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: Background —There is increasing evidence that obstructive sleep apnea ( OSA ) is an independent risk factor for arterial hypertension . Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure ( nCPAP ) therapy on hypertension in OSA , the impact of treatment on cardiovascular sequelae has been question ed altogether . Therefore , we studied the effect of nCPAP on arterial hypertension in patients with OSA . Methods and Results —Sixty consecutive patients with moderate to severe OSA were r and omly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average . Nocturnal polysomnography and continuous noninvasive blood pressure recording  for 19 hours was performed before and with treatment . Thirty two patients , 16 in each group , completed the study . Apneas and hypopneas were reduced by ≈95 % and 50 % in the therapeutic and subtherapeutic groups , respectively . Mean arterial blood pressure decreased by 9.9±11.4 mm Hg with effective nCPAP treatment , whereas no relevant change occurred with subtherapeutic nCPAP ( P = 0.01 ) . Mean , diastolic , and systolic blood pressures all decreased significantly by ≈10 mm Hg , both at night and during the day . Conclusions —Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure . The fact that a 50 % reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment . The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37 % and stroke risk by 56 % RATIONALE Twenty-eight percent of people with mild to moderate obstructive sleep apnea experience daytime sleepiness , which interferes with daily functioning . It remains unclear whether treatment with continuous positive airway pressure improves daytime function in these patients . OBJECTIVES To evaluate the efficacy of continuous positive airway pressure treatment to improve functional status in sleepy patients with mild and moderate obstructive sleep apnea . METHODS Patients with self-reported daytime sleepiness ( Epworth Sleepiness Scale score > 10 ) and an apnea-hypopnea index with 3 % desaturation and from 5 to 30 events per hour were r and omized to 8 weeks of active or sham continuous positive airway pressure treatment .  After the 8-week intervention , participants in the sham arm received 8 weeks of active continuous positive airway pressure treatment . MEASUREMENTS AND MAIN RESULTS The Total score on the Functional Outcomes of Sleep Question naire was the primary outcome measure . The adjusted mean change in the Total score after the first 8-week intervention was 0.89 for the active group ( n = 113 ) and -0.06 for the placebo group ( n = 110 ) ( P = 0.006 ) . The group difference in mean change corresponded to an effect size of 0.41 ( 95 % confidence interval , 0.14 - 0.67 ) . The mean ( SD ) improvement in Functional Outcomes of Sleep Question naire Total score from the beginning to the end of the crossover phase ( n = 91 ) was 1.73 ± 2.50 ( t[90 ] = 6.59 ; P < 0.00001 ) with an effect size of 0.69 . CONCLUSIONS Continuous positive airway pressure treatment improves the functional outcome of sleepy patients with mild and moderate obstructive sleep apnea BACKGROUND Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adrenergic loads and may thereby contribute to the progression of heart failure . We hypothesized that treatment of obstructive sleep apnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function . METHODS Twenty-four patients with a depressed left ventricular ejection fraction ( 45 percent or less ) and obstructive sleep apnea who were receiving optimal medical treatment for heart failure underwent polysomnography .  On the following morning , their blood pressure and heart rate were measured by digital photoplethysmography , and left ventricular dimensions and left ventricular ejection fraction were assessed by echocardiography . The subjects were then r and omly assigned to receive medical therapy either alone ( 12 patients ) or with the addition of continuous positive airway pressure ( 12 patients ) for one month . The assessment protocol was then repeated . RESULTS In the control group of patients who received only medical therapy , there were no significant changes in the severity of obstructive sleep apnea , daytime blood pressure , heart rate , left ventricular end-systolic dimension , or left ventricular ejection fraction during the study . In contrast , continuous positive airway pressure markedly reduced obstructive sleep apnea , reduced the daytime systolic blood pressure from a mean ( + /-SE ) of 126+/-6 mm Hg to 116+/-5 mm Hg ( P=0.02 ) , reduced the heart rate from 68+/-3 to 64+/-3 beats per minute ( P=0.007 ) , reduced the left ventricular end-systolic dimension from 54.5+/-1.8 to 51.7+/-1.2 mm ( P=0.009 ) , and improved the left ventricular ejection fraction from 25.0+/-2.8 to 33.8+/-2.4 percent ( P<0.001 ) . CONCLUSION In medically treated patients with heart failure , treatment of coexisting obstructive sleep apnea by continuous positive airway pressure reduces systolic blood pressure and improves left ventricular systolic function . Obstructive sleep apnea may thus have an adverse effect in heart failure that can be addressed by targeted therapy 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 : The effects of continuous positive airway pressure ( CPAP ) for obstructive sleep apnoea ( OSA ) on insulin resistance are not clear . Trials have found conflicting results and no appropriate control groups have been used . Methods : Forty-two men with known type 2 diabetes and newly diagnosed OSA ( > 10 dips/h in oxygen saturation of > 4 % ) were r and omised to receive therapeutic ( n = 20 ) or placebo CPAP ( n = 22 ) for 3 months . Baseline tests were performed and repeated after 3 months . The study was double blind . Results : Results are expressed as mean ( SD ) . CPAP  improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group ( −6.6 ( 4.5 ) vs −2.6 ( 4.9 ) , p = 0.01 ) . The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group ( + 10.6 ( 13.9 ) vs −4.7 ( 11.8 ) min , p = 0.001 ) . Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups : HbA1c ( −0.02 ( 1.5 ) vs + 0.1 ( 0.7 ) , p = 0.7 , 95 % CI −0.6 % to + 0.9 % ) , euglycaemic clamp ( M/I : + 1.7 ( 14.1 ) vs −5.7 ( 14.8 ) , p = 0.2 , 95 % CI −1.8 to + 0.3 l/kg/min1000 ) , HOMA-%S ( −1.5 ( 2.3 ) vs −1.1 ( 1.8 ) , p = 0.2 , 95 % CI −0.3 % to + 0.08 % ) and adiponectin ( −1.1 ( 1.2 ) vs −1.1 ( 1.3 ) , p = 0.2 , 95 % CI −0.7 to + 0.6 & mgr;g/ml ) . Body mass index , bioimpedance and anthropometric measurements were unchanged . Hours of CPAP use per night were 3.6 ( 2.8 ) in the treatment group and 3.3 ( 3.0 ) in the placebo group ( p = 0.8 ) . There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance . Conclusion : Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA 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 Objective To assess the effect of continuous positive airway pressure ( CPAP ) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of new onset and obstructive sleep apnoea . Design Multicentre , double blind , r and omised , placebo controlled trial . Setting Eleven general hospitals in Spain between 2004 and 2007 . Participants 340 patients recently diagnosed as having systemic hypertension by a general practitioner ( systolic blood pressure ≥140 mm Hg , diastolic blood pressure ≥90 mm Hg , or both ) and an apnoea-hypopnoea index per hour of sleep of > 15 events/hour . Intervention Patients were assigned to CPAP ( n=169 ) or sham CPAP ( n=171 ) for three months . Main outcome measurements Net changes in the different 24 hour ambulatory blood pressure monitoring values from baseline to three months of optimal or sham CPAP . Results 277 ( 81 % ) of the 340 patients r and omised were men ; the patients had a mean age of 52.4 ( SD 10.5 ) years , a body mass index of 31.9 ( 5.7 ) , an Epworth sleepiness scale score of 10.1 ( 4.3 ) , an apnoea-hypopnoea index of 43.5 ( 24.5 ) . No differences between groups were seen at baseline . Compared with placebo and analysed by intention 
    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: Background —There is increasing evidence that obstructive sleep apnea ( OSA ) is an independent risk factor for arterial hypertension . Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure ( nCPAP ) therapy on hypertension in OSA , the impact of treatment on cardiovascular sequelae has been question ed altogether . Therefore , we studied the effect of nCPAP on arterial hypertension in patients with OSA . Methods and Results —Sixty consecutive patients with moderate to severe OSA were r and omly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average . Nocturnal polysomnography and continuous noninvasive blood pressure recording  for 19 hours was performed before and with treatment . Thirty two patients , 16 in each group , completed the study . Apneas and hypopneas were reduced by ≈95 % and 50 % in the therapeutic and subtherapeutic groups , respectively . Mean arterial blood pressure decreased by 9.9±11.4 mm Hg with effective nCPAP treatment , whereas no relevant change occurred with subtherapeutic nCPAP ( P = 0.01 ) . Mean , diastolic , and systolic blood pressures all decreased significantly by ≈10 mm Hg , both at night and during the day . Conclusions —Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure . The fact that a 50 % reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment . The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37 % and stroke risk by 56 % RATIONALE Twenty-eight percent of people with mild to moderate obstructive sleep apnea experience daytime sleepiness , which interferes with daily functioning . It remains unclear whether treatment with continuous positive airway pressure improves daytime function in these patients . OBJECTIVES To evaluate the efficacy of continuous positive airway pressure treatment to improve functional status in sleepy patients with mild and moderate obstructive sleep apnea . METHODS Patients with self-reported daytime sleepiness ( Epworth Sleepiness Scale score > 10 ) and an apnea-hypopnea index with 3 % desaturation and from 5 to 30 events per hour were r and omized to 8 weeks of active or sham continuous positive airway pressure treatment .  