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: STUDY OBJECTIVE Changes in sleep parameters and neurobehavioral functioning were systematic ally investigated after an acute ( 1 night ) and short-term ( 7 nights ) period of withdrawal from  continuous positive airway pressure ( CPAP ) treatment  and 1 subsequent night of CPAP re introduction in patients with obstructive sleep apnea . DESIGN Repeated-measurement within-subject design . SETTING Sleep laboratory , university teaching hospital . PARTICIPANTS Twenty participants receiving optimal CPAP therapy for > or = 12 months . INTERVENTIONS CPAP withdrawal . MEASUREMENTS AND RESULTS Polysomnograms were performed on Night 0 ( with CPAP ) , Night 1 and Night 7 ( without CPAP ) and Night 8_R ( with CPAP ) . Acute CPAP withdrawal result ed in the recurrence of sleep-disordered breathing with sleep disruption , hypoxemia , and increased subjective sleepiness . Short-term CPAP withdrawal exacerbated hypoxemia , increased subjective and objective sleepiness and poor mood ratings . Neurobehavioral functioning assessed using the Psychomotor Vigilance Task was impaired following Night 7 and associated with hypoxemia and changes in morning levels of tumor necrosis factor-alpha . However , other neurobehavioral measures were not affected . Autonomic arousals measured via respiratory-related reductions in finger blood volume by peripheral arterial tonometry decreased from Night 1 to Night 7 . On Night 8_R , re introduction of CPAP treatment eliminated most airway obstruction , maintained oxygenation , and reversed daytime sleepiness and some vigilance decrements . CONCLUSION Despite recurrence of sleep-disordered breathing with increased sleepiness and impaired vigilance , most neurobehavioral variables were unaffected by CPAP withdrawal . The reduction in vigilance appeared to be associated with worsened hypoxemia and changed levels of tumor necrosis factor-alpha . Resumption of CPAP treatment had immediate benefits on sleep consolidation and subjective sleepiness 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 hypersomnolence ) . Male sex and obesity were strongly associated with the presence of sleep-disordered breathing . Habitual snorers , both men and women , tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher . CONCLUSIONS The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women . Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence Obstructive sleep apnoea syndrome ( OSAS ) has been associated with hypertension , stroke and myocardial ischaemia in epidemiological and observational studies . Continuous positive airway pressure ( CPAP ) is the treatment of choice for OSAS , but the impact of this intervention on established risk factors for cardiovascular disease remains incompletely understood . A total of 102 males with moderate-to-severe OSAS were r and omised to therapeutic ( n = 51 ) or subtherapeutic ( n = 51 ) CPAP treatment for 4 weeks to investigate the effects of active treatment on 24-h urinary catecholamine excretion , baroreflex sensitivity ( BRS ) , arterial stiffness ( augmentation index ) and 24-h ambulatory blood pressure ( ABP ) . After 4 weeks of therapeutic CPAP , significant reductions were seen in urine normetanephrine excretion ( from mean±sd 179.7±80.1 to 132.7±46.5 µmol·mol−1 creatinine ) and augmentation index ( from 14.5±11.3 to 9.1±13.8 % ) compared with the subtherapeutic control group . Furthermore , therapeutic CPAP significantly improved BRS ( from 7.1±3.3 to 8.8±4.2 ms·mmHg−1 ) and reduced mean arterial ABP by 2.6±5.4 mmHg . In conclusion , treatment of obstructive sleep apnoea with continuous positive airway pressure may lower cardiovascular risk by reducing sympathetic nerve activity , ambulatory blood pressure and arterial stiffness and by increasing sensitivity of the arterial baroreflex BACKGROUND Obstructive sleep apnea ( OSA ) is associated with endothelial dysfunction . In the current study , we assessed the effect of long-term modified Herbst m and ibular advancement splint ( MAS ) treatment on OSA , oxidative stress markers , and on endothelial function ( EF ) . METHODS A total of 16 subjects participated ( 11 men and 5 women ; mean [ + /- SD ] age , 54.0 + /- 8.3 years ; mean body mass index , 28.0 + /- 3.1 kg/m(2 ) ) , 12 of whom completed the 1-year evaluation .  