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: OBJECTIVE To examine whether a social cognitive therapy ( SCT ) intervention increases continuous positive airway pressure ( CPAP ) use compared to equivalent social interaction ( SI ) time . PARTICIPANTS Individuals with obstructive sleep apnea ( OSA ) referred for CPAP therapy . INTERVENTION Participants received a 30-min group education session regarding OSA and CPAP . Groups of three to four participants were then r and omly assigned to an SCT session or social interaction . MEASUREMENTS CPAP usage was assessed at 7 nights , then 1 , 3 , and 6 months . The two primary outcomes were adherence , usage ≥ 4 h per night at 6 months , and uptake of CPAP . Question naires were given pretreatment and posttreatment . RESULTS Two hundred six individuals were r and omized to SI ( n = 97 ) or SCT ( n = 109 ) . CPAP uptake was not different between groups ( 82 % in SI , 88 % in SCT groups , P = 0.35 ) . There were no differences between groups in adherence : 63 - 66 % at 1 week , and at 6 months 55 - 47 % ( P = 0.36 ) . Higher pretreatment apnea-hypopnea index , higher baseline self-efficacy , and use of CPAP ( ≥ 4 h ) at 1 week were independent predictors of CPAP adherence at 6 months . CPAP adherence increased by a factor of 1.8 ( odds ratio = 1.8 , 95 % confidence interval 1.1 - 3.0 ) for every one-unit increase in self-efficacy . There was no difference between groups postintervention in self-efficacy scores , sleepiness , mood , or sleep quality . CONCLUSIONS In this r and omized trial , a single SCT application did not increase adherence when compared with SI time . Although self-efficacy scores prior to CPAP predicted adherence , self-efficacy was not increased by the interventions . Increasing intensity and underst and ing of SCT interventions may be needed to improve CPAP adherence . CLINICAL TRIALS REGISTRATION Australian New Zeal and Clinical Trials Registry , ACTRN12607000424404 OBJECTIVES To study the effects of augmentation of continuous positive airway pressure ( CPAP ) education and support on compliance and outcome in patients with obstructive sleep apnea ( OSA ) . DESIGN A r and omized , controlled , parallel study of basic vs augmented CPAP education and support . SETTING A university teaching hospital . PATIENTS A total of 108 OSA patients r and omized into  basic-support ( BS ) and augmented-support ( AS ) groups . INTERVENTIONS Patients in the BS group ( n = 54 ) were given educational brochures on OSA and CPAP , CPAP education by nurses , CPAP acclimatization , and were review ed by physicians and nurses at weeks 4 and 12 . Patients in the AS group ( n = 54 ) received more education , including a videotape , telephone support by nurses , and early review at weeks 1 and 2 . MEASUREMENTS Objective CPAP compliance , Calgary sleep apnea quality of life index ( SAQLI ) , and cognitive function after 1 month and 3 months ; and Epworth sleepiness scale ( ESS ) after 3 months of CPAP treatment . RESULTS At 4 weeks , CPAP usage was 5.3 + /- 0.2 h/night ( mean + /- SEM ) vs 5.5 + /- 0.2 h/night in the BS and AS groups , respectively ( p = 0.4 ) . At 12 weeks , CPAP usage was 5.3 + /- 0.3 h/night vs 5.3 + /- 0.2 h/night in the two groups , respectively ( p = 0.98 ) . There was greater improvement of SAQLI at 4 weeks ( p = 0.008 ) and at 12 weeks ( p = 0.047 ) in the AS group . There was no significant difference between BS and AS groups in terms of improvement of ESS and cognitive function . CONCLUSION Augmentation of CPAP education and support does not increase CPAP compliance , but leads to a greater improvement of quality of life during the reinforced period Objective To evaluate whether follow-up of patients with obstructive sleep apnoea ( OSA ) undergoing CPAP treatment  could be performed in primary care ( PC ) setting s. Design Non-inferiority , r and omised , prospect i ve controlled study . Setting s Sleep unit ( SU ) at the University Hospital and in 8 PC units in Lleida , Spain . Participants Patients with OSA were r and omised to be followed up at the SU or PC units over a 6-month period . Main outcomes measured The primary outcome was  CPAP compliance at 6 months . The secondary outcomes were Epworth Sleep Scale ( ESS ) score , EuroQoL , patient