human
***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: The aim of this study was to evaluate the effect of a m and ibular advancement splint ( MAS ) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea ( OSA ) .  Using a r and omized crossover design , patients received 4 weeks of treatment with MAS and a control device ( inactive oral appliance ) , with an intervening 1-week washout . At the end of each treatment period , patients were reassessed by question naire , polysomnography , and multiple sleep latency test .  Fifty-nine men and 14 women with a mean ( + /- SD ) age of 48 + /- 11 years and proven OSA experienced a significantly improved mean ( + /- SEM ) sleep latency on the multiple sleep latency test ( 10.3 + /- 0.5 versus 9.1 + /- 0.5 minutes , p = 0.01 ) and Epworth sleepiness scale score ( 7 + /- 1 versus 9 + /- 1 , p < 0.0001 ) with the MAS compared with the control device after 4 weeks . The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device ( 82 versus 62 % , p < 0.01 ) , but this was not so for objective sleepiness ( 48 versus 34 % , p = 0.08 ) . Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device . MAS therapy improves a range of symptoms associated with OSA M and ibular repositioning splints ( MRSs ) and continuous positive airway pressure ( CPAP ) are used to treat the sleep apnea/hypopnea syndrome ( SAHS ) . There are some data suggesting that patients with milder symptoms prefer MRS , but there are few comparative data on outcomes . Therefore , we performed a r and omized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new out patients diagnosed with SAHS ( apnea/hypopnea index [ AHI ] > or= 5/hour , and > or= 2 symptoms including sleepiness ) . Assessment s at the end of both limbs comprised home sleep study , subjective ratings of treatment value , sleepiness , symptoms , and well-being , and objective tests of sleepiness and cognition .  Forty-eight of 51 recruited patients completed the trial ( 12 women ; age [ mean + /- SD ] , 46 + /- 9 years ; Epworth 14 + /- 4 ; median AHI , 22/hour ; interquartile ratio [ IQR ] , 11 - 43/hour ) . Significant ( p < or= 0.01 ) differences between MRS and CPAP were observed for 7 of 21 variables ( effect sizes , 0.3 - 0.6 SDs ) , all favoring CPAP , including AHI ( 15 + /- 16 and 8 + /- 6/hour , respectively ) , effectiveness rating , symptoms , Epworth ( 12 + /- 5 and 8 + /- 5 , respectively ) , functional outcomes of sleepiness question naire , short-form 36 health survey mental component , and health transition scores . Objective sleepiness , cognitive performance , and preference for treatments were not different . In patients experiencing a mild form of the syndrome ( AHI < 15 , n = 18 ) , symptoms , treatment efficacy and satisfaction , and subjective sleepiness were also better with CPAP than with MRS ( effect sizes , 0.7 - 1.1 SDs ) . These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS The enthusiasm for uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnoea ( OSA ) has declined in recent years , partly because of a lower success rate over time and partly because of adverse effects . Reports on the beneficial effects of dental appliances exist , but only one prospect i ve r and omized study has been published comparing dental appliances with nasal continuous positive airway pressure ( CPAP ) treatment . No study has been published comparing dental appliance treatment with UPPP .  Ninety-five male patients with confirmed OSA , subjective daytime sleepiness and an apnoea index ( AI ) > 5 were r and omized for subsequent treatment with either a dental appliance or UPPP . There were 49 patients in the dental appliance group and 46 in the UPPP group . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up . The success rate ( rate of patients with at least a 50 % reduction in AI ) for the dental appliance group was 95 % , which was significantly higher ( p < 0.01 ) than the 70 % success rate for the UPPP group . According to the criteria for OSA ( apnoea index > or = 5 or apnoea/hypopnoea index > or = 10 ) , 78 % of the dental appliance group and 51 % of the UPPP group were normalized after 12 months . The difference between the groups was significant ( p < 0.05 ) . These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA The purpose of this study was to investigate the effects of an oral appliance ( OA ) , with and without m and ible advance , in the treatment of  obstructive sleep apnea syndrome ( OSA ) . Twenty-four patients diagnosed with OSA agreed to participate in this study . The patients were treated for 3 months ( with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening ) . Patients were selected , using a r and omized design , to receive an OA