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: STUDY OBJECTIVES To determine predictors of neuropsychological functioning in patients with obstructive sleep apnea ( OSA ) and whether treatment with 2-week continuous positive airway pressure ( CPAP ) or supplemental oxygen would improve cognitive functioning . DESIGN R and omized placebo-controlled design . SETTING University-based clinical research center . PATIENTS Forty-six patients with untreated OSA . INTERVENTIONS Two-week CPAP , supplemental oxygen , or placebo-CPAP . MEASUREMENTS AND RESULTS Participants underwent polysomnography and completed a neuropsychological test battery before and after treatment . Prior to treatment , patients with OSA showed diffuse impairments , particularly in terms of speed of information processing , attention and working memory , executive functioning , learning and memory , as well as alertness and sustained attention . A global deficit score at baseline was positively correlated with percentage of stage 1 sleep ( p = .049 ) only and was not correlated with obesity , daytime sleepiness , depression , fatigue , OSA severity , and the other polysomnography variables . The 3 treatment groups ( therapeutic-CPAP , supplemental oxygen , and placebo-CPAP ) were compared using repeated- measures analysis of variance ( ANOVA ) . There was no significant Time x Treatment interaction for the global deficit score . When examining individual neuropsychological test scores , two thirds of them improved with time regardless of treatment , although only Digit Vigilance-Time ( p = .020 ) showed significant improvement specific to CPAP treatment . CONCLUSION The present results suggest that Digit Vigilance-Time might be the most sensitive neuropsychological test for measuring the effects of the treatments . In general , 2 weeks of CPAP or oxygen-supplementation treatment was insufficient to show overall beneficial cognitive effects , as compared with placebo-CPAP . However , 2 weeks of CPAP treatment might be helpful in terms of speed of information processing , vigilance , or sustained attention and alertness Aims /hypothesisAlthough the associations between obstructive sleep apnoea and type 2 diabetes mellitus have been reported in cross-sectional design studies , findings on the prospect i ve association between the two conditions are limited . We examined prospect ively the association between nocturnal intermittent hypoxia as a surrogate marker of obstructive sleep apnoea and risk of type 2 diabetes . Methods A total of 4,398 community residents aged 40 to 69 years who had participated in sleep investigation studies between 2001 and 2005 were enrolled .  Nocturnal intermittent hypoxia  was assessed by pulse-oximetry  and defined by the number of oxygen desaturation measurements ≤3 % per h , with five to < 15 per h corresponding to mild and 15 events or more per h corresponding to moderate-to-severe nocturnal intermittent hypoxia , respectively . The development of type 2 diabetes was defined by : ( 1 ) fasting serum glucose ≥7.00 mmol/l ( 126 mg/dl ) ; ( 2 ) non-fasting serum glucose ≥11.1 mmol/l ( 200 mg/dl ) ; and /or ( 3 ) initiation of glucose-lowering medication or insulin therapy . Multivariable model accounted for age , sex , BMI , smoking status , current alcohol intake , community , borderline type 2 diabetes , habitual snoring , excessive daytime sleepiness , sleep duration and ( for women ) menopausal status . Results By the end of 2007 , 92.2 % of participants had been followed up ( median follow-up duration [ interquartile range ] 3.0 [ 2.9–4.0 ] years ) and 210 persons identified as having developed diabetes . The multivariable-adjusted hazard ratio ( 95 % CI ) for developing type 2 diabetes was 1.26 ( 0.91–1.76 ) among those with mild nocturnal intermittent hypoxia and 1.69 ( 1.04–2.76 ) among those with moderate-to-severe nocturnal intermittent hypoxia ( p = 0.03 for trend ) . Conclusions /interpretationNocturnal intermittent hypoxia was associated with increased risk of developing type 2 diabetes among middle-aged Japanese 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 Obstructive sleep apnea ( OSA ) is associated