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: RATIONALE Continuous positive airway pressure ( CPAP ) and m and ibular advancement device ( MAD ) therapy are commonly used to treat obstructive sleep apnea ( OSA ) . Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes . OBJECTIVES To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA . METHODS In this r and omized crossover trial , we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes . MEASUREMENTS AND MAIN RESULTS Cardiovascular ( 24-h blood pressure , arterial stiffness ) , neurobehavioral ( subjective sleepiness , driving simulator performance ) , and quality of life ( Functional Outcomes of Sleep Question naire , Short Form-36 ) were compared between treatments . Our primary outcome was 24-hour mean arterial pressure .  A total of 126 patients with moderate-severe OSA ( apnea hypopnea index [ AHI ] , 25.6 [ SD 12.3 ] ) were r and omly assigned to a treatment order and 108 completed the trial with both devices . CPAP was more efficacious than MAD in reducing AHI ( CPAP AHI , 4.5 ± 6.6/h ; MAD AHI , 11.1 ± 12.1/h ; P < 0.01 ) but reported compliance was higher on MAD ( MAD , 6.50 ± 1.3 h per night vs. CPAP , 5.20 ± 2 h per night ; P < 0.00001 ) . The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP ( CPAP-MAD difference , 0.2 mm Hg [ 95 % confidence interval , -0.7 to 1.1 ] ) ; however , overall , neither treatment improved blood pressure . In contrast , sleepiness , driving simulator performance , and disease-specific quality of life improved on both treatments by similar amounts , although MAD was superior to CPAP for improving four general quality -of-life domains . CONCLUSIONS Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA . The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD , result ing in similar effectiveness . Clinical trial registered with https://www.anzctr.org.au ( ACTRN 12607000289415 ) Background : Previous r and omized controlled trials have addressed the efficacy of m and ibular advancement devices ( MADs ) in the treatment of obstructive sleep apnea ( OSA ) . Their common control condition , nasal continuous positive airway pressure ( nCPAP ) , was frequently found to be superior to MAD therapy . However , in most of these studies , only nCPAP was titrated objective ly but not MAD . To enable an unbiased comparison between both treatment modalities , the MAD should be titrated objective ly as well . Objective : The aim of the present study was to compare the treatment effects of a titrated MAD with those of nCPAP and an intra-oral placebo device . Methods : Sixty-four mild/moderate patients with obstructive sleep apnea ( OSA ; 52.0 ± 9.6 years ) were r and omly assigned to three parallel groups : MAD , nCPAP and placebo device . From all patients , two polysomnographic recordings were obtained at the hospital : one before treatment and one after approximately 6 months of treatment . Results : The change in the apnea-hypopnea index ( ΔAHI ) between baseline and therapy evaluation differed significantly between the three therapy groups ( ANCOVA ; p = 0.000 ) . No differences in the ΔAHI were found between the MAD and nCPAP therapy ( p = 0.092 ) , whereas the changes in AHI in these groups were significantly larger than those in the placebo group ( p = 0.000 and 0.002 , respectively ) . Conclusion : There is no clinical ly relevant difference between MAD and nCPAP in the treatment of mild/moderate OSA when both treatment modalities are titrated objective ly 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 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 control alone was not uniformly effective In clinical practice , oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure ( CPAP ) therapy . We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively . We r and omly assigned 103 individuals to oral-appliance or CPAP therapy .  Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance ( 76.5 % ) and for 43 of 52 persons using CPAP ( 82.7 % ) . For the difference in effectiveness , a 95 % two-sided confidence interval was calculated . Non-inferiority of oral-appliance therapy  was considered to be established when the lower boundary of this interval exceeded −25 % . The lower boundary of the confidence interval was −21.7 % , indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea . However , subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease ( apnea-hypopnea index > 30 ) . Since these people could be at particular cardiovascular risk , primary oral-appliance therapy appears to be supported only for those with non-severe apnea 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 Introduction M and ibular advancement splints ( MAS ) allowing self-adjustment may be better tolerated , but the optimum titration protocol needs systematic study . Aim The aims of the study are to assess the effectiveness of a titratable MAS device in consecutive patients with body mass index ( BMI ) < 35 kg/m2 and obstructive sleep apnoea [ OSA , apnoea – hypopnoea index ( AHI ) 10–40/h ] and compare two methods of adjustment  [ self-adjustment  or adjustment after polysomnographic ( PSG ) feedback ] . Material s and methods Twenty-eight patients ( 24 M , mean age 49 years , mean BMI 27.6 kg/m2 ) with symptomatic ( Epworth Sleepiness score > 8/24 , snoring , choking or poor sleep quality ) OSA ( mean AHI 25.7/h , range 10–46/h ) had a MAS set at 70 % maximal protrusion and were r and omised to subjective self-adjustment for 6 weeks ( n = 16 ) or objective adjustment ( n = 12 ; fixed position for 3 weeks , then PSG based feedback at 3 weeks with self-adjustment instructions ) . Primary outcome variable ( AHI ) and OSA symptoms were compared by t tests and chi-squared tests at baseline and after 6 weeks . Resolution of apnoea was defined as AHI < 5/h ; improvement was defined as AHI decreased by > 50 % but still > 5/h . Results The groups had similar baseline demographics , OSA severity and occlusal type . MAS therapy improved or resolved OSA in 20 out of 28 ( 71 % ) and was reportedly used nightly by 91 % of the objective group and 63 % of the subjective group ( p = 0.04 ) . MAS were used all night by 75 % of the objective group and 69 % of the subjective group ( p > 0.05 ) . MAS adjustment following PSG feedback did not lower AHI 