model either with ( 12 patients ) or without advance ( 12 patients ) . Before treatment , a snoring question naire , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , the Functional Outcomes of Sleep Question naire ( FOSQ ) , the Epworth Sleepiness Scale ( ESS ) , and polysomnography  were completed . Fifteen subjects completed the protocol ( 13 men , two women ) . With respect to basal values , the m and ible-advanced OA group presented a decrease in the mean apnea – hypopnea index ( AHI ) ( 33.8±4.7 versus 9.6±2.1 ; p<0.01 ) , number of arousals per hour ( 33.8±13.9 versus 16.0±1.5 ; p<0.05 ) , ESS score ( 14.7±5.1 versus 5.1±1.9 ; p<0.05 ) , snoring score ( 15.4±1.9 versus 10.1±3.2 ; p<0.05 ) , and total FOSQ score ( 78.1±22.6 versus 99.3±14.4 ; p<0.05 ) . After treatment , the non-advanced group presented a decrease in the mean AHI ( 24.0±12.2 versus . 11.7±7.9 ; p<0.05 ) . However , no significant differences were found in the number of arousals per hour , ESS score , snoring , and total FOSQ score in the non-advanced group . Neither study group showed significant difference in mean SF36 scores . Oral appliances , especially those that advance the m and ible , offer an effective treatment for OSA STUDY OBJECTIVE To investigate the short-term effect ( 4 weeks ) of oral appliance therapy for obstructive sleep apnea on blood pressure .  DESIGN R and omized , controlled , crossover trial . SETTING Multidisciplinary sleep disorders clinic in a university teaching hospital . PATIENTS Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography ( apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms -- daytime sleepiness , snoring , witnessed apneas , fragmented sleep ; age > 20 years ; and minimum m and ibular protrusion of 3 mm ) . INTERVENTION A m and ibular advancement splint ( MAS ) and control oral appliance for 4 weeks each . MEASUREMENTS AND RESULTS Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period . Patients showed a 50 % reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index . There was a significant reduction with the MAS in mean ( + /- SEM ) 24-hour diastolic blood pressure ( 1.8 + /- 0.5 mmHg ) compared with the control ( P = .001 ) but not in 24-hour systolic blood pressure . Awake blood-pressure variables were reduced with the MAS by an estimated mean ( + /- SEM ) of 3.3 + /- 1.1 mmHg for systolic blood pressure ( P = .003 ) and 3.4 + /- 0.9 mmHg for diastolic blood pressure ( P < .0001 ) . There was no significant difference in blood pressure measured asleep . CONCLUSION Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure , similar to that reported with continuous positive airway pressure therapy In a prospect i ve study , 95 patients with mild to moderate obstructive sleep apnoea ( OSA ) were r and omised to receive either surgical treatment , uvulopalatopharyngoplasty , ( 4 - 6 patients ) or treatment with a nocturnal dental appliance for m and ibular advancement  ( 49 patients ) . Of the 49 dental appliance patients , 37 completed the 12-month follow-up . The aim of this study was to evaluate the effects and adverse events of dental appliance treatment from a one-year perspective . Somnography was employed to measure treatment effects before and 12 months post-treatment . At the 12-month control , somnography was performed twice : the first time with the dental appliance and the second time without it . Adverse events were recorded 2 weeks and 3 , 6 , and 12 months after treatment was initiated . The patients used the dental appliance on average 6 nights/week . After 12 months of treatment , the apnoea , apnoea/hypopnoea , oxygen desaturation , and snoring indices decreased significantly . Ninety-five per cent of the patients reduced their apnoea index by > or = 50 % and 78 % of the patients were normalised following treatment . At the somnographic registration without the dental appliance , the values were found comparable to what they were before treatment . M and ibular mobility and occlusion were constant throughout the study . The adverse events result ing from using the dental appliance were relatively minor and infrequent , and no serious complications were observed except for two patients who reported pain from the temporom and ibular joint . In conclusion , the dental appliance has been shown to be a valuable treatment method for mild to moderate OSA with few adverse events in the stomatognathic system or other complications STUDY OBJECTIVES This study aim ed to assess the efficacy of a custom-made m and ibular advancement splint for the treatment of obstructive sleep apnea with respect to neuropsychological functioning and mood state . METHODS A r and omized controlled crossover design was used in which 73 participants ( mean age = 48.4 , SD = 11.0 , % men = 80.8 ) with at least 2 symptoms of obstructive sleep apnea and an apnea hypopnea index > or = 10 per hour underwent treatment with both m and ibular advancement splint and an inactive oral device .  