with recurrent episodes of nocturnal hypoxia and increased risk for development of systemic hypertension . Prior studies have been limited , however , in their ability to show reduction in blood pressure after continuous positive airway pressure ( CPAP ) therapy , and the effect of supplemental oxygen alone on blood pressure in OSA has not been evaluated . We performed a r and omized , double-blind , placebo-controlled study comparing the effects of 2 weeks of CPAP versus sham-CPAP versus supplemental nocturnal oxygen on 24-hour ambulatory blood pressure in 46 patients with moderate-severe OSA . We found that 2 weeks of CPAP therapy result ed in a significant reduction in daytime mean arterial and diastolic blood pressure and nighttime systolic , mean , and diastolic blood pressure ( all Ps < 0.05 ) . Although nocturnal supplemental oxygen therapy improved oxyhemoglobin saturation , it did not affect blood pressure . We conclude that CPAP therapy reduces both daytime and nighttime blood pressure in patients with OSA , perhaps through mechanisms other than improvement of nocturnal oxyhemoglobin saturation Abstract Psychological symptom improvement has been observed after continuous positive airway pressure ( CPAP ) treatment of obstructive sleep apnea ( OSA ) . Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation , the mechanism of psychological symptom improvement is unclear . Using a 3-arm placebo-controlled design , we parsed out the separate effects of treatment on psychological symptoms . OSA patients ( N = 38 ) were monitored 2 nights with polysomnography and then r and omized to 2-weeks therapeutic CPAP , placebo CPAP , or O2 supplementation . Pre- and post-treatment , patients completed the Brief Symptom Inventory ( BSI ) : Higher scores indicate greater severity . Repeated measures analysis of covariance reveals a Time × Treatment interaction for BSI Global Severity Index ( GSI ) : significant pre- to post-treatment reductions in GSI with O2 supplementation and therapeutic CPAP , but not placebo CPAP . A Time × Treatment interaction was also found for depression : Depression decreased with O2 supplementation but not with therapeutic CPAP or placebo CPAP . Both therapeutic CPAP and O2 supplementation result ed in decreased psychological symptoms . Results suggest hypoxemia may play a stronger role than sleep disruption vis-à-vis OSA related psychological distress CONTEXT Hypoxemia complicates the recovery of 30 % to 50 % of patients after abdominal surgery ; endotracheal intubation and mechanical ventilation may be required in 8 % to 10 % of cases , increasing morbidity and mortality and prolonging intensive care unit and hospital stay . OBJECTIVE To determine the effectiveness of continuous positive airway pressure compared with st and ard treatment in preventing the need for intubation and mechanical ventilation in patients who develop acute hypoxemia after elective major abdominal surgery . DESIGN AND SETTING R and omized , controlled , unblinded study with concealed allocation conducted between June 2002 and November 2003 at 15 intensive care units of the Piedmont Intensive Care Units Network in Italy . PATIENTS Consecutive patients who developed severe hypoxemia after major elective abdominal surgery . The trial was stopped for efficacy after 209 patients had been enrolled . INTERVENTIONS Patients were r and omly assigned to receive oxygen ( n = 104 ) or oxygen plus continuous positive airway pressure ( n = 105 ) . MAIN OUTCOME MEASURES The primary end point was incidence of endotracheal intubation ; secondary end points were intensive care unit and hospital lengths of stay , incidence of pneumonia , infection and sepsis , and hospital mortality . RESULTS Patients who received oxygen plus continuous positive airway pressure had a lower intubation rate ( 1 % vs 10 % ; P = .005 ; relative risk [ RR ] , 0.099 ; 95 % confidence interval [ CI ] , 0.01 - 0.76 ) and had a lower occurrence rate of pneumonia ( 2 % vs 10 % , RR , 0.19 ; 95 % CI , 0.04 - 0.88 ; P = .02 ) , infection ( 3 % vs 10 % , RR , 0.27 ; 95 % CI , 0.07 - 0.94 ; P = .03 ) , and sepsis ( 2 % vs 9 % ; RR , 0.22 ; 95 % CI , 0.04 - 0.99 ; P = .03 ) than did patients treated with oxygen alone . Patients who received oxygen plus continuous positive airway pressure also spent fewer mean ( SD ) days in the intensive care unit ( 1.4 [ 1.6 ] vs 2.6 [ 4.2 ] , P = .09 ) than patients treated with oxygen alone . The treatments did not affect the mean ( SD ) days that patients spent in the hospital ( 15 [ 13 ] vs 17 [ 15 ] , respectively ; P = .10 ) . None of those treated with oxygen plus continuous positive airway pressure died in the hospital while 3 deaths occurred among those treated with oxygen alone ( P = .12 ) . CONCLUSION Continuous positive airway pressure may decrease the incidence of endotracheal intubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery There is r and omized controlled evidence that patients with sleep apnea-hypopnea syndrome ( SAHS ) treated with continuous positive airway pressure ( CPAP )  have improved daytime function and quality of life . " Before- and -after " data indicate that CPAP improves sleep quality , but there is no r and omized controlled evidence of this . We tested the hypothesis that CPAP improved sleep quality in patients with SAHS . We also sought correlations between polysomnographic ( PSG ) indices and benefit from use of CPAP .  Twenty-two patients with SAHS ( median , [ interquartile range ] apnea-hypopnea index , 40 [ 25 - 65 ] events/h ) spent 1 mo receiving CPAP and 1 mo receiving placebo capsules , in r and om order , and home sleep studies were performed at the end of each month . CPAP result ed in a lower arousal index , less Stage 1 , and more Stage 3 + 4 sleep , but there was no increase in Stage REM ( rapid eye movement ) sleep . Improvement in Epworth score after 6 - 12 mo of treatment correlated significantly with PSG indices on CPAP :  sleep efficiency index ( r = 0.78 , p < 0.001 ) , Stage REM ( r = 0.55 , p = 0.001 ) , Stage 3 + 4 ( r = 0.5 , p = 0.02 ) , and arousal index ( r = -0.43 , p = 0.05 ) . This study provides r and omized controlled trial evidence that patients with SAHS  sleep better when receiving CPAP . Patients with 
    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: STUDY OBJECTIVES To determine predictors of neuropsychological functioning in patients with obstructive sleep apnea ( OSA ) and whether treatment with 2-week continuous positive airway pressure ( CPAP ) or supplemental oxygen would improve cognitive functioning . DESIGN R and omized placebo-controlled design . SETTING University-based clinical research center . PATIENTS Forty-six patients with untreated OSA . INTERVENTIONS Two-week CPAP , supplemental oxygen , or placebo-CPAP . MEASUREMENTS AND RESULTS Participants underwent polysomnography and completed a neuropsychological test battery before and after treatment . Prior to treatment , patients with OSA showed diffuse impairments , particularly in terms of speed of information processing , attention and working memory , executive functioning , learning and memory , as well as alertness and sustained attention . A global deficit score at baseline was positively correlated with percentage of stage 1 sleep ( p = .049 ) only and was not correlated with obesity , daytime sleepiness , depression , fatigue , OSA severity , and the other polysomnography variables . The 3 treatment groups ( therapeutic-CPAP , supplemental oxygen , and placebo-CPAP ) were compared using repeated- measures analysis of variance ( ANOVA ) . There was no significant Time x Treatment interaction for the global deficit score . When examining individual neuropsychological test scores , two thirds of them improved with time regardless of treatment , although only Digit Vigilance-Time ( p = .020 ) showed significant improvement specific to CPAP treatment . CONCLUSION The present results suggest that Digit Vigilance-Time might be the most sensitive neuropsychological test for measuring the effects of the treatments . In general , 2 weeks of CPAP or oxygen-supplementation treatment was insufficient to show overall beneficial cognitive effects , as compared with placebo-CPAP . However , 2 weeks of CPAP treatment might be helpful in terms of speed of information processing , vigilance , or sustained attention and alertness Aims /hypothesisAlthough the associations between obstructive sleep apnoea and type 2 diabetes mellitus have been reported in cross-sectional design studies , findings on the prospect i ve association between the two conditions are limited . We examined prospect ively the association between nocturnal intermittent hypoxia as a surrogate marker of obstructive sleep apnoea and risk of type 2 diabetes . Methods A total of 4,398 community residents aged 40 to 69 years who had participated in sleep investigation studies between 2001 and 2005 were enrolled .  