After the 8-week intervention , participants in the sham arm received 8 weeks of active continuous positive airway pressure treatment . MEASUREMENTS AND MAIN RESULTS The Total score on the Functional Outcomes of Sleep Question naire was the primary outcome measure . The adjusted mean change in the Total score after the first 8-week intervention was 0.89 for the active group ( n = 113 ) and -0.06 for the placebo group ( n = 110 ) ( P = 0.006 ) . The group difference in mean change corresponded to an effect size of 0.41 ( 95 % confidence interval , 0.14 - 0.67 ) . The mean ( SD ) improvement in Functional Outcomes of Sleep Question naire Total score from the beginning to the end of the crossover phase ( n = 91 ) was 1.73 ± 2.50 ( t[90 ] = 6.59 ; P < 0.00001 ) with an effect size of 0.69 . CONCLUSIONS Continuous positive airway pressure treatment improves the functional outcome of sleepy patients with mild and moderate obstructive sleep apnea BACKGROUND Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adrenergic loads and may thereby contribute to the progression of heart failure . We hypothesized that treatment of obstructive sleep apnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function . METHODS Twenty-four patients with a depressed left ventricular ejection fraction ( 45 percent or less ) and obstructive sleep apnea who were receiving optimal medical treatment for heart failure underwent polysomnography .  On the following morning , their blood pressure and heart rate were measured by digital photoplethysmography , and left ventricular dimensions and left ventricular ejection fraction were assessed by echocardiography . The subjects were then r and omly assigned to receive medical therapy either alone ( 12 patients ) or with the addition of continuous positive airway pressure ( 12 patients ) for one month . The assessment protocol was then repeated . RESULTS In the control group of patients who received only medical therapy , there were no significant changes in the severity of obstructive sleep apnea , daytime blood pressure , heart rate , left ventricular end-systolic dimension , or left ventricular ejection fraction during the study . In contrast , continuous positive airway pressure markedly reduced obstructive sleep apnea , reduced the daytime systolic blood pressure from a mean ( + /-SE ) of 126+/-6 mm Hg to 116+/-5 mm Hg ( P=0.02 ) , reduced the heart rate from 68+/-3 to 64+/-3 beats per minute ( P=0.007 ) , reduced the left ventricular end-systolic dimension from 54.5+/-1.8 to 51.7+/-1.2 mm ( P=0.009 ) , and improved the left ventricular ejection fraction from 25.0+/-2.8 to 33.8+/-2.4 percent ( P<0.001 ) . CONCLUSION In medically treated patients with heart failure , treatment of coexisting obstructive sleep apnea by continuous positive airway pressure reduces systolic blood pressure and improves left ventricular systolic function . Obstructive sleep apnea may thus have an adverse effect in heart failure that can be addressed by targeted therapy 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 : The effects of continuous positive airway pressure ( CPAP ) for obstructive sleep apnoea ( OSA ) on insulin resistance are not clear . Trials have found conflicting results and no appropriate control groups have been used . Methods : Forty-two men with known type 2 diabetes and newly diagnosed OSA ( > 10 dips/h in oxygen saturation of > 4 % ) were r and omised to receive therapeutic ( n = 20 ) or placebo CPAP ( n = 22 ) for 3 months . Baseline tests were performed and repeated after 3 months . The study was double blind . Results : Results are expressed as mean ( SD ) . CPAP  improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group ( −6.6 ( 4.5 ) vs −2.6 ( 4.9 ) , p = 0.01 ) . The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group ( + 10.6 ( 13.9 ) vs −4.7 ( 11.8 ) min , p = 0.001 ) . Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups : HbA1c ( −0.02 ( 1.5 ) vs + 0.1 ( 0.7 ) , p = 0.7 , 95 % CI −0.6 % to + 0.9 % ) , euglycaemic clamp ( M/I : + 1.7 ( 14.1 ) vs −5.7 ( 14.8 ) , p = 0.2 , 95 % CI −1.8 to + 0.3 l/kg/min1000 ) , HOMA-%S ( −1.5 ( 2.3 ) vs −1.1 ( 1.8 ) , p = 0.2 , 95 % CI −0.3 % to + 0.08 % ) and adiponectin ( −1.1 ( 1.2 ) vs −1.1 ( 1.3 ) , p = 0.2 , 95 % CI −0.7 to + 0.6 & mgr;g/ml ) . Body mass index , bioimpedance and anthropometric measurements were unchanged . Hours of CPAP use per night were 3.6 ( 2.8 ) in the treatment group and 3.3 ( 3.0 ) in the placebo group ( p = 0.8 ) . There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance . Conclusion : Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA 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 Objective To assess the effect of continuous positive airway pressure ( CPAP ) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of new onset and obstructive sleep apnoea . Design Multicentre , double blind , r and omised , placebo controlled trial . Setting Eleven general hospitals in Spain between 2004 and 2007 . Participants 340 patients recently diagnosed as having systemic hypertension by a general practitioner ( systolic blood pressure ≥140 mm Hg , diastolic blood pressure ≥90 mm Hg , or both ) and an apnoea-hypopnoea index per hour of sleep of > 15 events/hour . Intervention Patients were assigned to CPAP ( n=169 ) or sham CPAP ( n=171 ) for three months . Main outcome measurements Net changes in the different 24 hour ambulatory blood pressure monitoring values from baseline to three months of optimal or sham CPAP . Results 277 ( 81 % ) of the 340 patients r and omised were men ; the patients had a mean age of 52.4 ( SD 10.5 ) years , a body mass index of 31.9 ( 5.7 ) , an Epworth sleepiness scale score of 10.1 ( 4.3 ) , an apnoea-hypopnoea index of 43.5 ( 24.5 ) . No differences between groups were seen at baseline . Compared with placebo and analysed by intention 
    Output:
    