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 objective of this study was to compare the effect of two different degrees of m and ibular advancement ( MA ) , 75 % versus 50 % , on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea ( OSA ) . A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness . Eighty-six males with severe OSA ( apnea index ≥ 20 ) were r and omly allocated to either 75 % or 50 % MA . Forty patients in the 75 % MA group and 37 patients in the 50 % MA group completed the 6-month follow-up . The effectiveness of treatment in terms of normalization ( apnea index < 5 and apnea/hypopnea index < 10 ) with 75 % MA was 52 % , which was significantly higher ( p = 0.04 ) than the 31 % achieved with 50 % MA . The dental appliance had few adverse events on the stomatognathic system regardless of group , and the number of adverse events did not differ between the two groups . Finally , the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up ( p < 0.001 ) . No significant difference was observed between the two groups . The results indicate that a dental appliance could be an alternative treatment for some patients with severe 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 Purpose This prospect i ve clinical study investigates the efficacy of a specific custom-made titratable m and ibular advancement device ( MAD ) for the treatment of obstructive sleep apnea ( OSA ) . This MAD has attachments in the frontal teeth area that allow for progressive titration of the m and ible . Methods Sixty-one adult OSA patients were included ( age , 46.7 ± 9.0 years ; male/female ratio , 45/16 ; apnea – hypopnea index ( AHI ) , 23.2 ± 15.4 events/h sleep ; body mass index , 27.9 ± 4.1 kg/m² ) . After an adaptation period , titration started based on a protocol of symptomatic benefit or upon reaching the physiological limits of protrusion . As a primary outcome , treatment response was defined as an objective reduction in AHI following MAD treatment of ≥50 % compared to baseline , and treatment success as a reduction in AHI with MAD to less than 5 and 10 events/h sleep . Compliance failure was defined as an inability to continue treatment . Results A statistically significant decrease was observed in AHI , from 23.4 ± 15.7 at baseline to 8.9 ± 8.6 events/h with MAD ( p < 0.01 ) . Treatment response was achieved in 42 out of 61 patients ( 68.8 % ) , whereas 42.6 % met criteria of AHI < 5 and 63.9 % achieved an AHI < 10 events/h sleep , respectively . Four patients ( 6.6 % ) were considered as “ compliance failures . ” Conclusions The present study has evaluated the efficacy of a specific custom-made titratable MAD in terms of sleep apnea reduction Objectives This study aim ed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure ( CPAP ) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of m and ibular protrusion associated with oral appliance therapy . Material s and methods As part of a previously conducted RCT , 51 patients were r and omized to oral appliance therapy and 52 patients to CPAP therapy .  At baseline and after a 2-year follow-up , dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables . Results Long-term use of an oral appliance result ed in small but significant dental changes compared with CPAP . In the oral appliance group , overbite and overjet decreased 1.2 ( ±1.1 ) mm and 1.5 ( ±1.5 ) mm , respectively . Furthermore , we found a significantly larger anterior – posterior change in the occlusion ( −1.3 ± 1.5 mm ) in the oral appliance group compared to the CPAP group ( −0.1 ± 0.6 mm ) . Moreover , both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region . Linear regression analysis revealed that the decrease in overbite was associated with the mean m and ibular protrusion during follow-up [ regression coefficient ( β ) = −0.02 , 95 % confidence interval ( −0.04 to −0.00 ) ] . Conclusions Oral appliance therapy should be considered as a lifelong treatment , and there is a risk of dental side effects to occur . Clinical relevance Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine 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 STUDY OBJECTIVES The purpose of this study was to determine if subjects with moderate-to-severe obstructive sleep apnea would experience increasing treatment effect when a tongue retention component was added to a m and ibular repositioning appliance . DESIGN Cohort study . SETTING Sleep clinic . PATIENTS Forty-four sequentially recruited patients with moderate-to-severe obstructive sleep apnea . INTERVENTIONS Subjects were sleep tested at 4 treatment stages of oral appliance therapy . The 4 stages were : 6-mm m and ibular protrusion , 8-mm protrusion , 6-mm protrusion with a tongue retention bulb , and 8-mm protrusion with a tongue retention bulb . MEASUREMENTS AND RESULTS Forty-one of 44 subjects completed the protocol . There was a decrease in mean respiratory disturbance index from 33.5 events/h at baseline to 18.1 events/h at stage 4 ( p = 0.001 ) . Mean Epworth Sleepiness Scale ( ESS ) decreased from 12.3 at baseline to 9.0 at stage 4 ( p = 0.0001 . CONCLUSIONS A combined approach utilizing both m and ibular protrusion and tongue retention can provide effective treatment for moderate-to-severe obstructive sleep apnea . The addition of a tongue bulb may provide further treatment effect when m and ibular protrusion is limited . Appliance design s that allow for convenient combination therapy need to be developed for this purpose Many studies have shown a relationship between obstructive sleep apnea ( OSA ) and accidents , but to our knowledge , none have investigated prospect ively the effects of treatment with nasal continuous positive airway pressure ( CPAP ) . CPAP was proposed to 973 patients , of whom 893 patients actually underwent CPAP .  These patients were consecutively invited to enter a prospect i ve follow-up study including a question naire before treatment and after 6 and 12 months of treatment ; 547 patients completed the study ( 153 left the study , and only partial data were available for 193 ) . The baseline question naire included questions concerning accidents in the previous 12 months , asking whether patients had had an accident and , if so , whether they felt that the accident(s ) were related to sleepiness , and whether the patients felt that they had had near-miss accidents due to sleepiness . The question naires at 6 and 12 months included the same questions referring to the previous 6 months ; the accidents reported on each follow-up question naire were cumulated and compared with the accidents during the 1-year period before treatment . The number of patients having an accident decreased with treatment for real accidents ( from 60 to 36 ; p<0.01 ) , as well as for near-miss accidents ( from 151 to 32 ; p<0.01 ) . The average number of accidents per patient also decreased , for real accidents ( from 1.6+/-1.3 to 1.1+/-0.3 ; p<0.01 ) and for near-miss accidents ( from 4.5+/-6.5 to 1.8+/-1.4 ; p<0.01 ) . The cost , in terms of days in hospital related to accidents , decreased from 885 to 84 days . With caution due to the absence of a control group , it is suggested that treatment with CPAP decreases the number of accidents occurring in OSA patients . This result may have important implication s in the evaluation of the cost/benefit ratio when treating OSA patients OBJECTIVE To evaluate the effects of a m and ibular advancement device on  apneas and sleep in mild , moderate , and severe obstructive sleep apnea . DESIGN Prospect i ve study . SUBJECTS Forty-four of 47 patients included . INTERVENTION Individually adjusted m and ibular advancement devices . MEASUREMENTS Polysomnographic sleep recordings for 1 night without the device and 1 night with it , with a median of 1 day and no changes in weight , medication , or sleep position between the recordings . RESULTS The device reduced the median obstructive apnea-hypopnea index from 11 ( range , 7 to 19 ) to 5 ( range , 0 to 17 ) ( p<0.001 ) in 21 patients with mild sleep apnea , from 27 ( range , 20 to 38 ) to 7 ( range , 1 to 19 ) ( p<0.001 ) in 15 patients with moderate sleep apnea , and from 53 ( range , 44 to 66 ) to 14 ( range , 2 to 32 ) ( p<0.05 ) in 8 patients with severe sleep apnea . The arousal index decreased and the sleep stage patterns improved in all severity groups . Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring . Nine of 16 patients with treatment failure still reported a reduction in snoring . The success rate correlated inversely to the disease severity ( r=-0.41 ; p<0.01 ) . CONCLUSIONS A m and ibular advancement device reduces apneas and improves sleep quality in patients with obstructive sleep apnea , especially in those with mild and moderate disease . A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device This study aim ed to explore the effect of m and ibular advancement splints ( MAS ) on upper airway anatomy during wakefulness in obstructive sleep apnoea ( OSA ) . Patients commencing treatment for OSA with MAS were recruited . Response to treatment was defined by a ≥50 % reduction in the apnoea/hypopnoea index .  Nasopharyngoscopy was performed in the supine position . Nasopharyngoscopy was performed in 18 responders and 17 nonresponders . M and ibular advancement caused an increase in the calibre of the 
