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 ) 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 STUDY OBJECTIVE To evaluate the tolerability and to find predictors of treatment success for an individually adjusted , one-piece m and ibular advancement device in patients with snoring and obstructive sleep apnea . DESIGN Prospect i ve study . SETTING Departments of Respiratory Medicine and Orthodontics , Umeå University . PATIENTS Six hundred nineteen of 630 patients ( 98 % ) , who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000 , were followed up . They had a mean apnea-hypopnea index of 16 ( range , 0.0 to 76 ) and a mean body mass index of 28 ( range , 19 to 42 ) . MEASUREMENTS Interviews , question naires , and  overnight sleep apnea recordings .  Patients with an apnea-hypopnea index of > or=10 in the supine and /or lateral position were considered to have obstructive sleep apnea . A lateral apnea-hypopnea index of < 10 , together with a supine apnea-hypopnea index of > or= 10 , defined supine-dependent sleep apneas . RESULTS One hundred forty-eight of the 619 patients ( 24 % ) discontinued treatment . Female gender predicted treatment success , defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions , with an odds ratio of 2.4 ( p = 0.01 ) . In the women , the odds ratios for treatment success were 12 for mild sleep apnea ( p = 0.04 ) , and 0.1 for complaints of nasal obstruction ( p = 0.03 ) . In the men , the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas ( p < 0.001 ) , 2.5 for mild sleep apnea ( p = 0.04 ) , 1.3 for each millimeter of m and ibular advancement ( p = 0.03 ) , and 0.8 for each kilogram of weight increase ( p = 0.001 ) . CONCLUSIONS The m and ibular advancement device is recommended for women with sleep apnea , for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10 , and for snorers without sleep apnea . Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device STUDY OBJECTIVES Obstructive sleep apnea ( OSA ) results from the interaction of several physiological traits ; specifically a compromised upper airway anatomy and muscle function , and two key non-anatomical deficits : elevated loop gain and a low arousal threshold . Although continuous positive airway pressure ( CPAP ) is an efficacious treatment , it is often poorly tolerated . An alternative approach could involve administering therapies targeting the non-anatomic causes . However , therapies ( oxygen or hypnotics ) targeting these traits in isolation typically improve , but rarely resolve OSA . Therefore , our aim was to determine how the combination of oxygen and eszopiclone alters the phenotypic traits and OSA severity and to assess the baseline phenotypic characteristics of responders/nonresponders to combination therapy . METHODS In a single-blinded r and omized crossover study , 20 OSA patients received combination therapy ( 3 mg eszopiclone and 40 % oxygen ) versus placebo/sham air , with 1 w between conditions . Under each condition , we assessed the effects on OSA severity ( clinical polysomnography ) and the phenotypic traits causing OSA using CPAP manipulations ( research polysomnography ) . RESULTS Combination therapy reduced the apnea-hypopnea index ( 51.9 ± 6.2 vs. 29.5 ± 5.3 events/h ; P < 0.001 ) , lowered both the ventilation associated with arousal ( 5.7 ± 0.3 vs. 5.2 ± 0.3 L/min ; P = 0.05 ) and loop gain ( 3.3 ± 0.5 vs. 2.2 ± 0.3 ; P = 0.025 ) . Responders to therapy ( apnea-hypopnea index reduced by > 50 % to below 15 events/h ; n = 9/20 ) had less severe OSA ( P = 0.001 ) , a less collapsible upper airway ( P = 0.01 ) and greater upper airway muscle effectiveness ( P = 0.002 ) . CONCLUSIONS The combination of lowering loop gain and raising the arousal threshold is an effective therapy in patients whose anatomy is not severely compromised . Our work demonstrates that combining therapies that target multiple traits can resolve OSA in selected individuals . CLINICAL TRIAL REGISTRATION Clinical Trials.gov , ID : NCT01633827 Objective : The localization of upper airway obstruction in patients with obstructive sleep apnea ( OSA ) may optimize treatment . Nasoendoscopy during propofol sedation allows such an evaluation , but the effect of this drug on respiratory patterns and muscle relaxation is unknown . The objective of the present study was to determine through polysomnography whether propofol would change sleep parameters . Study Design : Prospect i ve