satisfaction , body mass index ( BMI ) , blood pressure and cost-effectiveness . Results We included 101 patients in PC ( ( mean±SD ) apnoea – hypopnoea index ( AHI ) 50.8±22.9/h , age 56.2±11 years , 74 % male ) and 109 in the SU ( AHI 51.4±24.4/h , age 55.8±11 years , 77 % male ) ) . The CPAP compliance was ( mean ( 95 % CI ) 4.94 ( 4.47 to 5.5 ) vs 5.23 ( 4.79 to 5.66 ) h , p=0.18 ) in PC and SU groups , respectively . In the SU group , there were greater improvements in ESS scores ( mean change 1.79 , 95 % CI + 0.05 to + 3.53 , p=0.04 ) and patient satisfaction ( −1.49 , 95 % CI −2.22 to −0.76 ) ; there was a significant mean difference in BMI between the groups ( 0.57 , 95 % CI + 0.01 to + 1.13 , p=0.04 ) . In the PC setting , there was a cost saving of 60 % , with similar effectiveness , as well as a decrease in systolic blood pressure ( −5.32 ; 95 % CI −10.91 to + 0.28 , p=0.06 ) . Conclusions For patients with OSA , treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative . Trial registration number Clinical Trials NCT01918449 OBJECTIVE  Weight loss  can decrease the severity of obstructive sleep apnea ( OSA ) in many obese individuals ; however , very few studies have investigated the effects of behavioral weight loss interventions for patients with OSA . The aims of this pilot study were to determine the feasibility and initial effects on weight and continuous positive airway pressure ( CPAP ) use of a brief minimal-contact self-monitoring-based weight loss intervention ( SM ) . An additional aim was to investigate the association between weight loss and CPAP adherence . METHODS Forty obese men and women diagnosed with mild or moderate OSA were r and omized to either the SM or an attention-control ( AC ) condition . SM participants completed daily dietary logs for 6 weeks . Participants were weighed at baseline , post-treatment ( 6 weeks ) , and at a 6-week follow up . RESULTS Recruitment and retention were good in this study and attrition rates did not differ significantly by group . Intent to treat repeated measures ANOVA indicated a main effect of time ( but not group ) , such that both groups lost weight over time . Pearson r correlations between weight change and CPAP adherence indicated that among SM participants , 6-week weight loss was correlated with CPAP adherence at post-treatment and follow-up , such that SM participants with greater weight loss at 6 weeks had greater CPAP adherence at 6 and 12 weeks . CONCLUSION This study provides initial support for the beneficial effects of a minimal-contact weight loss intervention for patients with obstructive sleep apnea and highlights a possible association between weight loss and CPAP adherence Background Continuous Positive Airway Pressure ( CPAP ) remains the reference treatment for moderate to severe forms of the Sleep Apnea/Hypopnea Syndrome ( SAHS ) . Compliance to the treatment appears to be a key factor to improving health status of these patients . Methods We conducted a multicenter , prospect i ve , r and omized , controlled , parallel group trial of st and ard support completed or not within 3 months of coaching sessions for newly diagnosed SAHS patients starting CPAP therapy .  This study has been recorded by AFSSAPS with the RCB number : 2009-A01127 - 50 and received favourably by the Human Studies Committee in France . The coaching session consisted of 5 sessions of telephone-based counselling by competent staff . The primary outcome was the proportion of patients using CPAP more than 3 h per night for 4 months ; the secondary outcome was mean hours of CPAP usage in the 2 groups . Results Three hundred and seventy-nine patients fulfilled the inclusion criteria and were r and omized . The percentage of patients using CPAP more than 3 h per night for 4 months was 65 % for the st and ard support group and 75 % for the coached group . This difference reached a statistical significance ( χ2 = 3.97 ) . The mean CPAP usage was increased in the coached group versus st and ard group . A difference of 26 min was observed ( 4 h34+/−2 h17 and 4 h08+/−2 h25 respectively , p = 0.04 ) . Conclusion This study shows that SAHS patients who benefit from phone coaching  are statistically more compliant to CPAP than a st and ard support group is . A