抄録
Objectives: The apnea-hypopnea index（AHI）is used to determine the therapeutic effect of an oral appliance（OA）on obstructive sleep apnea（OSA）. Even if the improvement in AHI is inadequate, the subjective symptoms of patients may improve. In addition to the medical judgment of the treating physician, it is important to consider the patient’s values and preferences together as the patient and the treating physician make joint decisions. Recently, studies on the values and preferences of treatment results（outcomes）of patients with various diseases have been reported, but there are still few studies on OA treatment for OSA. The aim of this prospective observational study was to investigate the values and preferences of patients for OSA treatment with OA by using a questionnaire survey.
Methods: From October 2018 to September 2019, 61 OSA patients planning to undergo OA treatment were surveyed by a questionnaire on therapeutic effects before the start of treatment. The following 11 items were scored by visual analogue scale（VAS）and evaluated: 1）health and longevity, 2）prevention of onset and exacerbation of heart disease, 3）prevention of onset and exacerbation of hypertension, 4）prevention of onset and exacerbation of diabetes, 5）improvement of apnea/hypopnea, 6）improvement of daytime sleepiness, 7）improvement of nighttime arousal, 8）improvement of snoring, 9）refreshment upon awakening, 10）improvement of thirst at night and when waking up, and 11）improvement of bed partner sleep. Statistical analysis was performed on the relationship between each score and patient information, duration of OSA, medical history, and polysomnography results.
Results: Among outcomes 1）to 11）, the highest mean scores were, in descending order, 5）improvement of apnea/hypopnea, 8）improvement of snoring, and 11）improvement of bed partner sleep, and the lowest mean scores were related to complications. Women emphasized items related to complications, especially those related to their medical history. In the group with poor sleep efficiency, the results were of high interest in 2）prevention of onset and exacerbation of heart disease and 11）improvement of bed partner sleep. In the group with severe oxygen desaturation, interest was low in 4）diabetes and 7）improvement of nighttime arousal. No significant relevance to the questionnaire results was found in any of the other items.
Conclusion: The findings of this study suggest that patients planning to undergo treatment with OA are mainly moderate and mild cases of OSA, and place more importance on improvement of subjective symptoms such as snoring than on improvement of prognosis and medical disease. On the other hand, since patients do not have sufficient medical knowledge related to OSA, there is a concern that they may have responded with a poor understanding of the intent of this questionnaire survey. Further study of this aspect is warranted.