    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 objective of this study was to compare the effect of two different degrees of m and ibular advancement ( MA ) , 75 % versus 50 % , on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea ( OSA ) . A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness . Eighty-six males with severe OSA ( apnea index ≥ 20 ) were r and omly allocated to either 75 % or 50 % MA . Forty patients in the 75 % MA group and 37 patients in the 50 % MA group completed the 6-month follow-up . The effectiveness of treatment in terms of normalization ( apnea index < 5 and apnea/hypopnea index < 10 ) with 75 % MA was 52 % , which was significantly higher ( p = 0.04 ) than the 31 % achieved with 50 % MA . The dental appliance had few adverse events on the stomatognathic system regardless of group , and the number of adverse events did not differ between the two groups . Finally , the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up ( p < 0.001 ) . No significant difference was observed between the two groups . The results indicate that a dental appliance could be an alternative treatment for some patients with severe 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 Purpose This prospect i ve clinical study investigates the efficacy of a specific custom-made titratable m and ibular advancement device ( MAD ) for the treatment of obstructive sleep apnea ( OSA ) . This MAD has attachments in the frontal teeth area that allow for progressive titration of the m and ible . Methods Sixty-one adult OSA patients were included ( age , 46.7 ± 9.0 years ; male/female ratio , 45/16 ; apnea – hypopnea index ( AHI ) , 23.2 ± 15.4 events/h sleep ; body mass index , 27.9 ± 4.1 kg/m² ) . After an adaptation period , titration started based on a protocol of symptomatic benefit or upon reaching the physiological limits of protrusion . As a primary outcome , treatment response was defined as an objective reduction in AHI following MAD treatment of ≥50 % compared to baseline , and treatment success as a reduction in AHI with MAD to less than 5 and 10 events/h sleep . Compliance failure was defined as an inability to continue treatment . Results A statistically significant decrease was observed in AHI , from 23.4 ± 15.7 at baseline to 8.9 ± 8.6 events/h with MAD ( p < 0.01 ) . Treatment response was achieved in 42 out of 61 patients ( 68.8 % ) , whereas 42.6 % met criteria of AHI < 5 and 63.9 % achieved an AHI < 10 events/h sleep , respectively . Four patients ( 6.6 % ) were considered as “ compliance failures . ” Conclusions The present study has evaluated the efficacy of a specific custom-made titratable MAD in terms of sleep apnea reduction Objectives This study aim ed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure ( CPAP ) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of m and ibular protrusion associated with oral appliance therapy . Material s and methods As part of a previously conducted RCT , 51 patients were r and omized to oral appliance therapy and 52 patients to CPAP therapy .  At baseline and after a 2-year follow-up , dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables . Results Long-term use of an oral appliance result ed in small but significant dental changes compared with CPAP . In the oral appliance group , overbite and overjet decreased 1.2 ( ±1.1 ) mm and 1.5 ( ±1.5 ) mm , respectively . Furthermore , we found a significantly larger anterior – posterior change in the occlusion ( −1.3 ± 1.5 mm ) in the oral appliance group compared to the CPAP group ( −0.1 ± 0.6 mm ) . Moreover , both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region . Linear regression analysis revealed that the decrease in overbite was associated with the mean m and ibular protrusion during follow-up [ regression coefficient ( β ) = −0.02 , 95 % confidence interval ( −0.04 to −0.00 ) ] . Conclusions Oral appliance therapy should be considered as a lifelong treatment , and there is a risk of dental side effects to occur . Clinical relevance Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine 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 STUDY OBJECTIVES The purpose of this study was to determine if subjects with moderate-to-severe obstructive sleep apnea would experience increasing treatment effect when a tongue retention component was added to a m and ibular repositioning appliance . DESIGN Cohort study . SETTING Sleep clinic . PATIENTS Forty-four sequentially recruited patients with moderate-to-severe obstructive sleep apnea . INTERVENTIONS Subjects were sleep tested at 4 treatment stages of oral appliance therapy . The 4 stages were : 6-mm m and ibular protrusion , 