simple phone coaching procedure based on knowledge of the disease and reinforcement messages about treatment benefits helps to improve CPAP adherence in SAHS patients .Trial registration STUDY OBJECTIVES To identify factors before a trial of nasal continuous positive airway pressure ( CPAP ) treatment that are associated with lower compliance . DESIGN A prospect i ve cohort study . Initial Hospital Anxiety and Depression Scale scores and other demographic data were noted . Machine use was recorded by clock timer after a 1-month trial of treatment . SETTING District General Hospital sleep-disordered breathing clinic . PATIENTS OR PARTICIPANTS Eighty consecutive patients with symptoms of sleep apnea-hypopnea syndrome and a 4 % Sao2 desaturation index greater than 10 events per hour . INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Those reporting ' initial problems ' with CPAP went on to have an average of 2.4 hours of on time per night , while those not reporting initial problems had an on time of 5.0 hours per night ( P < .001 ) . Those living alone had a machine on time of 3.2 hours compared with 4.5 hours for those with partners ( P = .04 ) . Pearson 's correlations between hours on time were -0.08 ( P = .48 ) for initial Anxiety score and 0.10 ( P = .37 ) for initial Depression score . CONCLUSIONS There was no association between baseline anxiety and depression scores , as measured by the Hospital Anxiety and Depression Scale , and subsequent machine use . Other factors observable prior to commencing treatment , in particular , ' initial problems ' ( reported at autotitration ) , ' recent life-events ' and ' living alone ' were associated with lower machine use . Regarding all initial variables , reporting problems after the first night of nCPAP seems the most important predictor of ensuing machine use . A single screening question immediately after autotitration is useful in identifying those at high risk of treatment failure Context Approaches that improve adherence to continuous positive airway pressure ( CPAP ) therapy are needed . Contribution In this trial , 160 adults with severe obstructive sleep apnea were r and omly assigned to eszopiclone or placebo for the first 14 nights of CPAP . Adherence to CPAP was then measured weekly for 24 weeks . Patients receiving eszopiclone were less likely to discontinue CPAP and used CPAP more nights and for longer periods per night than did patients receiving placebo . Implication Eszopiclone given during the first 2 weeks of therapy may help improve long-term adherence and use of CPAP in some patients with severe obstructive sleep apnea . The Editors Untreated obstructive sleep apnea ( OSA ) is associated with adverse effects on both health and quality of life ( 1 , 2 ) . Continuous positive airway pressure ( CPAP ) is recommended as first-line therapy for most patients to improve sleep quality , reduce daytime sleepiness , and enhance quality of life . It may also mitigate the increased risk for cardiovascular events ( 36 ) . However , adherence to CPAP is often poor , which limits its efficacy . Of patients who initiate CPAP , approximately 50 % discontinue use within the first year , most within the first month . The initial experience with CPAP influences who accepts and continues treatment ( 7 ) . Patients who experience initial discomfort , intolerance , or lack of perceived benefit are more likely to discontinue therapy ( 8) . Some studies suggest that psychosocial factors may also affect short- and intermediate-term adherence ( 9 , 10 ) . The only consistently reliable predictor of long-term adherence has been the use of  CPAP  during the initial treatment period ( 11 ) . The average nightly CPAP use during the first 3 months of therapy can predict use at 6 and 12 months ( 12 ) . Furthermore , long-term adherence patterns may be determined within the first few days of therapy ( 13 ) . Therefore , strategies aim ed at improving adherence with therapy should focus on the initial experience with CPAP . In theory , robust patient education , regular follow-up , and improvements in device comfort ( for example , autoadjustable units with heated humidifiers and better- design ed , better-fitted masks ) should increase CPAP tolerance and use . However 
