***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: BACKGROUND CONTEXT High prevalence rates of depression have been found in patients with chronic spinal disorder ( CSD ) . The biopsychosocial model has become widely adopted and , with it , the role of psychopathology in the development and /or exacerbation of CSD has become increasingly recognized . St and ardized diagnostic criteria , such as the Diagnostic and Statistical Manual of Mental Disorders ( DSM ) , have been used to diagnose major depressive disorder ( MDD ) . Many measures of MDD ( and depressive symptom inventories ) have been developed during the past 50 years , but their comparative utility in CSD population s is still unclear . PURPOSE To systemically compare the performance of depression screening question naires in detecting MDD among a large sample of patients with CSD . STUDY DESIGN / SETTING Prospect i ve cohort study comparing the screening ability of four popular depression measures for diagnosing MDD against the " gold st and ard " Structured Clinical Interview for DSM-IV Axis I Disorders ( SCID-I ) , using a receiver operating characteristic ( ROC ) analysis in a CSD population . PATIENT SAMPLE A consecutive cohort of 546 patients with CSD admitted to an interdisciplinary functional restoration program . OUTCOME MEASURES Sensitivity , specificity , ROC curves , area under the curve ( AUC ) , and optimal cutoff points that are most closely related to the prevalence rates of MDD , with balanced sensitivity and specificity analysis . METHODS Using the SCID-I diagnosis as a " gold st and ard , " the ability of four screening measures in detecting MDD were compared . These included : the Beck Depression Inventory ( BDI ) ; Hamilton Rating Scale for Depression ( HRSD ) ; 9-Item Patient Health Question naire Depression Module ( PHQ-9 ) ; and the Short Form-36 ( SF-36 ) . RESULTS Of 542 CSD patients , 331 ( 61.1 % ) were diagnosed with MDD by the SCID-I. Results of the ROC analysis revealed that the BDI ( AUC 0.768 ) , HRSD ( AUC 0.796 ) , and PHQ-9 ( AUC 0.768 ) have similar abilities to discriminate between depressed and nondepressed patients in this population . These depression measures outperformed the two mental health scales derived from the SF-36 ( Mental Component Summary score/5-Item Mental Health Index ; AUC 0.679 - 0.715 ) . The optimal cut-off scores of 15 ( for the BDI ) , 17 ( for the HRSD ) , and 10 ( for the PHQ-9 ) were also determined . Although the greatest overall accuracy ( sensitivity of 81.3 % and specificity of 65.4 % ) was obtained with the HRSD , it is the only clinician-administered instrument . Self-report measures of depression ( the BDI and PHQ-9 ) showed comparable abilities to detect depression , only slightly less than the HRSD . CONCLUSIONS Compared to the HRSD , both BDI and PHQ-9 are relatively short and easy to self-administer . The cut-off scores established in this study may be used to reliably determine whether a person should be evaluated more thoroughly for an MDD diagnosis . Using an acknowledged " gold st and ard , " the HRSD , BDI and PHQ-9 showed similar validity to recommend their use for future clinical and research purpose s. The SF-36 is less appropriate for diagnosing MDD The aim of this trial was to evaluate the efficacy of a m and ibular advancement appliance ( MAA ) for obstructive sleep apnoea ( OSA ) . Ninety-three patients with OSA and a mean apnoea-hypopnoea index ( AHI ) of 34.7 were central ly r and omised into three , parallel groups : ( a ) MAA ; ( b ) m and ibular non-advancement appliance ( MNA ) ; and ( c ) no intervention . The appliances were custom made , in one piece . The MAAs had a mean protrusion of the m and ible of 74 % ( range 64 - 85 % ) . Outcome measures , assessed after continuous use for 4 weeks , were AHI ( polysomnography ) , daytime sleepiness ( Epworth ) and quality of life ( SF-36 ) . Eighty-one patients ( 87 % ) completed the trial . The MAA group achieved mean AHI and Epworth scores significantly lower ( P < 0.001 and P < 0.05 ) than the MNA group and the no-intervention group . No significant differences were found between the MNA group and the no-intervention group . The MAA group had a mean AHI reduction of 14.1 ( 95 % CI 7.4 - 20.8 ) , and a mean Epworth score reduction of 3.3 ( 95 % CI 1.8 - 4.8 ) . Eight MAA patients ( 30 % ) achieved a reduction in AHI > or = 75 % ending with an AHI < 5 , half of them having baseline AHI > 30 . Sensitivity analyses confirmed these results . MAA had a significant beneficial effect on the vitality domain of SF-36 . Four MAA patients ( 14.8 % ) and two MNA patients ( 8 % ) discontinued interventions because of adverse effects . Our conclusion is that MAA has significant beneficial effects on OSA , including cure in some cases of severe OSA . Protrusion of the m and ible is essential for the effect . MNA has no placebo effect . MAA may be a good alternative to CPAP in subsets of OSA patients Application of continuous positive airway pressure ( CPAP ) as the st and ard treatment for  sleep apnea/hypopnea syndrome ( SAHS )  is a moot point . Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo . The recent description of a true placebo ( sham CPAP ) prompted us to conduct a r and omized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS . Forty-eight patients , stratified in four groups according to severity , were r and omly allocated into two treatment groups ( optimal and sham CPAP ) for a 6-wk period . Of these , 45 completed follow-up ( 91 % males ; age : 54 + /- 10 yr ; body mass index [ BMI ] : 32 + /- 6 kg/m(2 ) ; apnea-hypopnea index [ AHI ] : 54 + /- 19 events/h ; and Epworth Sleepiness Scale [ ESS ] : 16 + /- 5 ) . The ESS , a question naire on SAHS-related symptoms , Functional Outcomes Sleep Question naire ( FOSQ ) , and the Short Form Health Survey ( SF-36 ) were completed at inclusion and after treatment . After 10 d of washout , the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP . The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness ( -9.5 versus -2.3 , p < 0.001 ) , other SAHS-related symptoms ( -18.5 versus -4.5 , p < 0.001 ) , vigilance ( + 8.5 versus + 3.4 , p = 0.009 ) , and general productivity ( + 4.0 versus + 0.5 , p = 0.04 ) FOSQ scales . Both groups used a similar number of hours for the optimal and the sham CPAP ( 4.3 versus 4.5 , ( p = NS ) . The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS ( -2.3 versus -6.7 , p < 0.001 ) and other sleep apnea syndrome (SAS)-related symptoms ( -4.5 versus -11.2 , p = 0.02 ) . Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS The objective of this study was to measure the impact of a 6‐month delay in the diagnosis and treatment of patients with moderate obstructive sleep apnoea syndrome ( OSAS ) ( apnoea/hypopnoea index ( AHI ) < 30 ) or severe OSAS ( AHI ≥30 ) on daytime sleepiness , cognitive functions , quality of life and healthcare expenditure ( hospitalisations , medical visits , complementary tests , biological tests and drug prescriptions ) . In addition , this study aim ed to analyse the incremental cost effectiveness ratios related to daytime sleepiness or quality of life following immediate introduction of treatment in these two population s. This study was conducted as a multicentre r and omised controlled trial and carried out at two teaching hospitals in France . A total of 171 patients were followed for 6 months , with 82 patients r and omised to group 1 “ immediate polysomnography ” and 89 in group 2 “ polysomnography within 6 months ”  . Patients with severe OSAS were deprived of a significant improvement of their daytime sleepiness ( 5.1±5.0 at the Epworth Sleepiness Scale score in group 1 versus 0.2±3.4 in group 2 ) and quality of life ( 12.4±13.3 at the Nottingham Health Profile score in group 1 versus 0.7±10.1 in group 2 ) during the waiting time . The impact of delayed management in subjects with less severe OSAS only concerned daytime sleepiness ( 1.9±3.3 in group 1 versus 0.3±4.3 in group 2 ) . Delayed treatment did not affect cognitive functions or healthcare expenditure regardless of the severity of the disease . Incremental cost effectiveness ratios related to rapid introduction of treatment were significantly lower in the patients with more severe OSAS . These results provide fairly clear medical and economic arguments in favour of early management of patients with more severe forms of obstructive sleep apnoea syndrome BACKGROUND Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) report improved sleepiness , cognitive function , and psychological well being after continuous positive airway pressure ( CPAP ) therapy , and it is for these daytime features that CPAP is usually given . However , few r and omised or controlled studies exist on the effects of CPAP on daytime function . METHODS A prospect i ve , r and omised , single blind , placebo controlled , crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS , all with ⩾15 apnoeas+hypopnoeas/hour and ⩾2 symptoms of SAHS . All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment , following r and omisation to treatment order . With ethics committee approval , patients were told the placebo tablet might improve upper airway function . Average effective CPAP use was monitored using hidden time clocks . Assessment s of objective and subjective sleepiness , symptoms , cognitive performance , and psychological well being were performed on the last day of each treatment and compared . RESULTS Objective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP ( mean difference from placebo + 2.4 min , 95 % CI 0.8 to 4.0 ; p<0.001 ) as did subjective sleepiness on the Epworth scale ( mean difference –6 , 95 % CI –3 to –9 ; p = 0.001 ) . Symptom total score also fell with CPAP ( mean difference –1.6 , 95 % CI –2.2 to –1.0 ; p<0.001 ) . No determinants of these changes with active treatment were identified , and no significant enhancements to cognitive function or psychosocial well being were found in this small sample . CONCLUSIONS These findings provide further evidence for clinical ly significant benefits to daytime function  from CPAP Background : Patients with mild to moderate obstructive sleep apnoea ( OSA ) may be managed with different treatment options . This study compared the effectiveness of three commonly used non-surgical treatment modalities . Methods : Subjects with mild to moderate OSA were r and omised to one of three treatment groups for 10 weeks : conservative measures ( sleep hygiene ) only , continuous positive airways pressure ( CPAP ) in addition to conservative measures or an oral appliance in addition to conservative measures .  All overweight subjects were referred to a weight-reduction class . OSA  was assessed by polysomnography .  Blood pressure was recorded in the morning and evening in the sleep laboratory . Daytime sleepiness was assessed with the Epworth Sleepiness Scale . Health-related quality of life ( HRQOL ) was assessed with the 36-Item Short-Form Health Survey ( SF-36 ) and Sleep Apnoea Quality of Life Index ( SAQLI ) . Results : 101 subjects with a mean ( SEM ) apnoea – hypopnoea index ( AHI ) of 21.4 ( 1.1 ) were r and omised to one of the three groups . The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group , and the CPAP group was significantly better than the oral appliance group . Relief from sleepiness was significantly better in the CPAP group . CPAP was also better than the oral appliance or conservative measures in improving the “ bodily pain ” domain , and better than conservative measures in improving the “ physical function ” domain of SF-36 . Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI , although no difference was detected between the CPAP and oral appliance groups . CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values , but there was no difference in the changes in blood pressure between the groups . There was also a linear relationship between the changes in AHI and body weight . Conclusion : CPAP produced the best improvement in terms of physiological , symptomatic and HRQOL measures , while the oral appliance was slightly less effective . Weight loss , if achieved , result ed in an improvement in sleep parameters , but weight 
    Output:
    
CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression .