***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: OBJECTIVES /HYPOTHESIS The effect of the Pillar implant on  mild sleep-disordered breathing ( SDB ) has been assessed in various studies . However , most of these were conducted among a non-Asian population at a single institution . Therefore , the aim of this study was to prospect ively evaluate the efficacy of the Pillar implant in Asian patients with simple snoring and mild obstructive sleep apnea ( OSA ) at multiple centers . STUDY DESIGN Multicenter prospect i ve clinical trials . METHODS This study included consecutive subjects with simple snoring or mild OSA . We examined subjective symptoms ( snoring intensity , frequency , witnessed apnea , and daytime sleepiness ) and objective snoring and respiratory parameters ( snoring duration [ proportion of sleep while snoring louder than 50 dB ] , snoring loudness , apnea-hypopnea index , respiratory disturbance index , minimum arterial oxygen saturation , and oxygen desaturation index ≥ 4 % ) at 3 to 6 months after surgery . Adverse events were also investigated . RESULTS Twenty-nine subjects with mild SDB completed the study . Whole group analysis found significant improvements in various subjective symptoms , but not in the objective snoring and respiratory parameters . A subgroup analysis of subjects with mild OSA ( n = 11 ) found significant alleviation in various subjective symptoms , apnea-hypopnea index , respiratory disturbance index , and oxygen desaturation index ≥ 4 % . No major complication related to surgery was observed , and most minor adverse effects were resolved without morbidity . CONCLUSIONS In selected Korean patients , the Pillar implant significantly improved not only subjective symptoms of mild SDB but also respiratory disturbances in mild OSA . LEVEL OF EVIDENCE 2b BACKGROUND Limited data have suggested that sleep-disordered breathing , a condition of repeated episodes of apnea and hypopnea during sleep , is prevalent among adults . Data from the Wisconsin Sleep Cohort Study , a longitudinal study of the natural history of cardiopulmonary disorders of sleep , were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health . METHODS A r and om sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep ( the apnea-hypopnea score ) . We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score ( > or = 5 , > or = 10 , and > or = 15 ) ; we used logistic regression to investigate risk factors . RESULTS The estimated prevalence of sleep-disordered breathing , defined as an apnea-hypopnea score of 5 or higher , was 9 percent for women and 24 percent for men . We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome ( an apnea-hypopnea score of 5 or higher and daytime hypersomnolence ) . Male sex and obesity were strongly associated with the presence of sleep-disordered breathing . Habitual snorers , both men and women , tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher . CONCLUSIONS The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women . Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence OBJECTIVE We sought to find a combination of noninvasive treatments for snoring by adding weight loss to previously studied treatments , including the combination of sleeping on one 's side and using a decongestant nasal spray . STUDY POPULATION Twenty asymptomatic men who snore heavily were studied previously on a control night and on a night when they slept on their side and used a nasal spray . With these two treatments , minor improvements in apnea/hypopnea index ( AHI ) were seen , but no improvement occurred in snoring frequency .  Nineteen of these subjects subsequently completed a 6-month weight loss program , and 12 lost weight . These 19 subjects comprise the study population of this report . STUDY DESIGN At the conclusion of the weight loss program , a repeated sleep study was done from which the effect of adding weight loss to the two previously studied treatments could be assessed . RESULTS Those 12 subjects who lost any amount of weight showed a very mild reduction in snores per hour from 328 using two modalities of treatment to 232 per hour with the addition of weight loss ( p = 0.15 ) . The nine subjects who lost > or = 3 kg reduced the number of snores per hour from 320 to 176 ( p = 0.0496 ) . Three subjects losing an average of only 7.6 kg showed virtual elimination of snoring after weight