Apnea severity , levels of oxidative stress markers , and EF were assessed after 3 months and 1 year of receiving treatment . For comparison , 6 untreated patients underwent two evaluations 9 months apart , and 10 non-OSA individuals were assessed once as a reference group . The results are presented as the mean + /- SD . RESULTS The mean apnea-hypopnea index ( AHI ) decreased significantly from 29.7 + /- 18.5 events/h before treatment to 17.7 + /- 11.1 events/h after 3 months of treatment and 19.6 + /- 11.5 events/h after 1 year of treatment ( p < 0.005 for both ) . The mean Epworth sleepiness scale score decreased significantly from 12.4 + /- 6.0 before treatment to 10.2 + /- 6.6 after 3 months of treatment and 7.8 + /- 3.8 after 1 year of treatment ( p < 0.001 for both ) . The mean EF improved significantly from 1.77 + /- 0.4 before treatment to 2.1 + /- 0.4 after 3 months of treatment ( p < 0.05 ) and 2.0 + /- 0.3 after 1 year of treatment ( p = 0.055 ) , which were similar to the values of the reference group . Thiobarbituric acid-reactive substance ( TBARS ) levels decreased from 18.8 + /- 6.2 nmol malondialdehyde (MDA)/mL before treatment to 15.8 + /- 3.9 MDA/mL after 3 months of treatment ( p = 0.09 ) and 15.5 + /- 3.2 nmol MDA/mL after 1 year of treatment ( p < 0.05 ) . There was a correlation between the improvement in AHI and in EF or TBARS levels ( r = 0.55 ; p = 0.05 ) . The untreated control group remained unchanged . CONCLUSIONS The Herbst MAS may be a moderately effective long-term treatment for patients with OSA . EF improved to levels that were not significantly different than reference levels , even though apneic events were not completely eliminated . We think that these data are encouraging and that they justify the performance of larger r and omized controlled studies The efficacy of currently recommended treatments is uncertain in patients with mild to moderate obstructive sleep apnea ( apnea-hypopnea index [ AHI ] , 5 - 30 ) . A group of 114 sleep clinic patients with an AHI of 5 - 30 have participated in a r and omized controlled crossover trial of 3 months of treatment with each of nasal continuous positive airway pressure ( CPAP ) , a m and ibular advancement splint , and a placebo tablet . Outcomes were sleep fragmentation and hypoxemia , daytime sleepiness , quality of life , neurobehavioral function , and blood pressure . Both active treatments improved sleep outcomes , but positive airway pressure had a greater effect . The quality of life , symptoms , and subjective but not objective sleepiness improved to a similar degree with both treatments ; however , many of the improvements seen in neuropsychologic function and mood were not better than the placebo effect . Some aspects of nocturnal blood pressure were improved with the splint but not with CPAP . This study has shown that although both CPAP and m and ibular advancement splint effectively treated sleep-disordered breathing and sleepiness , the expected response in neurobehavioral function was incomplete . This may be due to the splint having a lesser therapeutic effect and CPAP being poorly tolerated and therefore used less in this patient group 
    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: STUDY OBJECTIVE Changes in sleep parameters and neurobehavioral functioning were systematic ally investigated after an acute ( 1 night ) and short-term ( 7 nights ) period of withdrawal from  continuous positive airway pressure ( CPAP ) treatment  and 1 subsequent night of CPAP re introduction in patients with obstructive sleep apnea . DESIGN Repeated-measurement within-subject design . SETTING Sleep laboratory , university teaching hospital . PARTICIPANTS Twenty participants receiving optimal CPAP therapy for > or = 12 months . INTERVENTIONS CPAP withdrawal . MEASUREMENTS AND RESULTS Polysomnograms were performed on Night 0 ( with CPAP ) , Night 1 and Night 7 ( without CPAP ) and Night 8_R ( with CPAP ) . Acute CPAP withdrawal result ed in the recurrence of sleep-disordered breathing with sleep disruption , hypoxemia , and increased subjective sleepiness . Short-term CPAP withdrawal exacerbated hypoxemia , increased subjective and objective sleepiness and poor mood ratings . Neurobehavioral functioning assessed using the Psychomotor Vigilance Task was impaired following Night 7 and associated with hypoxemia and changes in morning levels of tumor necrosis factor-alpha . However , other neurobehavioral measures were not affected . Autonomic arousals measured via respiratory-related reductions in finger blood volume by peripheral arterial tonometry decreased from Night 1 to Night 7 . On Night 8_R , re introduction of CPAP treatment eliminated most airway obstruction , maintained oxygenation , and reversed daytime sleepiness and some vigilance decrements . CONCLUSION Despite recurrence of sleep-disordered breathing with increased sleepiness and impaired vigilance , most neurobehavioral variables were unaffected by CPAP withdrawal . The reduction in vigilance appeared to be associated with worsened hypoxemia and changed levels of tumor necrosis factor-alpha . Resumption of CPAP treatment had immediate benefits on sleep consolidation and subjective sleepiness 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 hypersomnolence ) . Male sex and obesity were strongly associated with the presence of sleep-disordered breathing . Habitual snorers , both men and women , tended to have a higher prevalence of apnea-hypopnea scores of 15 or higher . CONCLUSIONS The prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women . Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence Obstructive sleep apnoea syndrome ( OSAS ) has been associated with hypertension , stroke and myocardial ischaemia in epidemiological and observational studies . Continuous positive airway pressure ( CPAP ) is the treatment of choice for OSAS , but the impact of this intervention on established risk factors for cardiovascular disease remains incompletely understood . A total of 102 males with moderate-to-severe OSAS were r and omised to therapeutic ( n = 51 ) or subtherapeutic ( n = 51 ) CPAP treatment for 4 weeks to investigate the effects of active treatment on 24-h urinary catecholamine excretion , baroreflex sensitivity ( BRS ) , arterial stiffness ( augmentation index ) and 24-h ambulatory blood pressure ( ABP ) . After 4 weeks of therapeutic CPAP , significant reductions were seen in urine normetanephrine excretion ( from mean±sd 179.7±80.1 to 132.7±46.5 µmol·mol−1 creatinine ) and augmentation index ( from 14.5±11.3 to 9.1±13.8 % ) compared with the subtherapeutic control group . Furthermore , therapeutic CPAP significantly improved BRS ( from 7.1±3.3 to 8.8±4.2 ms·mmHg−1 ) and reduced mean arterial ABP by 2.6±5.4 mmHg . In conclusion , treatment of obstructive sleep apnoea with continuous positive airway pressure may lower cardiovascular risk by reducing sympathetic nerve activity , ambulatory blood pressure and arterial stiffness and by increasing sensitivity of the arterial baroreflex BACKGROUND Obstructive sleep apnea ( OSA ) is associated with endothelial dysfunction . In the current study , we assessed the effect of long-term modified Herbst m and ibular advancement splint ( MAS ) treatment on OSA , oxidative stress markers , and on endothelial function ( EF ) . METHODS A total of 16 subjects participated ( 11 men and 5 women ; mean [ + /- SD ] age , 54.0 + /- 8.3 years ; mean body mass index , 28.0 + /- 3.1 kg/m(2 ) ) , 12 of whom completed the 1-year evaluation .  Apnea severity , levels of oxidative stress markers , and EF were assessed after 3 months and 1 year of receiving treatment . For comparison , 6 untreated patients underwent two evaluations 9 months apart , and 10 non-OSA individuals were assessed once as a reference group . The results are presented as the mean + /- SD . RESULTS The mean apnea-hypopnea index ( AHI ) decreased significantly from 29.7 + /- 18.5 events/h before treatment to 17.7 + /- 11.1 events/h after 3 months of treatment and 19.6 + /- 11.5 events/h after 1 year of treatment ( p < 0.005 for both ) . The mean Epworth sleepiness scale score decreased significantly from 12.4 + /- 6.0 before treatment to 10.2 + /- 6.6 after 3 months of treatment and 7.8 + /- 3.8 after 1 year of treatment ( p < 0.001 for both ) . The mean EF improved significantly from 1.77 + /- 0.4 before treatment to 2.1 + /- 0.4 after 3 months of treatment ( p < 0.05 ) and 2.0 + /- 0.3 after 1 year of treatment ( p = 0.055 ) , which were similar to the values of the reference group . Thiobarbituric acid-reactive substance ( TBARS ) levels decreased from 18.8 + /- 6.2 nmol malondialdehyde (MDA)/mL before treatment to 15.8 + /- 3.9 MDA/mL after 3 months of treatment ( p = 0.09 ) and 15.5 + /- 3.2 nmol MDA/mL after 1 year of treatment ( p < 0.05 ) . There was a correlation between the improvement in AHI and in EF or TBARS levels ( r = 0.55 ; p = 0.05 ) . The untreated control group remained unchanged . CONCLUSIONS The Herbst MAS may be a moderately effective long-term treatment for patients with OSA . EF improved to levels that were not significantly different than reference levels , even though apneic events were not completely eliminated . We think that these data are encouraging and that they justify the performance of larger r and omized controlled studies The efficacy of currently recommended treatments is uncertain in patients with mild to moderate obstructive sleep apnea ( apnea-hypopnea index [ AHI ] , 5 - 30 ) . A group of 114 sleep clinic patients with an AHI of 5 - 30 have participated in a r and omized controlled crossover trial of 3 months of treatment with each of nasal continuous positive airway pressure ( CPAP ) , a m and ibular advancement splint , and a placebo tablet . Outcomes were sleep fragmentation and hypoxemia , daytime sleepiness , quality of life , neurobehavioral function , and blood pressure . Both active treatments improved sleep outcomes , but positive airway pressure had a greater effect . The quality of life , symptoms , and subjective but not objective sleepiness improved to a similar degree with both treatments ; however , many of the improvements seen in neuropsychologic function and mood were not better than the placebo effect . Some aspects of nocturnal blood pressure were improved with the splint but not with CPAP . This study has shown that although both CPAP and m and ibular advancement splint effectively treated sleep-disordered breathing and sleepiness , the expected response in neurobehavioral function was incomplete . This may be due to the splint having a lesser therapeutic effect and CPAP being poorly tolerated and therefore used less in this patient group 
    Output:
    