    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: OBJECTIVE To examine whether a social cognitive therapy ( SCT ) intervention increases continuous positive airway pressure ( CPAP ) use compared to equivalent social interaction ( SI ) time . PARTICIPANTS Individuals with obstructive sleep apnea ( OSA ) referred for CPAP therapy . INTERVENTION Participants received a 30-min group education session regarding OSA and CPAP . Groups of three to four participants were then r and omly assigned to an SCT session or social interaction . MEASUREMENTS CPAP usage was assessed at 7 nights , then 1 , 3 , and 6 months . The two primary outcomes were adherence , usage ≥ 4 h per night at 6 months , and uptake of CPAP . Question naires were given pretreatment and posttreatment . RESULTS Two hundred six individuals were r and omized to SI ( n = 97 ) or SCT ( n = 109 ) . CPAP uptake was not different between groups ( 82 % in SI , 88 % in SCT groups , P = 0.35 ) . There were no differences between groups in adherence : 63 - 66 % at 1 week , and at 6 months 55 - 47 % ( P = 0.36 ) . Higher pretreatment apnea-hypopnea index , higher baseline self-efficacy , and use of CPAP ( ≥ 4 h ) at 1 week were independent predictors of CPAP adherence at 6 months . CPAP adherence increased by a factor of 1.8 ( odds ratio = 1.8 , 95 % confidence interval 1.1 - 3.0 ) for every one-unit increase in self-efficacy . There was no difference between groups postintervention in self-efficacy scores , sleepiness , mood , or sleep quality . CONCLUSIONS In this r and omized trial , a single SCT application did not increase adherence when compared with SI time . Although self-efficacy scores prior to CPAP predicted adherence , self-efficacy was not increased by the interventions . Increasing intensity and underst and ing of SCT interventions may be needed to improve CPAP adherence . CLINICAL TRIALS REGISTRATION Australian New Zeal and Clinical Trials Registry , ACTRN12607000424404 OBJECTIVES To study the effects of augmentation of continuous positive airway pressure ( CPAP ) education and support on compliance and outcome in patients with obstructive sleep apnea ( OSA ) . DESIGN A r and omized , controlled , parallel study of basic vs augmented CPAP education and support . SETTING A university teaching hospital . PATIENTS A total of 108 OSA patients r and omized into  basic-support ( BS ) and augmented-support ( AS ) groups . INTERVENTIONS Patients in the BS group ( n = 54 ) were given educational brochures on OSA and CPAP , CPAP education by nurses , CPAP acclimatization , and were review ed by physicians and nurses at weeks 4 and 12 . Patients in the AS group ( n = 54 ) received more education , including a videotape , telephone support by nurses , and early review at weeks 1 and 2 . MEASUREMENTS Objective CPAP compliance , Calgary sleep apnea quality of life index ( SAQLI ) , and cognitive function after 1 month and 3 months ; and Epworth sleepiness scale ( ESS ) after 3 months of CPAP treatment . RESULTS At 4 weeks , CPAP usage was 5.3 + /- 0.2 h/night ( mean + /- SEM ) vs 5.5 + /- 0.2 h/night in the BS and AS groups , respectively ( p = 0.4 ) . At 12 weeks , CPAP usage was 5.3 + /- 0.3 h/night vs 5.3 + /- 0.2 h/night in the two groups , respectively ( p = 0.98 ) . There was greater improvement of SAQLI at 4 weeks ( p = 0.008 ) and at 12 weeks ( p = 0.047 ) in the AS group . There was no significant difference between BS and AS groups in terms of improvement of ESS and cognitive function . CONCLUSION Augmentation of CPAP education and support does not increase CPAP compliance , but leads to a greater improvement of quality of life during the reinforced period Objective To evaluate whether follow-up of patients with obstructive sleep apnoea ( OSA ) undergoing CPAP treatment  could be performed in primary care ( PC ) setting s. Design Non-inferiority , r and omised , prospect i ve controlled study . Setting s Sleep unit ( SU ) at the University Hospital and in 8 PC units in Lleida , Spain . Participants Patients with OSA were r and omised to be followed up at the SU or PC units over a 6-month period . Main outcomes measured The primary outcome was  CPAP compliance at 6 months . The secondary outcomes were Epworth Sleep Scale ( ESS ) score , EuroQoL , patient