Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
Department of Oral Public Health, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.
Eur J Orthod. 2021 Aug 3;43(4):408-414. doi: 10.1093/ejo/cjaa084.
Treatment effectiveness, in terms of health benefits, is a composite of efficacy and adherence. Oral appliance (OA) usage is mainly based on self-reports, but nowadays, objective adherence monitoring for OAs is available. This study investigated the objective OA adherence and its determinants in obstructive sleep apnoea (OSA) patients.
There were 29 subjects who were treated with OA; mean [SD] age 51.4 [11.1]; mean apnoea-hypopnoea index (AHI) [SD] 19.5 [10.0]. Anthropometric and sociodemographic parameters, AHI, daytime sleepiness, snoring, and adverse effects of OA as potential determinants were evaluated. Patients were classified as regular users if they wore OA at least 4 hours nightly 5-7 nights a week. Statistical analyses included the chi-square test, t-test, Mann-Whitney U-test, and linear regression analyses.
At the 3-month follow-up, 68% of subjects were regular users and at 12-month follow-up, 64%. AHI, sociodemographic parameters, or adverse effects were not associated with OA adherence. Snoring seemed to improve weakly adherence, whereas mandibular retrusion reduced the weekly use, and smoking the nightly use of OAs.
The follow-up time was short, and there were a relatively small number of patients with obtainable adherence data, therefore it is difficult to establish if OA therapy alone is a successful long-term treatment option for OSA patients.
CONCLUSIONS/IMPLICATIONS: Adherence to OA therapy is mainly the outcome of patients' subjective comfort in everyday life through eliminating social disturbance of snoring. To best meet a subject's individual treatment need and to prevent suboptimal use of OA, a patient-tailored therapy including digital wear-time documentation is recommended.
治疗效果（健康获益）是疗效和依从性的综合体现。口腔矫治器（OA）的使用主要基于自我报告，但如今，OA 的客观依从性监测已经可用。本研究旨在调查阻塞性睡眠呼吸暂停（OSA）患者的 OA 客观依从性及其决定因素。
共有 29 名接受 OA 治疗的患者；平均（标准差）年龄 51.4（11.1）岁；平均呼吸暂停低通气指数（AHI）（标准差）19.5（10.0）。评估了人体测量学和社会人口学参数、AHI、日间嗜睡、打鼾和 OA 的不良反应等潜在决定因素。如果患者每周至少 5-7 天每晚佩戴 OA 4 小时以上，则将其归类为规律使用者。统计分析包括卡方检验、t 检验、Mann-Whitney U 检验和线性回归分析。
在 3 个月的随访中，68%的患者为规律使用者，在 12 个月的随访中，64%的患者为规律使用者。AHI、社会人口学参数或不良反应与 OA 依从性无关。打鼾似乎与弱依从性相关，而下颌后缩减少了每周的使用，吸烟则减少了每晚使用 OA 的次数。
随访时间较短，且可获得依从性数据的患者数量相对较少，因此难以确定 OA 治疗是否是 OSA 患者成功的长期治疗选择。
结论/意义：OA 治疗的依从性主要是患者通过消除打鼾对社交的干扰，在日常生活中主观舒适的结果。为了最大程度地满足患者的个体治疗需求并防止 OA 使用不当，建议采用包括数字佩戴时间记录在内的个体化治疗。