loss . Subjects who gained weight had no improvement in snoring . Weight loss added to the other two modalities of treatment had no effect on the AHI . CONCLUSION In most cases , the combination of weight loss , sleeping on one 's side , and the administration of a nasal decongestant significantly reduces the frequency of snoring in asymptomatic men who snore heavily . The major effect appears to be related to weight loss OBJECTIVE The aim of this study was to assess the effects of laser irradiation with a novel snoring h and piece on the histological structures of the soft palate in a rat model . BACKGROUND Snoring is a common problem and studies have shown that 20 - 50 % of the population is affected . An apnea-hypopnea index of < 5/h without daytime somnolence is documented as simple snoring . No snoring treatment should ever be attempted until a sleep study has been completed to rule out sleep apnea . METHODS Twenty adult Wistar rats , weighing 200 - 250 g , were used in this study . Rats were r and omized into two groups : experimental group ( n = 10 ) and control group ( n = 10 ) . Laser energy was delivered in a horizontal direction to the surface of the soft palate of each rat in the experimental group for 2 min with an Er : YAG laser ( LightWalker AT ; Fotona ) with snoring h and piece ( PS04 ) in a noncontact mode ( 1.15 W , 2 Hz , 1.5 J/cm(2 ) ) . The animals were sacrificed after 24 h , 1 week , 3 weeks , or 5 weeks . The soft palate of each rat was removed by excisional biopsy . The specimens underwent histological examination . Contractions and fibrosis were reported as grading from 1 + to 3 + , while edema and hyperemia were evaluated according to the absence ( 0 ) or presence ( 1 ) of any changes . Statistical analysis was done with the Mann-Whitney U and Spearman 's rho tests . RESULT A noticeable contraction of the soft palate occurred immediately after laser application . Inflammatory changes were observed histologically at 3 weeks postoperatively . Keratinization appeared after the procedure in both groups and decreased gradually . Statistically , there was a strong correlation among inflammation and time and also keratinization and time ( p < 0.05 ) . CONCLUSIONS The present study indicates that Er : YAG laser irradiation with snoring h and piece ( PS04 ) causes acute shrinkage of the mucosa . This contraction decreases gradually but is still present at the end of fifth week Introduction : Adenotonsillar hypertrophy ( AH ) is considered the most common cause of upper respiratory tract obstruction among children . It results in a spectrum of symptoms from mouth breathing , nasal obstruction , hyponasal speech , snoring , and obstructive sleep apnea ( OSA ) to growth failure and cardiovascular morbidity .  Adenotonsillectomy is a typical strategy for patients with AH , but may lead to serious complications such as bleeding ( 4–5 % ) and postoperative respiratory compromise ( 27 % ) , especially among young children , as well as recurrence of adenoid tissue ( 10–20 % ) . Thus , non-surgical therapies have attracted considerable attention as an alternative strategy . The inflammatory mechanism proposed for AH has lead to the use of anti-inflammatory drugs to manage this condition . The present study aim ed to evaluate the effect of chewable tablets of montelukast , a cysteinyl- leukotriene receptor antagonist , in children with AH . Material s and Methods : Sixty children between the ages of 4–12 years with > 75 % choanal obstruction on primary nasal endoscopy were recruited in this r and omized , placebo-controlled trial and r and omly divided into two groups . The study group was treated with montelukast 5 mg daily for 12 weeks while the control group received matching placebo for the same period of time . A question naire was completed by each child ’s parent/guardian to assess the severity of sleep discomfort , snoring , and mouth breathing before and after the intervention . Results : Adenoid size decreased in 76 % of the study group compared with 3 % of the placebo group after 12 weeks . A statically significant improvement was observed in the study group compared with the placebo group in terms of sleep discomfort , snoring , and mouth breathing . The symptoms average total score dropped from 7.7 to 3.3 in the study group , while in the placebo group the total score changed from 7.4 to 6.7 . Conclusion : Montelukast