    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: RATIONALE Continuous positive airway pressure ( CPAP ) and m and ibular advancement device ( MAD ) therapy are commonly used to treat obstructive sleep apnea ( OSA ) . Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes . OBJECTIVES To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA . METHODS In this r and omized crossover trial , we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes . MEASUREMENTS AND MAIN RESULTS Cardiovascular ( 24-h blood pressure , arterial stiffness ) , neurobehavioral ( subjective sleepiness , driving simulator performance ) , and quality of life ( Functional Outcomes of Sleep Question naire , Short Form-36 ) were compared between treatments . Our primary outcome was 24-hour mean arterial pressure .  A total of 126 patients with moderate-severe OSA ( apnea hypopnea index [ AHI ] , 25.6 [ SD 12.3 ] ) were r and omly assigned to a treatment order and 108 completed the trial with both devices . CPAP was more efficacious than MAD in reducing AHI ( CPAP AHI , 4.5 ± 6.6/h ; MAD AHI , 11.1 ± 12.1/h ; P < 0.01 ) but reported compliance was higher on MAD ( MAD , 6.50 ± 1.3 h per night vs. CPAP , 5.20 ± 2 h per night ; P < 0.00001 ) . The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP ( CPAP-MAD difference , 0.2 mm Hg [ 95 % confidence interval , -0.7 to 1.1 ] ) ; however , overall , neither treatment improved blood pressure . In contrast , sleepiness , driving simulator performance , and disease-specific quality of life improved on both treatments by similar amounts , although MAD was superior to CPAP for improving four general quality -of-life domains . CONCLUSIONS Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA . The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD , result ing in similar effectiveness . Clinical trial registered with https://www.anzctr.org.au ( ACTRN 12607000289415 ) Background : Previous r and omized controlled trials have addressed the efficacy of m and ibular advancement devices ( MADs ) in the treatment of obstructive sleep apnea ( OSA ) . Their common control condition , nasal continuous positive airway pressure ( nCPAP ) , was frequently found to be superior to MAD therapy . However , in most of these studies , only nCPAP was titrated objective ly but not MAD . To enable an unbiased comparison between both treatment modalities , the MAD should be titrated objective ly as well . Objective : The aim of the present study was to compare the treatment effects of a titrated MAD with those of nCPAP and an intra-oral placebo device . Methods : Sixty-four mild/moderate patients with obstructive sleep apnea ( OSA ; 52.0 ± 9.6 years ) were r and omly assigned to three parallel groups : MAD , nCPAP and placebo device . From all patients , two polysomnographic recordings were obtained at the hospital : one before treatment and one after approximately 6 months of treatment . Results : The change in the apnea-hypopnea index ( ΔAHI ) between baseline and therapy evaluation differed significantly between the three therapy groups ( ANCOVA ; p = 0.000 ) . No differences in the ΔAHI were found between the MAD and nCPAP therapy ( p = 0.092 ) , whereas the changes in AHI in these groups were significantly larger than those in the placebo group ( p = 0.000 and 0.002 , respectively ) . Conclusion : There is no clinical ly relevant difference between MAD and nCPAP in the treatment of mild/moderate OSA when both treatment modalities are titrated objective ly 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 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 control alone was not uniformly effective In clinical practice , oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure ( CPAP ) therapy . We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively . We r and omly assigned 103 individuals to oral-appliance or CPAP therapy .  Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance ( 76.5 % ) and for 43 of 52 persons using CPAP ( 82.7 % ) . For the difference in effectiveness , a 95 % two-sided confidence interval was calculated . Non-inferiority of oral-appliance therapy  was considered to be established when the lower boundary of this interval exceeded −25 % . The lower boundary of the confidence interval was −21.7 % , indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea . However , subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease ( apnea-hypopnea index > 30 ) . Since these people could be at particular cardiovascular risk , primary oral-appliance therapy appears to be supported only for those with non-severe apnea 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 Introduction M and ibular advancement splints ( MAS ) allowing self-adjustment may be better tolerated , but the optimum titration protocol needs systematic study . Aim The aims of the study are to assess the effectiveness of a titratable MAS device in consecutive patients with body mass index ( BMI ) < 35 kg/m2 and obstructive sleep apnoea [ OSA , apnoea – hypopnoea index ( AHI ) 10–40/h ] and compare two methods of adjustment  [ self-adjustment  or adjustment after polysomnographic ( PSG ) feedback ] . Material s and methods Twenty-eight patients ( 24 M , mean age 49 years , mean BMI 27.6 kg/m2 ) with symptomatic ( Epworth Sleepiness score > 8/24 , snoring , choking or poor sleep quality ) OSA ( mean AHI 25.7/h , range 10–46/h ) had a MAS set at 70 % maximal protrusion and were r and omised to subjective self-adjustment for 6 weeks ( n = 16 ) or objective adjustment ( n = 12 ; fixed position for 3 weeks , then PSG based feedback at 3 weeks with self-adjustment instructions ) . Primary outcome variable ( AHI ) and OSA symptoms were compared by t tests and chi-squared tests at baseline and after 6 weeks . Resolution of apnoea was defined as AHI < 5/h ; improvement was defined as AHI decreased by > 50 % but still > 5/h . Results The groups had similar baseline demographics , OSA severity and occlusal type . MAS therapy improved or resolved OSA in 20 out of 28 ( 71 % ) and was reportedly used nightly by 91 % of the objective group and 63 % of the subjective group ( p = 0.04 ) . MAS were used all night by 75 % of the objective group and 69 % of the subjective group ( p > 0.05 ) . MAS adjustment following PSG feedback did not lower AHI 
    Output:
    