***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The aim of this study was to evaluate the association between respiratory disorders and sleep bruxism , with an evaluation of demographic/socioeconomic factors and childhood stress as confounding variables . Methods A cross-sectional study was performed in the city of Diamantina , Brazil , with 448 r and omly selected schoolchildren aged 8 to 11 years . The schoolchildren underwent an oral examination for the evaluation of  bruxism . Parents/caregivers answered a question naire for the assessment of  sleep bruxism ; socioeconomic-demographic factors ; and respiratory disorders , such as rhinitis , sinusitis , and bronchitis . The schoolchildren filled out the Children ’s Stress Scale . Poisson regression models were constructed separately for each respiratory disorder to determine prevalence ratios ( PRs ) and 95 % confidence intervals ( CIs ) . Results Sleep bruxism was more prevalent among children with rhinitis ( PR = 1.45 ; 95%CI 1.08–1.93 ; p = 0.012 ) and sinusitis ( PR = 1.58 ; 95%CI 1.06–2.36 ; p = 0.023 ) . No significant association was found between sleep bruxism and bronchitis . A greater frequency of sleep bruxism was found among children whose mothers had a higher level of schooling and those who reported stress in the resistance/exhaustion phase . Conclusion Rhinitis and sinusitis were associated with sleep bruxism . Moreover , sleep bruxism was more prevalent among children whose mothers had a higher level of schooling and those with higher degrees of stress OBJECTIVES To inform the debate over whether human sleep can be chronically reduced without consequences , we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation . DESIGN The chronic sleep restriction experiment involved r and omization to one of three sleep doses ( 4 h , 6 h , or 8 h time in bed per night ) , which were maintained for 14 consecutive days . The total sleep deprivation experiment involved 3 nights without sleep ( 0 h time in bed ) . Each study also involved 3 baseline ( pre-deprivation ) days and 3 recovery days . SETTING Both experiments were conducted under st and ardized laboratory conditions with continuous behavioral , physiological and medical monitoring . PARTICIPANTS A total of n = 48 healthy adults ( ages 21 - 38 ) participated in the experiments . INTERVENTIONS Noctumal sleep periods were restricted to 8 h , 6 h or 4 h per day for 14 days , or to 0 h for 3 days . All other sleep was prohibited . RESULTS Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days result ed in significant cumulative , dose-dependent deficits in cognitive performance on all tasks . Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days , and did not significantly differentiate the 6 h and 4 h conditions . Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis -- displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights . Comparison of chronic sleep restriction to total sleep deprivation showed that the latter result ed in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost . A statistical model revealed that , regardless of the mode of sleep deprivation , lapses in behavioral alertness were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h ( s.e . 0.73 h ) . CONCLUSIONS Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation , it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults . Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits , which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign . Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses , but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions . This suggests that sleep debt is perhaps best understood as result ing in additional wakefulness that has a neurobiological " cost " which accumulates over time OBJECTIVE To examine the independent and combined associations of sleep duration and sleep quality with hypertension in a middle-aged and older Chinese population . METHODS We included 21,912 individuals aged 62.2 years at baseline from September 2008 to June 2010 , and they were followed until October 2013 .  Sleep duration was self-reported and sleep quality was evaluated with questions design ed according to the Pittsburgh Sleep Quality Index . Hypertension was defined as blood pressure ≥140/90 mmHg , or self-reported physician diagnosis of hypertension , or self-reported current use of antihypertensive medication . RESULTS In the cross-sectional analyses , the odds ratio of hypertension prevalence was significantly elevated ( OR = 1.13 , 95 % CI = 1.03 - 1.24 ) in those who slept less than 7 h after adjusting for sex , age , body mass index , midday napping , cigarette smoking and sleep quality . It was particularly evident among males ( OR = 1.19 , 95 % CI = 1.01 - 1.40 ) and individuals who were thin ( OR = 2.00 , 95 % CI = 1.01 - 3.93 ) with full adjustment . The association was also found for sleep duration of 9∼<10 h after adjusting various covariates ( OR = 1.14 , 95 % CI = 1.04 - 1.27 ) . In addition , impaired sleep quality was only associated with hypertension in obese individuals ( OR = 1.25 , 95 % CI = 1.02 - 1.50 ) , not in other subgroups . However , no significant association was detected in any category of sleep duration or sleep quality in all models in the prospect i ve analyses , and the results remained unchanged in the subgroup analyses of sex , age and body mass index . CONCLUSIONS The results of this study provide limited support for association of sleep duration and sleep quality with hypertension in middle-aged and older Chinese . Further studies are needed to confirm the results Background and objective The obstructive sleep apnea ( OSA ) is a common respiratory disorder in children , especially those at preschool and school ages . This study aim ed to describe the characteristics of asthmatic children with OSA and the symptoms for a high risk of OSA . Subjects and methods It was a prospect i ve and descriptive study . The data of asthmatic children including medical history , clinical examination , blood tests , spirometry , exhaled nitric oxide ( NO ) , and respiratory