Polysomnographic , neuropsychological and self-report measures were conducted at baseline and repeated after each of the two 4-week treatment phases . RESULTS MAS treatment was associated with improvements on the somatic component of the Beck Depression Inventory and the Vigor-Activity and Fatigue-Inertia scales of the Profile of Mood States . While there were no improvements within the neuropsychological domains of attention/working memory , verbal memory , visuospatial or executive functioning , treatment with the m and ibular advancement splint was associated with faster performance on a test of vigilance/psychomotor speed . These changes , however , did not correspond to the improved subjective sleepiness or apnea-hypopnea index during treatment . CONCLUSIONS Treatment with the m and ibular advancement splint results in improvements in self-reported sleepiness , fatigue/energy levels and vigilance/psychomotor speed in patients with obstructive sleep apnea Although there is increasing interest in the use of oral appliances to treat obstructive sleep apnea ( OSA ) , the evidence base for this is weak . Furthermore , the precise mechanisms of action are uncertain . We aim ed to systematic ally investigate the efficacy of a novel m and ibular advancement splint ( MAS ) in patients with OSA . The sample consisted of 28 patients with proven OSA . A r and omized , controlled three-period ( ABB/BAA ) crossover study design was used . After an acclimatization period , patients underwent three polysomnographs with either a control oral plate , which did not advance the m and ible ( A ) , or MAS ( B ) , 1 wk apart , in either the ABB or BAA sequence . Complete response ( CR ) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index ( AHI ) to < 5/h , and partial response ( PR ) as a > or = 50 % reduction in AHI , but remaining > or = 5/h . Twenty-four patients ( 19 men , 5 women ) completed the protocol . Subjective improvements with the  MAS  were reported by the majority of patients ( 96 % ) . There were significant improvements in AHI ( 30 + /- 2/h versus 14 + /- 2/h , p < 0.0001 ) , MinSa( 
    Output:
    
agent
***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: The aim of this study was to evaluate the effect of a m and ibular advancement splint ( MAS ) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea ( OSA ) .  Using a r and omized crossover design , patients received 4 weeks of treatment with MAS and a control device ( inactive oral appliance ) , with an intervening 1-week washout . At the end of each treatment period , patients were reassessed by question naire , polysomnography , and multiple sleep latency test .  Fifty-nine men and 14 women with a mean ( + /- SD ) age of 48 + /- 11 years and proven OSA experienced a significantly improved mean ( + /- SEM ) sleep latency on the multiple sleep latency test ( 10.3 + /- 0.5 versus 9.1 + /- 0.5 minutes , p = 0.01 ) and Epworth sleepiness scale score ( 7 + /- 1 versus 9 + /- 1 , p < 0.0001 ) with the MAS compared with the control device after 4 weeks . The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device ( 82 versus 62 % , p < 0.01 ) , but this was not so for objective sleepiness ( 48 versus 34 % , p = 0.08 ) . Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device . MAS therapy improves a range of symptoms associated with OSA M and ibular repositioning splints ( MRSs ) and continuous positive airway pressure ( CPAP ) are used to treat the sleep apnea/hypopnea syndrome ( SAHS ) . There are some data suggesting that patients with milder symptoms prefer MRS , but there are few comparative data on outcomes . Therefore , we performed a r and omized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new out patients diagnosed with SAHS ( apnea/hypopnea index [ AHI ] > or= 5/hour , and > or= 2 symptoms including sleepiness ) . Assessment s at the end of both limbs comprised home sleep study , subjective ratings of treatment value , sleepiness , symptoms , and well-being , and objective tests of sleepiness and cognition .  