Sleep Center, Peking University People's Hospital, Beijing, China.
Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
J Sleep Res. 2021 Aug;30(4):e13240. doi: 10.1111/jsr.13240. Epub 2020 Nov 30.
Although mandibular advancement device (MAD) treatment of adults with obstructive sleep apnea (OSA) is generally less efficacious than positive airway pressure (PAP), the two treatments are associated, with similar clinical outcomes. As a sub-analysis of a randomized trial comparing the effect of MAD versus PAP on blood pressure, this study compared objectively measured adherence to MAD versus PAP treatment in adults with OSA. Adults with OSA (age 54.1 ± 11.2 [standard deviation] years, 71.1% male, apnea-hypopnea index 31.6 ± 22.7 events/h) were randomized to MAD (n = 89) or PAP (n = 91) treatment for 3-6 months. Objective adherence was assessed with a thermal sensor embedded in the MAD and a pressure sensor in the PAP unit. In a per protocol analysis, no difference was observed in average daily hours of use over all days in participants on MAD (n = 35, 4.4 ± 2.9 h) versus PAP (n = 51, 4.7 ± 1.6 h, p = .597) treatment when days with missing adherence data were included as no use. MAD was used on a lower percentage of days (62.5 ± 36.4% versus 79.9 ± 19.8%, p = .047), but with greater average daily hours of use on days used (6.4 ± 1.9 h versus 5.7 ± 1.2 h, p = .013). Average daily hours of use in the first week were associated with long-term adherence to MAD (p < .0001) and PAP (p = .0009) treatment. Similar results were obtained when excluding days with missing adherence data. In conclusion, no significant difference was observed in objectively measured average daily hours of MAD and PAP adherence in adults with OSA, despite differences in the patterns of use. MAD adherence in the first week predicted long-term use.
尽管下颌前移装置（MAD）治疗成人阻塞性睡眠呼吸暂停（OSA）的效果一般不如气道正压通气（PAP），但两种治疗方法相关，具有相似的临床效果。作为一项比较 MAD 与 PAP 对血压影响的随机试验的亚分析，本研究比较了 OSA 成人中客观测量的 MAD 与 PAP 治疗的依从性。患有 OSA 的成年人（年龄 54.1±11.2 [标准差] 岁，71.1%为男性，呼吸暂停低通气指数 31.6±22.7 次/小时）被随机分配至 MAD（n=89）或 PAP（n=91）治疗 3-6 个月。使用嵌入 MAD 的热敏传感器和 PAP 装置中的压力传感器评估客观依从性。在方案分析中，当将缺少依从性数据的天数视为无使用天数时，MAD 组（n=35，4.4±2.9 小时）与 PAP 组（n=51，4.7±1.6 小时，p=0.597）所有天数的平均每日使用时间无差异。MAD 的使用天数较少（62.5±36.4% 与 79.9±19.8%，p=0.047），但使用天数的平均每日使用时间较长（6.4±1.9 小时与 5.7±1.2 小时，p=0.013）。第一周的平均每日使用时间与 MAD 和 PAP 治疗的长期依从性相关（p<0.0001 和 p=0.0009）。当排除缺少依从性数据的天数时，得到了相似的结果。结论：尽管使用模式存在差异，但在患有 OSA 的成年人中，客观测量的 MAD 和 PAP 依从性的平均每日使用时间无显著差异。第一周的 MAD 依从性预测长期使用。