Nocturnal intermittent hypoxia  was assessed by pulse-oximetry  and defined by the number of oxygen desaturation measurements ≤3 % per h , with five to < 15 per h corresponding to mild and 15 events or more per h corresponding to moderate-to-severe nocturnal intermittent hypoxia , respectively . The development of type 2 diabetes was defined by : ( 1 ) fasting serum glucose ≥7.00 mmol/l ( 126 mg/dl ) ; ( 2 ) non-fasting serum glucose ≥11.1 mmol/l ( 200 mg/dl ) ; and /or ( 3 ) initiation of glucose-lowering medication or insulin therapy . Multivariable model accounted for age , sex , BMI , smoking status , current alcohol intake , community , borderline type 2 diabetes , habitual snoring , excessive daytime sleepiness , sleep duration and ( for women ) menopausal status . Results By the end of 2007 , 92.2 % of participants had been followed up ( median follow-up duration [ interquartile range ] 3.0 [ 2.9–4.0 ] years ) and 210 persons identified as having developed diabetes . The multivariable-adjusted hazard ratio ( 95 % CI ) for developing type 2 diabetes was 1.26 ( 0.91–1.76 ) among those with mild nocturnal intermittent hypoxia and 1.69 ( 1.04–2.76 ) among those with moderate-to-severe nocturnal intermittent hypoxia ( p = 0.03 for trend ) . Conclusions /interpretationNocturnal intermittent hypoxia was associated with increased risk of developing type 2 diabetes among middle-aged Japanese 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 Obstructive sleep apnea ( OSA ) is associated with recurrent episodes of nocturnal hypoxia and increased risk for development of systemic hypertension . Prior studies have been limited , however , in their ability to show reduction in blood pressure after continuous positive airway pressure ( CPAP ) therapy , and the effect of supplemental oxygen alone on blood pressure in OSA has not been evaluated . We performed a r and omized , double-blind , placebo-controlled study comparing the effects of 2 weeks of CPAP versus sham-CPAP versus supplemental nocturnal oxygen on 24-hour ambulatory blood pressure in 46 patients with moderate-severe OSA . We found that 2 weeks of CPAP therapy result ed in a significant reduction in daytime mean arterial and diastolic blood pressure and nighttime systolic , mean , and diastolic blood pressure ( all Ps < 0.05 ) . Although nocturnal supplemental oxygen therapy improved oxyhemoglobin saturation , it did not affect blood pressure . We conclude that CPAP therapy reduces both daytime and nighttime blood pressure in patients with OSA , perhaps through mechanisms other than improvement of nocturnal oxyhemoglobin saturation Abstract Psychological symptom improvement has been observed after continuous positive airway pressure ( CPAP ) treatment of obstructive sleep apnea ( OSA ) . Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation , the mechanism of psychological symptom improvement is unclear . Using a 3-arm placebo-controlled design , we parsed out the separate effects of treatment on psychological symptoms . OSA patients ( N = 38 ) were monitored 2 nights with polysomnography and then r and omized to 2-weeks therapeutic CPAP , placebo CPAP , or O2 supplementation . Pre- and post-treatment , patients completed the Brief Symptom Inventory ( BSI ) : Higher scores indicate greater severity . Repeated measures analysis of covariance reveals a Time × Treatment interaction for BSI Global Severity Index ( GSI ) : significant pre- to post-treatment reductions in GSI with O2 supplementation and therapeutic CPAP , but not placebo CPAP . A Time × Treatment interaction was also found for