study of subjects su bmi tted to polysomnography  under sedation with propofol . Setting : Tertiary referral center . Subjects and Methods : Fifteen non-obese subjects ( 4 controls/11 OSA patients ) were su bmi tted to two diurnal polysomnograms ( 90 - 120 minutes of sleep ) , with and without the use of propofol . The parameters presence of snoring , apnea-hypopnea index ( AHI ) , oxygen desaturation , and sleep architecture were compared . Results : The use of propofol did not induce snoring in the control subjects , whereas 100 percent of the OSA patients snored . AHI and mean oxygen saturation ( SaO2 ) did not differ significantly between examinations with and without sedation . However , minimum SaO2 differed significantly ( P < 0.05 ) with sedation , being lower during propofol sedation . Propofol also significantly changed the sleep architecture , with a significant increase in N3 sleep ( P < 0.005 ) and total abolishment of rapid eye movement sleep ( P < 0.0005 ) during propofol sedation . Conclusions : These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation , because the main respiratory parameters evaluated in OSA are maintained . These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease 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 BACKGROUND Limited data have suggested that sleep-disordered breathing , a condition of repeated episodes of apnea and hypopnea during sleep , is prevalent among adults . Data from the Wisconsin Sleep Cohort Study , a longitudinal study of the natural history of cardiopulmonary disorders of sleep , were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health . METHODS A r and om sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep ( the apnea-hypopnea score ) . We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score ( > or = 5 , > or = 10 , and > or = 15 ) ; we used logistic regression to investigate risk factors . RESULTS The estimated prevalence of sleep-disordered breathing , defined as an apnea-hypopnea score of 5 or higher , was 9 percent for women and 24 percent for men . We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome ( an apnea-hypopnea score of 5 or higher and daytime 
    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 ) 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 STUDY OBJECTIVE To evaluate the tolerability and to find predictors of treatment success for an individually adjusted , one-piece m and ibular advancement device in patients with snoring and obstructive sleep apnea . DESIGN Prospect i ve study . SETTING Departments of Respiratory Medicine and Orthodontics , Umeå University . PATIENTS Six hundred nineteen of 630 patients ( 98 % ) , who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000 , were followed up . They had a mean apnea-hypopnea index of 16 ( range , 0.0 to 76 ) and a mean body mass index of 28 ( range , 19 to 42 ) . MEASUREMENTS Interviews , question naires , and  overnight sleep apnea recordings .  Patients with an apnea-hypopnea index of > or=10 in the supine and /or lateral position were considered to have obstructive sleep apnea . A lateral apnea-hypopnea index of < 10 , together with a supine apnea-hypopnea index of > or= 10 , defined supine-dependent sleep apneas . RESULTS One hundred forty-eight of the 619 patients ( 24 % ) discontinued treatment . Female gender predicted treatment success , defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions , with an odds ratio of 2.4 ( p = 0.01 ) . In the women , the odds ratios for treatment success were 12 for mild sleep apnea ( p = 0.04 ) , and 0.1 for complaints of nasal obstruction ( p = 0.03 ) . In the men , the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas ( p < 0.001 ) , 2.5 for mild sleep apnea ( p = 0.04 ) , 1.3 for each millimeter of m and ibular advancement ( p = 0.03 ) , and 0.8 for each kilogram of weight increase ( p = 0.001 ) . CONCLUSIONS The m and ibular advancement device is recommended for women with sleep apnea , for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10 , and for snorers without sleep apnea . Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device STUDY OBJECTIVES Obstructive sleep apnea ( OSA ) results from the interaction of several physiological traits ; specifically a compromised upper airway anatomy and muscle function , and two key non-anatomical deficits : elevated loop gain and a low arousal threshold . Although continuous positive airway pressure ( CPAP ) is an efficacious treatment , it is often poorly tolerated . An alternative approach could involve administering therapies targeting the non-anatomic causes . However , therapies ( oxygen or hypnotics ) targeting these traits in isolation typically improve , but rarely resolve OSA . Therefore , our aim was to determine how the combination of oxygen and eszopiclone alters the phenotypic traits and OSA severity and to assess the baseline phenotypic characteristics of responders/nonresponders to combination therapy . METHODS In a single-blinded r and omized crossover study , 20 OSA patients received combination therapy ( 3 mg eszopiclone and 40 % oxygen ) versus placebo/sham air , with 1 w between conditions . Under each condition , we assessed the effects on OSA severity ( clinical polysomnography ) and the phenotypic traits causing OSA using CPAP manipulations ( research polysomnography ) . RESULTS Combination therapy reduced the apnea-hypopnea index ( 51.9 ± 6.2 vs. 29.5 ± 5.3 events/h ; P < 0.001 ) , lowered both the ventilation associated with arousal ( 5.7 ± 0.3 vs. 5.2 ± 0.3 L/min ; P = 0.05 ) and loop gain ( 3.3 ± 0.5 vs. 2.2 ± 0.3 ; P = 0.025 ) . Responders to therapy ( apnea-hypopnea index reduced by > 50 % to below 15 events/h ; n = 9/20 ) had less severe OSA ( P = 0.001 ) , a less collapsible upper airway ( P = 0.01 ) and greater upper airway muscle effectiveness ( P = 0.002 ) . CONCLUSIONS The combination of lowering loop gain and raising the arousal threshold is an effective therapy in patients whose anatomy is not severely compromised . Our work demonstrates that combining therapies that target multiple traits can resolve OSA in selected individuals . CLINICAL TRIAL REGISTRATION Clinical Trials.gov , ID : NCT01633827 Objective : The localization of upper airway obstruction in patients with obstructive sleep apnea ( OSA ) may optimize treatment . Nasoendoscopy during propofol sedation allows such an evaluation , but the effect of this drug on respiratory patterns and muscle relaxation is unknown . The objective of the present study was to determine through polysomnography whether propofol would change sleep parameters . Study Design : Prospect i ve study of subjects su bmi tted to polysomnography  under sedation with propofol . Setting : Tertiary referral center . Subjects and Methods : Fifteen non-obese subjects ( 4 controls/11 OSA patients ) were su bmi tted to two diurnal polysomnograms ( 90 - 120 minutes of sleep ) , with and without the use of propofol . The parameters presence of snoring , apnea-hypopnea index ( AHI ) , oxygen desaturation , and sleep architecture were compared . Results : The use of propofol did not induce snoring in the control subjects , whereas 100 percent of the OSA patients snored . AHI and mean oxygen saturation ( SaO2 ) did not differ significantly between examinations with and without sedation . However , minimum SaO2 differed significantly ( P < 0.05 ) with sedation , being lower during propofol sedation . Propofol also significantly changed the sleep architecture , with a significant increase in N3 sleep ( P < 0.005 ) and total abolishment of rapid eye movement sleep ( P < 0.0005 ) during propofol sedation . Conclusions : These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation , because the main respiratory parameters evaluated in OSA are maintained . These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease 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 BACKGROUND Limited data have suggested that sleep-disordered breathing , a condition of repeated episodes of apnea and hypopnea during sleep , is prevalent among adults . Data from the Wisconsin Sleep Cohort Study , a longitudinal study of the natural history of cardiopulmonary disorders of sleep , were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health . METHODS A r and om sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep ( the apnea-hypopnea score ) . We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score ( > or = 5 , > or = 10 , and > or = 15 ) ; we used logistic regression to investigate risk factors . RESULTS The estimated prevalence of sleep-disordered breathing , defined as an apnea-hypopnea score of 5 or higher , was 9 percent for women and 24 percent for men . We estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the minimal diagnostic criteria for the sleep apnea syndrome ( an apnea-hypopnea score of 5 or higher and daytime 
    Output:
    