影响成人阻塞性睡眠呼吸暂停患者口腔矫治器治疗依从性的因素：系统评价和荟萃分析。
Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea: a systematic review and meta-analysis.
机构信息
Department of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, London, United Kingdom.
Department of Population and Patient Health, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom.
出版信息
J Clin Sleep Med. 2021 Jul 1;17(7):1485-1498. doi: 10.5664/jcsm.9184.
STUDY OBJECTIVES
The review aimed to identify the factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea.
METHODS
The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615) prior to undertaking a comprehensive electronic search of databases and references without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool.
RESULTS
Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, and psychological and social factors on adherence levels was also assessed. There was a total of 31 included studies, which consisted of 8 randomized controlled trials, 2 controlled clinical trial, 7 prospective cohorts, 11 retrospective cohorts, and the remaining 3 studies were a case-series, case-control, and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66) and low levels of heterogeneity (I² = 0%).
CONCLUSIONS
A weak relationship was observed between objective adherence and patient and disease characteristics, such as age, sex, obesity, apnea-hypopnea index, and daytime sleepiness, to oral appliance therapy. Nonadherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first 3 months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative to examine the relationship between psychosocial factors and adherence to oral appliance therapy.
研究目的
本次综述旨在确定影响成人阻塞性睡眠呼吸暂停患者口腔矫治器治疗依从性的因素。
方法
在进行全面的电子数据库和参考文献检索时，不限制语言和日期，该研究方案最初在国际系统评价注册库（PROSPERO：CRD42019122615）进行了注册。使用 Cochrane 协作风险偏倚工具和预后研究质量工具（QUIPS）对质量进行评估。
结果
研究在各自质量评估工具评估的领域中显示出低或不明确的偏倚风险。还评估了独立变量（如疾病特征、患者特征、矫治器特征以及心理和社会因素）对依从性水平的影响。共有 31 项研究纳入其中，包括 8 项随机对照试验、2 项对照临床试验、7 项前瞻性队列研究、11 项回顾性队列研究，其余 3 项研究分别为病例系列研究、病例对照研究和混合方法研究。所有 31 项纳入研究均进行了定性分析，仅有 4 项研究进行了定量分析。荟萃分析的结果表明，定制矫治器的依从性更高，平均差异为-1.34（-2.02 至-0.66），异质性水平低（I²=0%）。
结论
客观依从性与患者和疾病特征（如年龄、性别、肥胖、呼吸暂停低通气指数和日间嗜睡）之间观察到弱相关。不依从的患者报告使用口腔矫治器的副作用比使用者更多，并且往往在治疗的前 3 个月内停止治疗。与成品矫治器相比，定制口腔矫治器更受患者青睐，且依从性更高。进一步的研究对于检验口腔矫治器治疗依从性与心理社会因素之间的关系至关重要。
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