satisfaction , body mass index ( BMI ) , blood pressure and cost-effectiveness . Results We included 101 patients in PC ( ( mean±SD ) apnoea – hypopnoea index ( AHI ) 50.8±22.9/h , age 56.2±11 years , 74 % male ) and 109 in the SU ( AHI 51.4±24.4/h , age 55.8±11 years , 77 % male ) ) . The CPAP compliance was ( mean ( 95 % CI ) 4.94 ( 4.47 to 5.5 ) vs 5.23 ( 4.79 to 5.66 ) h , p=0.18 ) in PC and SU groups , respectively . In the SU group , there were greater improvements in ESS scores ( mean change 1.79 , 95 % CI + 0.05 to + 3.53 , p=0.04 ) and patient satisfaction ( −1.49 , 95 % CI −2.22 to −0.76 ) ; there was a significant mean difference in BMI between the groups ( 0.57 , 95 % CI + 0.01 to + 1.13 , p=0.04 ) . In the PC setting , there was a cost saving of 60 % , with similar effectiveness , as well as a decrease in systolic blood pressure ( −5.32 ; 95 % CI −10.91 to + 0.28 , p=0.06 ) . Conclusions For patients with OSA , treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative . Trial registration number Clinical Trials NCT01918449 OBJECTIVE  Weight loss  can decrease the severity of obstructive sleep apnea ( OSA ) in many obese individuals ; however , very few studies have investigated the effects of behavioral weight loss interventions for patients with OSA . The aims of this pilot study were to determine the feasibility and initial effects on weight and continuous positive airway pressure ( CPAP ) use of a brief minimal-contact self-monitoring-based weight loss intervention ( SM ) . An additional aim was to investigate the association between weight loss and CPAP adherence . METHODS Forty obese men and women diagnosed with mild or moderate OSA were r and omized to either the SM or an attention-control ( AC ) condition . SM participants completed daily dietary logs for 6 weeks . Participants were weighed at baseline , post-treatment ( 6 weeks ) , and at a 6-week follow up . RESULTS Recruitment and retention were good in this study and attrition rates did not differ significantly by group . Intent to treat repeated measures ANOVA indicated a main effect of time ( but not group ) , such that both groups lost weight over time . Pearson r correlations between weight change and CPAP adherence indicated that among SM participants , 6-week weight loss was correlated with CPAP adherence at post-treatment and follow-up , such that SM participants with greater weight loss at 6 weeks had greater CPAP adherence at 6 and 12 weeks . CONCLUSION This study provides initial support for the beneficial effects of a minimal-contact weight loss intervention for patients with obstructive sleep apnea and highlights a possible association between weight loss and CPAP adherence Background Continuous Positive Airway Pressure ( CPAP ) remains the reference treatment for moderate to severe forms of the Sleep Apnea/Hypopnea Syndrome ( SAHS ) . Compliance to the treatment appears to be a key factor to improving health status of these patients . Methods We conducted a multicenter , prospect i ve , r and omized , controlled , parallel group trial of st and ard support completed or not within 3 months of coaching sessions for newly diagnosed SAHS patients starting CPAP therapy .  This study has been recorded by AFSSAPS with the RCB number : 2009-A01127 - 50 and received favourably by the Human Studies Committee in France . The coaching session consisted of 5 sessions of telephone-based counselling by competent staff . The primary outcome was the proportion of patients using CPAP more than 3 h per night for 4 months ; the secondary outcome was mean hours of CPAP usage in the 2 groups . Results Three hundred and seventy-nine patients fulfilled the inclusion criteria and were r and omized . The percentage of patients using CPAP more than 3 h per night for 4 months was 65 % for the st and ard support group and 75 % for the coached group . This difference reached a statistical significance ( χ2 = 3.97 ) . The mean CPAP usage was increased in the coached group versus st and ard group . A difference of 26 min was observed ( 4 h34+/−2 h17 and 4 h08+/−2 h25 respectively , p = 0.04 ) . Conclusion This study shows that SAHS patients who benefit from phone coaching  are statistically more compliant to CPAP than a st and ard support group is . A simple