规范化健康教育在提高自行调节式口腔矫治器治疗OSAHS患者依从性方面的研究
【摘要】
目的：探讨通过规范化健康教育提高阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）患者使用自行调节式口腔矫治器（self-adjusting oral appliance，SOA）治疗依从性的效果。
方法：研究纳入60例经PSG监测为轻、中度的OSAHS患者，随机分入实验组和对照组，两组患者均使用SOA治疗OSAHS。实验组的患者采用规范化健康教育施教，对照组的患者采用传统健康教育方式施教。使用多导睡眠监测（PSG）评价疗效；健康教育效果评价采用根据睡眠呼吸暂停知识问卷（the apnea knowledge test，AKT）自行设计的“OSAHS睡眠呼吸暂停知识测验（SOA版）”进行评价；依从性客观评价标准采用临床依从性量表（CCE）；依从性主观评价标准采用Morisky测量表（MG）自制量表。实验组和对照组患者在戴用SOA治疗前一周进行施教前后OSAHS健康教育效果评价；在治疗前1周及治疗后1、6个月通过多导睡眠监测行评价SOA的疗效；在治疗后1个月、3个月、6个月分别填写临床依从性量表（CCE）和Morisky测量表（MG）自制量表评价依从性。其中Morisky测量表（MG）自制量表由患者填写，临床依从性量（CCE）表由医师填写。对所获资料采用SPSS24.0进行统计学分析，以P<0.05差异有统计学意义。
结果：施教前后，实验组和对照组“OSAHS睡眠呼吸暂停知识测验（SOA版）”健康教育效果评价得分比较差异有统计学意义（P<0.05）；治疗前与治疗1个月后PSG监测疗效指标AHI下降率为实验组（52.71±9.19）%，对照组为（53.93±10.15）%，两组均有疗效且差异无统计学意义（P＞0.05），治疗后6个月PSG监测指标之间组间比较差异性显著（P<0.05）；治疗后1个月、3个月、6个月分别行依从性评价结果为：临床依从性量表（CCE）显示实验组随治疗时间变长，口腔卫生、复诊时间、矫治器的维护三个依从性指标下降差异无统计学意义（P>0.05），矫治器的佩戴指标下降差异具有统计学意义（P<0.05）；对照组随治疗时间变长，复诊时间和矫治器的佩戴两指标差异具有统计学意义（P<0.05），其余指标下降无统计学意义（P>0.05）；组间比较治疗后3、6个月时复诊时间和矫治器的佩戴两指标差异有统计学意义（P<0.05）；Morisky测量表（MG）自制量表显示实验组随治疗时间变长，依从性指标得分下降差异具有统计学意义（P<0.05），对照组随治疗时间变长依从性指标得分下降差异具有统计学意义（P<0.05），组间比较依从性指标得分差异有统计学意义（P<0.05）。
结论：实验组的规范化健康教育手段的施教效果要好于对照组的传统健康教育手段；SOA对实验组和对照组均有疗效，且疗效相当无差异性；随着治疗时间的变长，实验组和对照组的依从性都有下降，但实施规范化健康教育手段的实验组的依从性要好于实施传统健康教育手段的对照组。
【关键词】规范化健康教育；自行调节式口腔矫治器（SOA）；阻塞性睡眠呼吸暂停低通气综合征（OSAHS）；依从性
Research on the improvement of compliance of OSAHS patients with Self-adjusting Oral Appliance through standardized health education
ABSTRACT
Objective：To investigate the effect on the improvement of compliance of OSAHS patients with Self-adjusting Oral Appliance through standardized health education.
Methods：Sixty patients with mild and moderate OSAHS monitored by PSG were randomly divided into experimental group and control group.Both groups were treated with SOA.The patients in the experimental group were taught by standardized health education，while the patients in the control group were taught by the traditional health education method.PSG was used to evaluate the therapeutic effect；The effect of health education was evaluated by“OSAHS Sleep apnea knowledge Test（SOA version）”，selfdesigned by the apnea knowledge Test（AKT）；The objective evaluation index of compliance was measured by clinical compliance scale，and the subjective evaluation index of compliance was measured by Morisky self-made scale.The effect of OSAHS health education before and after teaching was evaluated in the experimental group and the control group one week before the treatment；The efficacy of SOA was evaluated by polysomnography one week before treatment and one month after treatment；One month，three months and six months after treatment，patients and physicians filled out the clinical compliance scale（CCE）and the Morisky self-made scale to evaluate compliance.The self-made Morisky scale was filled out by the patient and the clinical compliance scale was filled out by the physician.The data were analyzed by SPSS24.0，and P<0.05 was considered to be statistically significant.
Results：Before and after teaching，the scores of health education effect evaluation in the experimental group and the control group were significantly different from those in the control group（P<0.05）through the OSAHS Sleep apnea knowledge Test（SOA version）；Before and after 1 month of treatment，the decrease rate of AHI was（52.71±9.19）%in the experimental group and（53.93±10.15）%in the control group，respectively，there was no significant difference between the two groups（P>0.05）.Six months after treatment，there was a significant difference in PSG monitoring between groups（P<0.05）.One month，three months and six months after treatment，the results of compliance evaluation were as follows:The clinical compliance scale（CCE）showed that there was no significant difference between the three compliance indexes of the experiental group（P>0.05），such as“oral hygiene”，“revisiting time”，“appliance maintenance”，but the difference of the“wear of the appliance”was statistically significant（P<0.05）.In the control group，there was a significant difference between the two indexes of“revisiting time”and“wearing of appliance”（P<0.05），but there was no significant difference in the other indexes（P>0.05）.At 3 and 6 months after treatment，there was a significant difference between the two indexes of“time of re-examination”and“wearing of appliance”between the two groups（P<0.05）；The self-made Morisky scale showed that the scores of compliance index had statistical significance in the experimental group and the control group（P<0.05），there was significant difference in the scores of compliance index between groups（P<0.05）.
Conclusion：The effect of standardized health education in the experimental group was better than the traditional health education in the control group.There was no difference in the efficacy of SOA between the experimental group and the control group，and the compliance of the experimental group and the control group decreased with the increase of the treatment time.But the compliance of the experimental group was better than that of the control group.
Key words：Standardized health education；self-adjusting oral appliance（SOA）；obstructive sleep apnea hypopnea syndrome（OSAHS）；compliance