polygraphy  were registered for analyses . Results Eighty-five asthmatic children with a mean age of 9.5 ± 2.1 years were included . The prevalence of OSA was 65.9 % ( 56/85 ) in study subjects . The prevalence of severe OSA in children with moderate asthma was significantly higher than intermittent and mild asthma . The percentage of asthmatic children with OSA who had snoring , sleep disturbance , and nocturnal sweats was significantly higher than that of asthmatic children without OSA ( 48.2 % vs 17.2 % , 71.4 % vs 27.5 % , and 55.1 % vs 31.0 % , respectively ) . The presence of allergic rhinitis and snoring was associated significantly with a high probability for the presence of OSA . Conclusion Children with asthma have a risk of OSA . Asthmatic children with suggested symptoms such as snoring or waking up at night should be screened for OSA Background Sleep disorders are often underreported to physicians by patients with allergies . This study aim ed to characterize the sleep disorders associated with respiratory allergy to  house dust mites ( HDM ) at the time of initiation of sublingual allergen immunotherapy ( SLIT ) in routine clinical practice . Methods This prospect i ve , cross-sectional , observational study was conducted between November 2014 and March 2015 at 189 French trial sites and included 1750 participants suffering from HDM allergy who were initiating SLIT . Participants aged less than 5 years old and those who had previously started an allergen immunotherapy ( AIT ) for HDM allergy were not enrolled in the study . Sleep disorders were assessed by self-administered question naires : the Epworth Sleepiness Scale ( ESS ) , the Insomnia Severity Index ( ISI ) and a modified version of the Hotel Dieu-42 ( HD-42 ) sleep disorder question naire . Logistic regression models adjusted for obesity , smoking status , asthma control and nasal obstruction were used to study the relationship between allergic rhinitis ( AR ) classification and sleep disorders/complaints . Results Of the 1786 participants enrolled , 1750 ( 907 adults and 843 children ) composed the analysis population . The majority of participants ( 73.5 % of adults and 65.8 % of children ) reported that their sleep disorders had prompted them to consult their physician . The most commonly observed sleep complaints were poor- quality sleep ( 50.3 % of adults and 37.3 % of children ) , snoring ( 48.1 and 41.4 % , respectively ) and nocturnal awakening ( 37.6 and 28.2 % , respectively ) . Difficulties falling asleep were reported by 27.0 % of adults and 24.7 % of children . Adults and children suffering from severe persistent AR experienced sleep complaints significantly more often than participants with intermittent or mild persistent AR . Conclusions This study highlights the high frequency of sleep disorders and their significant impact on patients with AR induced by HDM , in particular when AR is persistent and severe . Consequently , asking allergic patients about the quality of their sleep appears to be important , especially when the patient has persistent and severe AR Objective : To estimate the prevalence of symptoms of obstructive sleep apnea ( OSA ) , nasal obstruction , and enuresis in children with nonsyndromic unilateral cleft lip and palate . Design : Prospect i ve cross-sectional study . Setting : Referral care center . Participants : One hundred seventy-four children aged 6 to 12 years of both genders . Interventions : Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the  Sleep Disturbance Scale for Children ( SDSC ) and Congestion Quantifier ( CQ-5 ) . Enuresis was considered as present when urinary loss was reported during sleep ( at least 1 episode/month , last 3 months ) . To characterize the enuresis as mono- or polysymptomatic , symptoms of dysfunction of the lower urinary tract ( DLUT ) were investigated by the Dysfunctional Voiding Scoring System ( DVSS ) . Statistical analysis was performed at a 5 % level of significance . Results : Positive SDSC scores for OSA were observed in 60 ( 34 % ) children ; positive CQ-5 scores for nasal obstruction in 45 ( 26 % ) , positive DVSS scores for DLUT in 30 ( 17 % ) , and enuresis was reported by 29 ( 17 % ) , being categorized as primary in 66 % and polysymptomatic in 72 % of the children . Compared to the pediatric population , OSA , nasal obstruction , and enuresis prevalence ratios were up to 7 ( 95 % confidence interval [ CI ] 5 - 9 ) , 2 ( 95 % CI 2 - 3 ) , and 3 times ( 95 % CI 2 - 5 ) higher , respectively . There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001 ) . No correlation was seen between symptoms of OSA and enuresis . Conclusions : Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence BACKGROUND Allergic rhinitis ( AR ) is a frequent disease affecting up to 20 % of the population . AR causes a hypersensitivity reaction , which results in inflamed nasal mucosa and nasal congestion . Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse , airway obstruction , and an increased number of sleep microarousals . Sleep disturbances and microarousals can detrimentally affect daytime energy levels , mood , and daytime function . It is unknown whether treatment directed to reduce congestion may reduce these microarousals , sleep problems , and , consequently , associated daytime fatigue . OBJECTIVE We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints 
    Output:
    
Patients with allergic rhinitis presented with significantly higher sleep quality scores , sleep disturbances scores , and sleep latency scores ; more frequent use of sleep medications ; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography .
Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions , including insomnia , nocturnal enuresis , restless sleep , sleep-disordered breathing , obstructive sleep apnea , and snoring .
Meta- analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction , including difficulty waking up , daytime sleepiness , morning headache , and the use of sleep medications .
This study demonstrates that there is a significant association of AR with sleep characteristics