depression : Depression decreased with O2 supplementation but not with therapeutic CPAP or placebo CPAP . Both therapeutic CPAP and O2 supplementation result ed in decreased psychological symptoms . Results suggest hypoxemia may play a stronger role than sleep disruption vis-à-vis OSA related psychological distress CONTEXT Hypoxemia complicates the recovery of 30 % to 50 % of patients after abdominal surgery ; endotracheal intubation and mechanical ventilation may be required in 8 % to 10 % of cases , increasing morbidity and mortality and prolonging intensive care unit and hospital stay . OBJECTIVE To determine the effectiveness of continuous positive airway pressure compared with st and ard treatment in preventing the need for intubation and mechanical ventilation in patients who develop acute hypoxemia after elective major abdominal surgery . DESIGN AND SETTING R and omized , controlled , unblinded study with concealed allocation conducted between June 2002 and November 2003 at 15 intensive care units of the Piedmont Intensive Care Units Network in Italy . PATIENTS Consecutive patients who developed severe hypoxemia after major elective abdominal surgery . The trial was stopped for efficacy after 209 patients had been enrolled . INTERVENTIONS Patients were r and omly assigned to receive oxygen ( n = 104 ) or oxygen plus continuous positive airway pressure ( n = 105 ) . MAIN OUTCOME MEASURES The primary end point was incidence of endotracheal intubation ; secondary end points were intensive care unit and hospital lengths of stay , incidence of pneumonia , infection and sepsis , and hospital mortality . RESULTS Patients who received oxygen plus continuous positive airway pressure had a lower intubation rate ( 1 % vs 10 % ; P = .005 ; relative risk [ RR ] , 0.099 ; 95 % confidence interval [ CI ] , 0.01 - 0.76 ) and had a lower occurrence rate of pneumonia ( 2 % vs 10 % , RR , 0.19 ; 95 % CI , 0.04 - 0.88 ; P = .02 ) , infection ( 3 % vs 10 % , RR , 0.27 ; 95 % CI , 0.07 - 0.94 ; P = .03 ) , and sepsis ( 2 % vs 9 % ; RR , 0.22 ; 95 % CI , 0.04 - 0.99 ; P = .03 ) than did patients treated with oxygen alone . Patients who received oxygen plus continuous positive airway pressure also spent fewer mean ( SD ) days in the intensive care unit ( 1.4 [ 1.6 ] vs 2.6 [ 4.2 ] , P = .09 ) than patients treated with oxygen alone . The treatments did not affect the mean ( SD ) days that patients spent in the hospital ( 15 [ 13 ] vs 17 [ 15 ] , respectively ; P = .10 ) . None of those treated with oxygen plus continuous positive airway pressure died in the hospital while 3 deaths occurred among those treated with oxygen alone ( P = .12 ) . CONCLUSION Continuous positive airway pressure may decrease the incidence of endotracheal intubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery There is r and omized controlled evidence that patients with sleep apnea-hypopnea syndrome ( SAHS ) treated with continuous positive airway pressure ( CPAP )  have improved daytime function and quality of life . " Before- and -after " data indicate that CPAP improves sleep quality , but there is no r and omized controlled evidence of this . We tested the hypothesis that CPAP improved sleep quality in patients with SAHS . We also sought correlations between polysomnographic ( PSG ) indices and benefit from use of CPAP .  Twenty-two patients with SAHS ( median , [ interquartile range ] apnea-hypopnea index , 40 [ 25 - 65 ] events/h ) spent 1 mo receiving CPAP and 1 mo receiving placebo capsules , in r and om order , and home sleep studies were performed at the end of each month . CPAP result ed in a lower arousal index , less Stage 1 , and more Stage 3 + 4 sleep , but there was no increase in Stage REM ( rapid eye movement ) sleep . Improvement in Epworth score after 6 - 12 mo of treatment correlated significantly with PSG indices on CPAP :  sleep efficiency index ( r = 0.78 , p < 0.001 ) , Stage REM ( r = 0.55 , p = 0.001 ) , Stage 3 + 4 ( r = 0.5 , p = 0.02 ) , and arousal index ( r = -0.43 , p = 0.05 ) . This study provides r and omized controlled trial evidence that patients with SAHS  sleep better when receiving CPAP . Patients with 
    Output:
    