两种口腔矫治器治疗OSAHS患者的依从性比较
【摘要】
目的：采用多导睡眠监测（PSG）、Epworth嗜睡评分量表（ESS）、临床依从性量表（CCE）及Morisky测量表（MG）自制量表，比较与评价自行调节式口腔矫治器与改良Activator矫治器治疗OSAHS患者的依从性。
方法：研究纳入60例轻、中度OSAHS患者，随机分入实验组和对照组。实验组患者戴用自行调节式口腔矫治器进行治疗，对照组患者戴用改良Activator口腔矫治器进行治疗。客观评价标准为多导睡眠监测（PSG）、临床依从性量表，主观评价标准为Epworth嗜睡评分量表及Morisky测量表（MG）自制量表。治疗前一周患者做多导睡眠监测并填写Epworth嗜睡量表，治疗3个月后再次做多导睡眠监测并填写Epworth嗜睡量表、临床依从性量表和Morisky测量表（MG）自制量表。其中Epworth嗜睡量表和Morisky测量表（MG）自制量表由患者填写，临床依从性量表由医师填写。把各量表评分数据录入SPSS并进行统计学分析，以P<0.05为差异有统计学意义。
结果：实验组AHI治疗后下降了（5.32±3.97），LSaO2升高了（4.51±2.20），差异有统计学意义（P<0.05）。对照组AHI治疗后下降了（6.48±3.81），LSaO2升高了（6.09±3.06），差异有统计学意义（P<0.05）。实验组ESS评分在戴用自行调节式口腔矫治器治疗后比治疗前减少（6.27±3.03），差异具有统计学意义（P<0.05）。对照组ESS评分在戴用改良Activator口腔矫治器治疗后比治疗前减少（5.03±2.27），差异具有统计学意义（P<0.05）。实验组OSAHS患者治疗前后ESS评分变化与对照组的评分变化差异无统计学意义（P>0.05）。表3结果显示：实验组“口腔卫生”依从性好的患者占76.67%，对照组“口腔卫生”依从性好的患者占73.33%；实验组“复诊时间”依从性好的患者占83.33%，对照组“复诊时间”依从性好的患者占66.67%；实验组“矫治器的维护”依从性好的患者占70.00%，对照组“矫治器的维护”依从性好的患者占86.67%；实验组“矫治器的佩戴”依从性好的患者占80.00%，对照组“矫治器的维护”依从性好的患者占50.00%，两组患者在依从性分类构成上无显著性差异（P>0.05）。表4结果显示：依从性良好的患者在实验组中占了73.33%，对照组依从性良好的患者占53.33%，两组的依从性无显著性差异（P>0.05）。
结论：戴用自行调节式口腔矫治器与改良Activator口腔矫治器患者的依从性均较好。自行调节式口腔矫治器与改良Activator口腔矫治器同样有效，是治疗轻、中度OSAHS的有效方法。
【关键词】自行调节式口腔矫治器；改良Activator口腔矫治器；阻塞性睡眠呼吸暂停低通气综合征；依从性
The comparison of two kinds of oral appliances compliance in patients with OSAHS(https://www.daowen.com)
Abstract
Objective：Using the polysomnography（PSG），Epworth sleepiness scale（ESS），clinical compliance scale（CCE），the Morisky measurement table（MG）and self-made questionnaire，to evaluate patient compliance of the self adjustable oral appliance and the modified Activator appliance.
Methods：The study included 60 patients with mild and moderate OSAHS，who were randomly divided into experimental group and control group.The experimental group were treated with the self-adjustable oral appliance while patients of control group were treated with the modified activator appliance.Objective evaluation criteria for polysomnography（PSG），clinical compliance scale，subjective evaluation criteria for the Epworth sleepiness scale and Morisky measurement table（MG）self-made scale.A week before treatment patients were asked to do the polysomnography and fill out the Epworth sleepiness scale，After 3 months treatment，the Epworth sleepiness scale，clinical compliance scale and Morisky scale（MG）were completed and the polysomnography has been done.Among them，ESS scale and Morisky measurement table self-made scale was completed by patients，The clinical compliance questionnaire was completed by the physician.According to the data for statistical analysis，there were statistically significant differences when P<0.05.
Results：The experimental group AHI after treatment decreased（5.32±3.97）；LSaO2 was increased（4.51±2.20），the difference was statistically significant（P<0.05）.The control group AHI after treatment decreased（6.48±3.81）；LSaO2was increased（6.09±3.06），the difference was statistically significant（P<0.05）.The ESS score of the experimental group was lower than before treatment（6.27±3.03），with statistical difference（P<0.05）.The control group OSAHS patients ESS score than before treatment decreased（5.03±2.27），with statistical difference（P<0.05）.There was no statistical difference in the ESS score between the experimental group and the control group before and after treatment（P>0.05）.Table 3 results showed that：the experimental group oral hygiene compliance of patients accounted for 76.67%，the control group oral hygiene compliance of patients accounted for 73.33%.The experimental group of referral patients with good compliance，accounting for 83.3%.The control group of referral patients with good compliance，accounting for 66.67%.The experimental group appliance maintenance good compliance patients accounted for 70%.The control group appliance maintenance good compliance patients accounted for 86.67%.The experimental group appliance wear good compliance patients accounted for 80%.The control group appliance maintenance good compliance patients accounted for 50%.There was no significant difference between the experimental group and the control group（P>0.05）.Table 4 the results showed that：the experimental group with good compliance patients accounted for 73.33%，patients with good compliance of the control group accounted for 53.33%.There was no significant difference between the experimental group and the control group（P>0.05）.
Conclusion：The compliance of the self adjustable oral appliance and improved Activator appliance are good.The Self adjustable oral appliance and modified activator oral appliance equally effective，is the effective method to treat mild or moderate OSAHS.
Key words：The self adjustable oral appliance；Modified Activator oral appliance；Obstructive sleep apnea hypopnea syndrome；Compliance