Forty-eight of 51 recruited patients completed the trial ( 12 women ; age [ mean + /- SD ] , 46 + /- 9 years ; Epworth 14 + /- 4 ; median AHI , 22/hour ; interquartile ratio [ IQR ] , 11 - 43/hour ) . Significant ( p < or= 0.01 ) differences between MRS and CPAP were observed for 7 of 21 variables ( effect sizes , 0.3 - 0.6 SDs ) , all favoring CPAP , including AHI ( 15 + /- 16 and 8 + /- 6/hour , respectively ) , effectiveness rating , symptoms , Epworth ( 12 + /- 5 and 8 + /- 5 , respectively ) , functional outcomes of sleepiness question naire , short-form 36 health survey mental component , and health transition scores . Objective sleepiness , cognitive performance , and preference for treatments were not different . In patients experiencing a mild form of the syndrome ( AHI < 15 , n = 18 ) , symptoms , treatment efficacy and satisfaction , and subjective sleepiness were also better with CPAP than with MRS ( effect sizes , 0.7 - 1.1 SDs ) . These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS The enthusiasm for uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnoea ( OSA ) has declined in recent years , partly because of a lower success rate over time and partly because of adverse effects . Reports on the beneficial effects of dental appliances exist , but only one prospect i ve r and omized study has been published comparing dental appliances with nasal continuous positive airway pressure ( CPAP ) treatment . No study has been published comparing dental appliance treatment with UPPP .  Ninety-five male patients with confirmed OSA , subjective daytime sleepiness and an apnoea index ( AI ) > 5 were r and omized for subsequent treatment with either a dental appliance or UPPP . There were 49 patients in the dental appliance group and 46 in the UPPP group . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up . The success rate ( rate of patients with at least a 50 % reduction in AI ) for the dental appliance group was 95 % , which was significantly higher ( p < 0.01 ) than the 70 % success rate for the UPPP group . According to the criteria for OSA ( apnoea index > or = 5 or apnoea/hypopnoea index > or = 10 ) , 78 % of the dental appliance group and 51 % of the UPPP group were normalized after 12 months . The difference between the groups was significant ( p < 0.05 ) . These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA The purpose of this study was to investigate the effects of an oral appliance ( OA ) , with and without m and ible advance , in the treatment of  obstructive sleep apnea syndrome ( OSA ) . Twenty-four patients diagnosed with OSA agreed to participate in this study . The patients were treated for 3 months ( with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening ) . Patients were selected , using a r and omized design , to receive an OA model either with ( 12 patients ) or without advance ( 12 patients ) . Before treatment , a snoring question naire , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , the Functional Outcomes of Sleep Question naire ( FOSQ ) , the Epworth Sleepiness Scale ( ESS ) , and polysomnography  were completed . Fifteen subjects completed the protocol ( 13 men , two women ) . With respect to basal values , the m and ible-advanced OA group presented a decrease in the mean apnea – hypopnea index ( AHI ) ( 33.8±4.7 versus 9.6±2.1 ; p<0.01 ) , number of arousals per hour ( 33.8±13.9 versus 16.0±1.5 ; p<0.05 ) , ESS score ( 14.7±5.1 versus 5.1±1.9 ; p<0.05 ) , snoring score ( 15.4±1.9 versus 10.1±3.2 ; p<0.05 ) , and total FOSQ score ( 78.1±22.6 versus 99.3±14.4 ; p<0.05 ) . After treatment , the non-advanced group presented a decrease in the mean AHI ( 24.0±12.2 versus . 11.7±7.9 ; p<0.05 ) . However , no significant differences were found in the number of arousals per hour , ESS score , snoring , and total FOSQ score in the non-advanced group . Neither study group showed significant difference in mean SF36 scores . Oral appliances , especially those that advance the m and ible , offer an effective treatment for OSA STUDY OBJECTIVE To investigate the short-term effect ( 4 weeks ) of oral appliance therapy for obstructive sleep apnea on blood pressure .  DESIGN R and omized , controlled , crossover trial . SETTING Multidisciplinary sleep disorders clinic in a university teaching hospital . PATIENTS Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography ( apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms -- daytime sleepiness , snoring , witnessed apneas , fragmented sleep ; age > 20 years ; and minimum m and ibular protrusion of 3 mm ) . INTERVENTION A m and ibular advancement splint ( MAS ) and control oral appliance for 4 weeks each . MEASUREMENTS AND RESULTS Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period . Patients showed a 50 % reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index . There was a significant reduction with the MAS in mean ( + /- SEM ) 24-hour diastolic blood pressure ( 1.8 + /- 0.5 mmHg ) compared with the control ( P = .001 ) but not in 24-hour systolic blood pressure . Awake blood-pressure variables were reduced with the MAS by an estimated mean ( + /- SEM ) of 3.3 + /- 1.1 mmHg for systolic blood