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: OBJECTIVES The aim of this study was to compare the relative efficacy of continuous positive airway pressure ( CPAP ) and positional treatment in the management of positional obstructive sleep apnea ( OSA ) , using objective outcome measures . DESIGN A prospect i ve , r and omized , single blind crossover comparison of CPAP and positional treatment for 2 weeks each . SETTING A university teaching hospital . PATIENTS Thirteen patients with positional OSA , aged ( mean+/-SD ) 51+/-9 years , with an apnea-hypopnea index ( AHI ) of 17+/-8 . MEASUREMENTS ( 1 ) Daily Epworth Sleepiness Scale scores ; ( 2 ) overnight polysomnography , an objective assessment of sleep quality and AHI ; ( 3 ) maintenance of wakefulness testing ; ( 4 ) psychometric test battery ; ( 5 ) mood scales ; ( 6 ) quality -of-life question naires ; and ( 7 ) individual patient 's treatment preference . RESULTS Positional treatment was highly effective in reducing time spent supine ( median , 0 ; range , 0 to 32 min ) . The AHI was lower ( mean difference , 6.1 ; 95 % confidence interval [ CI ] , 2 to 10.2 ; p = 0.007 ) , and the minimum oxygen saturation was higher ( 4 % ; 95 % CI , 1 % to 8 % ; p = 0.02 ) on CPAP as compared with positional treatment . There was no significant difference , however , in sleep architecture , Epworth Sleepiness Scale scores , maintenance of wakefulness testing sleep latency , psychometric test performance , mood scales , or quality -of-life measures . CONCLUSION Positional treatment and CPAP have similar efficacy in the treatment of patients with positional OSA 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 % OBJECTIVES : Radiofrequency volume reduction ( RFTVR ) is a minor procedure directed at reducing the tongue base volume to treat obstructive sleep apnea . Subjective and objective treatment effectiveness was evaluated . STUDY DESIGN AND SETTING : Two separate prospect i ve , matched , nonr and omized , open enrollment treatment groups ( RFTVR , n = 73 and nasal continuous positive airway pressure ( CPAP , n = 99 ) were concurrently enrolled in a multicenter study . RESULTS : Fifty-six ( 76.7 % ) RFTVR  completed PSG with a mean 5.4 ± 1.8 treatments ( 13,394 ± 5459 joules ) . Perioperatively , acute pain was mild to moderate ; edema , mucosal erosion , paresthesia , tinnitus were infrequent ; and speech , swallowing taste , or throat irritation were unchanged . Self-reported outcomes did not differ between RFTVR and CPAP groups . Mean apnea/hypopnea index decreased ( 40.5 ± 21.5 to 32.8 ± 22.6 events/hr , P < 0.01 ) . Electrolyte solution injected predicted results ( r = 0.43 , P < 0.001 ) . The most severe complication was abscess ( 1.1 % ) . CONCLUSION : RFTVR  improves apnea/hypopnea index . Improvement may be related to solution injected with treatment . RFTVR and CPAP clinical outcomes improvement were similar . CLINICAL SIGNIFICANCE : In mild obstructive sleep apnea , treatment of symptomatic outcomes with RFTVR may be an alternative to CPAP Obstructive sleep apnea and hypertension are common conditions that frequently coexist . Continuous positive airway pressure ( CPAP ) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension . However , the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension , conditions associated with increased cardiovascular risk , is unknown . Thirty-six male patients ( age , 43±7 years ; body mass index , 28.8±3.0 kg/m2 ) with untreated severe obstructive sleep apnea ( apnea – hypopnea index , 56±22 events/hr on polysomnography ) with diagnostic criteria for prehypertension and /or masked hypertension , based on office and 24-hour ambulatory blood pressure monitoring , respectively , were studied . The patients r and omized to no treatment ( control ; n=18 ) or CPAP ( n=18 ) for 3 months had similar frequency of prehypertension and masked hypertension at study entry . There were no significant changes in blood pressure in patients r and omized to the control group . In contrast , patients r and omized to CPAP presented significant reduction in office systolic ( from 126±5 to 121±7 mm Hg ; P=0.001 ) and a trend for diastolic blood pressure ( from 75±7 to 73±8 mm Hg ; P=0.08 ) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure ( P<0.05 for each comparison ) . There was a