chewable tablets achieved a significant reduction in adenoid size and improved the related clinical symptoms of AH and can therefore be considered an effective alternative to surgical treatment in children with adenoid hypertrophy Snoring is a sleep phenomenon due to the partial upper airway obstruction during sleep which causes vibration of the tissues of the rhino-oro-hypopharynx and less frequently the larynx . This study evaluated the use and effectiveness of the erbium : YAG 2940-nm laser as an adjunctive in providing treatment for patients suffering from chronic snoring-related sleep disorders . A prospect i ve study of 40 consecutive patients with snoring and sleep disorders was performed , assessing data before and after three Er : YAG laser treatment sessions . During laser treatment , the pain was almost absent . There were no side effects , except a very mild sore throat in 1 out of 40 patients . The patient ’s evaluation of satisfaction of the results obtained after the treatments showed that 85 % of cases were very satisfied , 5 patients ( 12.5 % ) reported being fairly satisfied with the treatment and only 1 subject ( 2.5 % ) was not satisfied . Mallampati , Friedman Tongue Position , and degree of O ( oropharynx ) at nose oropharynx hypopharynx and larynx classification were significantly decreased after the laser sessions . The decrease of Epworth Sleepiness Scale and Visual Analogue Scale for loudness of snoring , waking up during sleep because of snoring , dry mouth on waking , and choking was all statistically significant . The incidence of dreaming during the night also raised significantly ; 30/40 ( 75 % ) of cases perceived less tightness in their throat and better breathing after treatment . These results were stable at 20 months follow-up ( 14–24 q ) in 72 % of cases . Nonsurgical and non-invasive Er : YAG laser treatment demonstrated to be a valid procedure in reducing the loudness of snoring In a prospect i ve study aim ed at evaluating objective ly the compliance with nasal continuous positive airway pressure ( CPAP ) treatment , 233 obstructive sleep apnea ( OSA ) ( apnea index , > 10 apneas/hour ) patients and 36 nonapneic snorers were studied . The compliance to treatment was measured by the mean rate of use of the CPAP device , obtained from a built-in time counter . The follow-up period was 874 + /- 48 in OSA patients and 675 + /- 83 in snorers .  CPAP was proposed to all OSA patients but only to those snorers who felt improved after an initial laboratory night on CPAP . Nineteen OSA patients refused CPAP .  Of the 214 OSA patients who accepted CPAP  , 181 are still on treatment , with a mean daily rate of use of 5.6 + /- 0.1 hours ( mean + /- SEM ) ; 22 patients stopped CPAP after a variable period of time ; 10 patients died and one acromegalic patient was considered cured after hypophysectomy for a pituitary adenoma . Depending upon the definition of acceptable compliance , the compliance rate in this group was between 77 % and 89 % . The mean rate of use was correlated with indices of disease severity ( apnea index , apnea+hypopnea index , minimal SaO2 during sleep , daytime PaO2 , pulmonary artery pressure ) . Thirty-six nonapneic snorers accepted CPAP . In this group , 26 are still on CPAP , with a mean daily rate of use of 5.4 + /- 0.5 hours ; one patient died ; one underwent uvolopalatopharyngoplasty without follow-up ; and eight stopped CPAP . The compliance rate in this group was between 58 % and 78 % . This study shows that CPAP is reasonably accepted by OSA patients as well as by nonapneic snorers . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES To develop and vali date a new risk-of-bias tool for nonr and omized studies ( NRSs ) . STUDY DESIGN AND SETTING We developed the Risk of Bias Assessment Tool for Nonr and omized Studies ( RoBANS ) . A validation process with 39 NRSs examined the reliability ( interrater agreement ) , validity ( the degree of correlation between the overall assessment s of RoBANS and Method ological Index for Nonr and omized Studies [ MINORS ] , obtained by plotting the overall risk of bias relative to effect size and funding source ) , face validity with eight experts 
    Output:
    
There were minimal side effects without serious adverse effects  .
Er : YAG laser is shown to be effective in a way to reduce snoring without significant AHI or RDI changes .