phone coaching procedure based on knowledge of the disease and reinforcement messages about treatment benefits helps to improve CPAP adherence in SAHS patients .Trial registration STUDY OBJECTIVES To identify factors before a trial of nasal continuous positive airway pressure ( CPAP ) treatment that are associated with lower compliance . DESIGN A prospect i ve cohort study . Initial Hospital Anxiety and Depression Scale scores and other demographic data were noted . Machine use was recorded by clock timer after a 1-month trial of treatment . SETTING District General Hospital sleep-disordered breathing clinic . PATIENTS OR PARTICIPANTS Eighty consecutive patients with symptoms of sleep apnea-hypopnea syndrome and a 4 % Sao2 desaturation index greater than 10 events per hour . INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Those reporting ' initial problems ' with CPAP went on to have an average of 2.4 hours of on time per night , while those not reporting initial problems had an on time of 5.0 hours per night ( P < .001 ) . Those living alone had a machine on time of 3.2 hours compared with 4.5 hours for those with partners ( P = .04 ) . Pearson 's correlations between hours on time were -0.08 ( P = .48 ) for initial Anxiety score and 0.10 ( P = .37 ) for initial Depression score . CONCLUSIONS There was no association between baseline anxiety and depression scores , as measured by the Hospital Anxiety and Depression Scale , and subsequent machine use . Other factors observable prior to commencing treatment , in particular , ' initial problems ' ( reported at autotitration ) , ' recent life-events ' and ' living alone ' were associated with lower machine use . Regarding all initial variables , reporting problems after the first night of nCPAP seems the most important predictor of ensuing machine use . A single screening question immediately after autotitration is useful in identifying those at high risk of treatment failure Context Approaches that improve adherence to continuous positive airway pressure ( CPAP ) therapy are needed . Contribution In this trial , 160 adults with severe obstructive sleep apnea were r and omly assigned to eszopiclone or placebo for the first 14 nights of CPAP . Adherence to CPAP was then measured weekly for 24 weeks . Patients receiving eszopiclone were less likely to discontinue CPAP and used CPAP more nights and for longer periods per night than did patients receiving placebo . Implication Eszopiclone given during the first 2 weeks of therapy may help improve long-term adherence and use of CPAP in some patients with severe obstructive sleep apnea . The Editors Untreated obstructive sleep apnea ( OSA ) is associated with adverse effects on both health and quality of life ( 1 , 2 ) . Continuous positive airway pressure ( CPAP ) is recommended as first-line therapy for most patients to improve sleep quality , reduce daytime sleepiness , and enhance quality of life . It may also mitigate the increased risk for cardiovascular events ( 36 ) . However , adherence to CPAP is often poor , which limits its efficacy . Of patients who initiate CPAP , approximately 50 % discontinue use within the first year , most within the first month . The initial experience with CPAP influences who accepts and continues treatment ( 7 ) . Patients who experience initial discomfort , intolerance , or lack of perceived benefit are more likely to discontinue therapy ( 8) . Some studies suggest that psychosocial factors may also affect short- and intermediate-term adherence ( 9 , 10 ) . The only consistently reliable predictor of long-term adherence has been the use of  CPAP  during the initial treatment period ( 11 ) . The average nightly CPAP use during the first 3 months of therapy can predict use at 6 and 12 months ( 12 ) . Furthermore , long-term adherence patterns may be determined within the first few days of therapy ( 13 ) . Therefore , strategies aim ed at improving adherence with therapy should focus on the initial experience with CPAP . In theory , robust patient education , regular follow-up , and improvements in device comfort ( for example , autoadjustable units with heated humidifiers and better- design ed , better-fitted masks ) should increase CPAP tolerance and use . However 
    Output:
    