pressure ( P = .003 ) and 3.4 + /- 0.9 mmHg for diastolic blood pressure ( P < .0001 ) . There was no significant difference in blood pressure measured asleep . CONCLUSION Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure , similar to that reported with continuous positive airway pressure therapy In a prospect i ve study , 95 patients with mild to moderate obstructive sleep apnoea ( OSA ) were r and omised to receive either surgical treatment , uvulopalatopharyngoplasty , ( 4 - 6 patients ) or treatment with a nocturnal dental appliance for m and ibular advancement  ( 49 patients ) . Of the 49 dental appliance patients , 37 completed the 12-month follow-up . The aim of this study was to evaluate the effects and adverse events of dental appliance treatment from a one-year perspective . Somnography was employed to measure treatment effects before and 12 months post-treatment . At the 12-month control , somnography was performed twice : the first time with the dental appliance and the second time without it . Adverse events were recorded 2 weeks and 3 , 6 , and 12 months after treatment was initiated . The patients used the dental appliance on average 6 nights/week . After 12 months of treatment , the apnoea , apnoea/hypopnoea , oxygen desaturation , and snoring indices decreased significantly . Ninety-five per cent of the patients reduced their apnoea index by > or = 50 % and 78 % of the patients were normalised following treatment . At the somnographic registration without the dental appliance , the values were found comparable to what they were before treatment . M and ibular mobility and occlusion were constant throughout the study . The adverse events result ing from using the dental appliance were relatively minor and infrequent , and no serious complications were observed except for two patients who reported pain from the temporom and ibular joint . In conclusion , the dental appliance has been shown to be a valuable treatment method for mild to moderate OSA with few adverse events in the stomatognathic system or other complications STUDY OBJECTIVES This study aim ed to assess the efficacy of a custom-made m and ibular advancement splint for the treatment of obstructive sleep apnea with respect to neuropsychological functioning and mood state . METHODS A r and omized controlled crossover design was used in which 73 participants ( mean age = 48.4 , SD = 11.0 , % men = 80.8 ) with at least 2 symptoms of obstructive sleep apnea and an apnea hypopnea index > or = 10 per hour underwent treatment with both m and ibular advancement splint and an inactive oral device .  Polysomnographic , neuropsychological and self-report measures were conducted at baseline and repeated after each of the two 4-week treatment phases . RESULTS MAS treatment was associated with improvements on the somatic component of the Beck Depression Inventory and the Vigor-Activity and Fatigue-Inertia scales of the Profile of Mood States . While there were no improvements within the neuropsychological domains of attention/working memory , verbal memory , visuospatial or executive functioning , treatment with the m and ibular advancement splint was associated with faster performance on a test of vigilance/psychomotor speed . These changes , however , did not correspond to the improved subjective sleepiness or apnea-hypopnea index during treatment . CONCLUSIONS Treatment with the m and ibular advancement splint results in improvements in self-reported sleepiness , fatigue/energy levels and vigilance/psychomotor speed in patients with obstructive sleep apnea Although there is increasing interest in the use of oral appliances to treat obstructive sleep apnea ( OSA ) , the evidence base for this is weak . Furthermore , the precise mechanisms of action are uncertain . We aim ed to systematic ally investigate the efficacy of a novel m and ibular advancement splint ( MAS ) in patients with OSA . The sample consisted of 28 patients with proven OSA . A r and omized , controlled three-period ( ABB/BAA ) crossover study design was used . After an acclimatization period , patients underwent three polysomnographs with either a control oral plate , which did not advance the m and ible ( A ) , or MAS ( B ) , 1 wk apart , in either the ABB or BAA sequence . Complete response ( CR ) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index ( AHI ) to < 5/h , and partial response ( PR ) as a > or = 50 % reduction in AHI , but remaining > or = 5/h . Twenty-four patients ( 19 men , 5 women ) completed the protocol . Subjective improvements with the  MAS  were reported by the majority of patients ( 96 % ) . There were significant improvements in AHI ( 30 + /- 2/h versus 14 + /- 2/h , p < 0.0001 ) , MinSa( 
    Output:
    