive sleep apnea (OSA) with mandibular advancement appliances (MAA), their effectiveness is dependent on the patients compliance. Our aims were to evaluate the long-term adherence to MAA therapy and patients experiences of the treatment in OSA.
Sixty-nine patients (52 males, 17 females; Mean age: 54.4±10.8 years) were included in the study. The subjects were mild (56%) and moderate (44%) OSA patients who had been treated using MAA at least 4 years prior to the study. A phone survey was used to determine the demographic characteristics of the patients, as well as to assess self-reported adherence to therapy, subjective long-term effectiveness, and patient experiences with the appliance. Descriptive statistics, Pearson Chi-square test, and independent samples t-test were used for data analysis.
Only 22 (32%) patients reported using the appliance regularly. Most of the non-adherent patients had stopped using their appliances in the first year (55%). The mean duration of appliance use was 33.5 months (Median: 12 months). No significant differences in appliance type, OSA severity, educational level, gender, marital status, income status, employment status or place of residence existed between adherent and non-adherent subjects. Adherent subjects were significantly younger than non-adherent subjects (Age: 50.6 ± 11.9 versus 56.1 ± 9.9, p < 0.05). The most common reasons reported by patients were inability to adapt to the appliance (62%) and pain in the temporomandibular joint (38%). The most common factors associated with continued usage were effectiveness (100%) and ease of use (64%).
The overall long-term nonadherence to MAA therapy in mild-to moderate OSA patients was high suggesting that barriers to MAA therapy adherence should be prevented to increase the efficiency of oral appliance treatment in OSA and achieve better outcomes for this disease.
尽管下颌前移矫治器（MAA）在阻塞性睡眠呼吸暂停（OSA）治疗方面取得了进展，但其有效性取决于患者的依从性。我们的目的是评估OSA患者对MAA治疗的长期依从性以及他们对该治疗的体验。
本研究纳入了69例患者（52例男性，17例女性；平均年龄：54.4±10.8岁）。这些受试者为轻度（56%）和中度（44%）OSA患者，在研究前至少已使用MAA治疗4年。通过电话调查确定患者的人口统计学特征，并评估自我报告的治疗依从性、主观长期疗效以及患者对矫治器的体验。采用描述性统计、Pearson卡方检验和独立样本t检验进行数据分析。
只有22例（32%）患者报告经常使用该矫治器。大多数不依从的患者在第一年就停止使用矫治器（55%）。矫治器的平均使用时长为33.5个月（中位数：12个月）。依从和不依从的受试者在矫治器类型、OSA严重程度、教育水平、性别、婚姻状况、收入状况、就业状况或居住地点方面无显著差异。依从的受试者明显比不依从的受试者年轻（年龄：50.6±11.9岁对56.1±9.9岁，p<0.05）。患者报告的最常见原因是无法适应矫治器（62%）和颞下颌关节疼痛（38%）。与持续使用相关的最常见因素是有效性（100%）和易用性（64%）。
轻度至中度OSA患者对MAA治疗的总体长期不依从率较高，这表明应预防MAA治疗依从性的障碍，以提高OSA口腔矫治器治疗的效率，并为该疾病取得更好的治疗效果。
