軽度から中等度の閉塞性睡眠時無呼吸患者における歯科装置またはUPPPによる治療のQOL評価。前向き無作為化1年追跡研究

Quality of life assessment of treatment with dental appliance or UPPP in patients with mild to moderate obstructive sleep apnoea. A prospective randomized 1-year follow-up study.

抄録

この研究の目的は、介入前と歯科装置または口蓋垂口蓋咽頭形成術（UPPP）による治療1年後の活力、満足感、睡眠の3つのQOL（Quality of Life）次元の変化を評価すること、これら3つの次元に対するこれら2つの治療群間の治療効果を比較すること、およびQOLスコアと体表検査値との関係を明らかにすることである。軽度から中等度の閉塞性睡眠時無呼吸（OSA）患者95人（AI > 5）を、歯科装具治療群とUPPP治療群のいずれかに無作為に割り付けた。7人の患者が無作為化後、治療前に離脱し、88人の患者が治療対象となった。介入前と介入1年後に、患者をソムノグラフィーで検査し、QOL質問票であるMSE-P（Minor Symptoms Evaluation-Profile）を実施した。歯科器具群では37人、UPPP群では43人の患者が1年間の追跡調査を完了した。活力、満足感、睡眠の3項目の平均値は、歯科装置群とUPPP群で介入1年後に有意に改善した。ベースライン時のQOLスコアに群間差は認められなかった。介入から1年後、UPPP群は歯科器具群よりも満足感が有意に高かった。一方、活力と睡眠に関しては、両群間に差はみられなかった。QOLスコアと体温測定値との間に有意な相関は認められなかった。結論として、QOLは介入1年後に歯科装置群とUPPP群で有意に改善した。しかし、歯科装置群はUPPP群より満足度が低く、ソムノグラフィ値はUPPP群の方が優れていた。

The objectives of this study were: to evaluate the change in the three quality of life (QOL) dimensions of vitality, contentment and sleep before intervention and 1 year after treatment with a dental appliance or uvulopalatopharyngoplasty (UPPP); to compare the effect of treatment between these two treatment groups on these three dimensions; and to determine the relation between the QOL scores and somnographic values. Ninety-five patients with mild to moderate obstructive sleep apnoea (OSA) (AI > 5) were randomly allocated to either a dental appliance or UPPP treatment group. Seven patients withdrew after randomization but before treatment, leaving 88 patients eligible for treatment. The patients were examined using somnography and administered the Minor Symptoms Evaluation-Profile (MSE-P), a QOL questionnaire, before and 1 year after intervention. Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 1-year follow-up. The mean values for the three dimensions vitality, contentment and sleep improved significantly 1 year after intervention in the dental appliance and UPPP groups. No difference in the QOL scores at baseline was noted between the groups. One year after intervention the UPPP group showed significantly more contentment than the dental appliance group. In contrast, vitality and sleep dimensions did not differ between the two treatment groups. No significant correlations were observed between the QOL scores and somnographic values. In conclusion, quality of life improved significantly in the dental appliance and UPPP groups 1 year after intervention. However, the dental appliance group showed a lower level of contentment than the UPPP group, even though the somnographic values were superior in the former group.