8-mm protrusion , 6-mm protrusion with a tongue retention bulb , and 8-mm protrusion with a tongue retention bulb . MEASUREMENTS AND RESULTS Forty-one of 44 subjects completed the protocol . There was a decrease in mean respiratory disturbance index from 33.5 events/h at baseline to 18.1 events/h at stage 4 ( p = 0.001 ) . Mean Epworth Sleepiness Scale ( ESS ) decreased from 12.3 at baseline to 9.0 at stage 4 ( p = 0.0001 . CONCLUSIONS A combined approach utilizing both m and ibular protrusion and tongue retention can provide effective treatment for moderate-to-severe obstructive sleep apnea . The addition of a tongue bulb may provide further treatment effect when m and ibular protrusion is limited . Appliance design s that allow for convenient combination therapy need to be developed for this purpose Many studies have shown a relationship between obstructive sleep apnea ( OSA ) and accidents , but to our knowledge , none have investigated prospect ively the effects of treatment with nasal continuous positive airway pressure ( CPAP ) . CPAP was proposed to 973 patients , of whom 893 patients actually underwent CPAP .  These patients were consecutively invited to enter a prospect i ve follow-up study including a question naire before treatment and after 6 and 12 months of treatment ; 547 patients completed the study ( 153 left the study , and only partial data were available for 193 ) . The baseline question naire included questions concerning accidents in the previous 12 months , asking whether patients had had an accident and , if so , whether they felt that the accident(s ) were related to sleepiness , and whether the patients felt that they had had near-miss accidents due to sleepiness . The question naires at 6 and 12 months included the same questions referring to the previous 6 months ; the accidents reported on each follow-up question naire were cumulated and compared with the accidents during the 1-year period before treatment . The number of patients having an accident decreased with treatment for real accidents ( from 60 to 36 ; p<0.01 ) , as well as for near-miss accidents ( from 151 to 32 ; p<0.01 ) . The average number of accidents per patient also decreased , for real accidents ( from 1.6+/-1.3 to 1.1+/-0.3 ; p<0.01 ) and for near-miss accidents ( from 4.5+/-6.5 to 1.8+/-1.4 ; p<0.01 ) . The cost , in terms of days in hospital related to accidents , decreased from 885 to 84 days . With caution due to the absence of a control group , it is suggested that treatment with CPAP decreases the number of accidents occurring in OSA patients . This result may have important implication s in the evaluation of the cost/benefit ratio when treating OSA patients OBJECTIVE To evaluate the effects of a m and ibular advancement device on  apneas and sleep in mild , moderate , and severe obstructive sleep apnea . DESIGN Prospect i ve study . SUBJECTS Forty-four of 47 patients included . INTERVENTION Individually adjusted m and ibular advancement devices . MEASUREMENTS Polysomnographic sleep recordings for 1 night without the device and 1 night with it , with a median of 1 day and no changes in weight , medication , or sleep position between the recordings . RESULTS The device reduced the median obstructive apnea-hypopnea index from 11 ( range , 7 to 19 ) to 5 ( range , 0 to 17 ) ( p<0.001 ) in 21 patients with mild sleep apnea , from 27 ( range , 20 to 38 ) to 7 ( range , 1 to 19 ) ( p<0.001 ) in 15 patients with moderate sleep apnea , and from 53 ( range , 44 to 66 ) to 14 ( range , 2 to 32 ) ( p<0.05 ) in 8 patients with severe sleep apnea . The arousal index decreased and the sleep stage patterns improved in all severity groups . Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring . Nine of 16 patients with treatment failure still reported a reduction in snoring . The success rate correlated inversely to the disease severity ( r=-0.41 ; p<0.01 ) . CONCLUSIONS A m and ibular advancement device reduces apneas and improves sleep quality in patients with obstructive sleep apnea , especially in those with mild and moderate disease . A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device This study aim ed to explore the effect of m and ibular advancement splints ( MAS ) on upper airway anatomy during wakefulness in obstructive sleep apnoea ( OSA ) . Patients commencing treatment for OSA with MAS were recruited . Response to treatment was defined by a ≥50 % reduction in the apnoea/hypopnoea index .  Nasopharyngoscopy was performed in the supine position . Nasopharyngoscopy was performed in 18 responders and 17 nonresponders . M and ibular advancement caused an increase in the calibre of the 
    Output:
    