Chen Yanlong, Pliska Benjamin T, Zou Bingshuang, Almeida Fernanda R
Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
Eur J Orthod. 2025 Jun 12;47(4). doi: 10.1093/ejo/cjaf037.
Oral appliance (OA) therapy is widely used as an alternative to continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnea (OSA). Traditionally, OA adherence has been assessed through subjective self-reports before, but the availability of objective adherence sensors now allows for more accurate monitoring. This study aimed to analyze one-year objective adherence data to identify adherence patterns over time and factors influencing adherence to OA therapy.
Fifty-five OSA patients were recruited from a cohort study and underwent clinical follow-ups at baseline, 1, 6 and 12 months. Patients were treated with custom-made, titratable OAs, and adherence was objectively collected using embedded sensors. Adherence data were analyzed using both intention-to-treat (ITT) and per-protocol (PP) approaches. Statistical methods, including comparative analyses, logistic regression models, and multivariate linear regression were performed to identify predictors of adherence.
Twenty-one patients dropped out before the 12-month follow-up, leaving 34 completed the entire study. At the 1-month follow-up, 80.0% of patients were classified as adherent, with a mean wearing time of 5.98 ± 2.38 hours per night. By 6 months, adherence decreased to 67.3%, with a mean wearing time of 5.69 ± 2.08 hours per night. Several significant predictors of adherence were identified, including larger baseline overjet, younger age, and marital status.
OA adherence declined significantly within the first 6 months but stabilized between 6 and 12 months. Key baseline factors, such as larger overjet, younger age, and being married or partnered are predictors of better adherence, while psychological Comorbidities are associated with lower adherence.
口腔矫治器（OA）疗法作为持续气道正压通气（CPAP）疗法的替代方法，被广泛用于治疗阻塞性睡眠呼吸暂停（OSA）。传统上，OA的依从性是通过主观自我报告来评估的，但现在客观依从性传感器的出现使得更准确的监测成为可能。本研究旨在分析一年的客观依从性数据，以确定随时间变化的依从模式以及影响OA疗法依从性的因素。
从一项队列研究中招募了55名OSA患者，并在基线、1个月、6个月和12个月进行了临床随访。患者接受定制的、可滴定的OA治疗，并使用嵌入式传感器客观收集依从性数据。依从性数据采用意向性分析（ITT）和符合方案分析（PP）两种方法进行分析。采用包括比较分析、逻辑回归模型和多元线性回归在内的统计方法来确定依从性的预测因素。
21名患者在12个月随访前退出，34名患者完成了整个研究。在1个月的随访中，80.0%的患者被归类为依从，平均每晚佩戴时间为5.98±2.38小时。到6个月时，依从性降至67.3%，平均每晚佩戴时间为5.69±2.08小时。确定了几个依从性的重要预测因素，包括更大的基线覆盖、更年轻的年龄和婚姻状况。
OA依从性在最初6个月内显著下降，但在6至12个月之间稳定。关键的基线因素，如更大的覆盖、更年轻的年龄以及已婚或有伴侣，是依从性更好的预测因素，而心理合并症与较低的依从性相关。