significant reduction in the frequency of prehypertension ( from 94 % to 55 % ; P=0.02 ) and masked hypertension ( from 39 % to 5 % ; P=0.04 ) only in the CPAP group . In conclusion , effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe 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 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 STUDY OBJECTIVE To compare the lateral pharyngoplasty procedure with uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnea hypopnea syndrome ( OSAHS ) . DESIGN Prospect i ve r and omized study . SETTING Academic tertiary center . PATIENTS Twenty-seven adults with OSAHS originally selected for treatment with UPPP .  INTERVENTIONS Patients were r and omly assigned to 2 groups : in one group , we performed the lateral pharyngoplasty ( 15 cases ) , and in the other , we did the UPPP ( 12 cases ) . MEASUREMENTS AND RESULTS We compared treatment outcomes through the evaluation of OSAHS-related symptoms and the analysis of polysomnographic tests and computed tomography measurements of pharyngeal airway . The lateral pharyngoplasty group achieved a statistically greater reduction in body weight , excessive daytime sleepiness , and apnea-hypopnea index . In addition , only in this group did we observe a statistically significant increase in the amount of deep sleep stages and improvement in morning headaches . Patients from the UPPP group did not present significant changes in the polysomnographic parameters . Pharyngeal airway measurement outcomes were similar in both groups and did not reflect the clinical and polysomnographic differences we observed . CONCLUSIONS Lateral pharyngoplasty produces better clinical and polysomnographic outcomes in the treatment of OSAHS than does UPPP , without result ant differences in the cross-sectional measurements of the pharyngeal airway between these treatments OBJECTIVE To determine the efficacy of the laser-assisted uvulopalatoplasty ( LAUP ) procedure on snoring and Apnea-Hypopnea-Index ( AHI ) improvement in patients with snoring and mild obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN Prospect i ve , nonr and omized , nonblinded assessment of 
    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: OBJECTIVES The aim of this study was to compare the relative efficacy of continuous positive airway pressure ( CPAP ) and positional treatment in the management of positional obstructive sleep apnea ( OSA ) , using objective outcome measures . DESIGN A prospect i ve , r and omized , single blind crossover comparison of CPAP and positional treatment for 2 weeks each . SETTING A university teaching hospital . PATIENTS Thirteen patients with positional OSA , aged ( mean+/-SD ) 51+/-9 years , with an apnea-hypopnea index ( AHI ) of 17+/-8 . MEASUREMENTS ( 1 ) Daily Epworth Sleepiness Scale scores ; ( 2 ) overnight polysomnography , an objective assessment of sleep quality and AHI ; ( 3 ) maintenance of wakefulness testing ; ( 4 ) psychometric test battery ; ( 5 ) mood scales ; ( 6 ) quality -of-life question naires ; and ( 7 ) individual patient 's treatment preference . RESULTS Positional treatment was highly effective in reducing time spent supine ( median , 0 ; range , 0 to 32 min ) . The AHI was lower ( mean difference , 6.1 ; 95 % confidence interval [ CI ] , 2 to 10.2 ; p = 0.007 ) , and the minimum oxygen saturation was higher ( 4 % ; 95 % CI , 1 % to 8 % ; p = 0.02 ) on CPAP as compared with positional treatment . There was no significant difference , however , in sleep architecture , Epworth Sleepiness Scale scores , maintenance of wakefulness testing sleep latency , psychometric test performance , mood scales , or quality -of-life measures . CONCLUSION Positional treatment and CPAP have similar efficacy in the treatment of patients with positional OSA 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 % OBJECTIVES : Radiofrequency volume reduction ( RFTVR ) is a minor procedure directed at reducing the tongue base volume to treat obstructive sleep apnea . Subjective and objective treatment effectiveness was evaluated . STUDY DESIGN AND SETTING : Two separate prospect i ve , matched , nonr and omized , open enrollment treatment groups ( RFTVR , n = 73 and nasal continuous positive airway pressure ( CPAP , n = 99 ) were concurrently enrolled in a multicenter study . RESULTS : Fifty-six ( 76.7 % ) RFTVR  completed PSG with a mean 5.4 ± 1.8 treatments ( 13,394 ± 5459 joules ) . Perioperatively , acute pain was mild to moderate ; edema , mucosal erosion , paresthesia , tinnitus were infrequent ; and speech , swallowing taste , or throat irritation were unchanged . Self-reported outcomes did not differ between RFTVR and CPAP groups . Mean apnea/hypopnea index decreased ( 40.5 ± 21.5 to 32.8 ± 22.6 events/hr , P < 0.01 ) . Electrolyte solution injected predicted results ( r = 0.43 , P < 0.001 ) . The most severe complication was abscess ( 1.1 % ) . CONCLUSION : RFTVR  improves apnea/hypopnea index . Improvement may be related to solution injected with treatment . RFTVR and CPAP clinical outcomes improvement were similar . CLINICAL SIGNIFICANCE : In mild obstructive sleep apnea , treatment of symptomatic outcomes with RFTVR may be an alternative to CPAP Obstructive sleep apnea and hypertension are common conditions that frequently coexist . Continuous positive airway pressure ( CPAP ) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension . However , the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension , conditions associated with increased cardiovascular risk , is unknown . Thirty-six male patients ( age , 43±7 years ; body mass index , 28.8±3.0 kg/m2 ) with untreated severe obstructive sleep apnea ( apnea – hypopnea index , 56±22 events/hr on polysomnography ) with diagnostic criteria for prehypertension and /or masked hypertension , based on office and 24-hour ambulatory blood pressure monitoring , respectively , were studied . The patients r and omized to no treatment ( control ; n=18 ) or CPAP ( n=18 ) for 3 months had similar frequency of prehypertension and masked hypertension at study entry . There were no significant changes in blood pressure in patients r and omized to the control group . In contrast , patients r and omized to CPAP presented significant reduction in office systolic ( from 126±5 to 121±7 mm Hg ; P=0.001 ) and a trend for diastolic blood pressure ( from 75±7 to 73±8 mm Hg ; P=0.08 ) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure ( P<0.05 for each comparison ) . There was a significant reduction in the frequency of prehypertension ( from 94 % to 55 % ; P=0.02 ) and masked hypertension ( from 39 % to 5 % ; P=0.04 ) only in the CPAP group . In conclusion , effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe 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 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 STUDY OBJECTIVE To compare the lateral pharyngoplasty procedure with uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnea hypopnea syndrome ( OSAHS ) . DESIGN Prospect i ve r and omized study . SETTING Academic tertiary center . PATIENTS Twenty-seven adults with OSAHS originally selected for treatment with UPPP .  INTERVENTIONS Patients were r and omly assigned to 2 groups : in one group , we performed the lateral pharyngoplasty ( 15 cases ) , and in the other , we did the UPPP ( 12 cases ) . MEASUREMENTS AND RESULTS We compared treatment outcomes through the evaluation of OSAHS-related symptoms and the analysis of polysomnographic tests and computed tomography measurements of pharyngeal airway . The lateral pharyngoplasty group achieved a statistically greater reduction in body weight , excessive daytime sleepiness , and apnea-hypopnea index . In addition , only in this group did we observe a statistically significant increase in the amount of deep sleep stages and improvement in morning headaches . Patients from the UPPP group did not present significant changes in the polysomnographic parameters . Pharyngeal airway measurement outcomes were similar in both groups and did not reflect the clinical and polysomnographic differences we observed . CONCLUSIONS Lateral pharyngoplasty produces better clinical and polysomnographic outcomes in the treatment of OSAHS than does UPPP , without result ant differences in the cross-sectional measurements of the pharyngeal airway between these treatments OBJECTIVE To determine the efficacy of the laser-assisted uvulopalatoplasty ( LAUP ) procedure on snoring and Apnea-Hypopnea-Index ( AHI ) improvement in patients with snoring and mild obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN Prospect i ve , nonr and omized , nonblinded assessment of 
    Output:
    