human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to compare the effect of two different degrees of m and ibular advancement ( MA ) , 75 % versus 50 % , on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea ( OSA ) . A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness . Eighty-six males with severe OSA ( apnea index ≥ 20 ) were r and omly allocated to either 75 % or 50 % MA . Forty patients in the 75 % MA group and 37 patients in the 50 % MA group completed the 6-month follow-up . The effectiveness of treatment in terms of normalization ( apnea index < 5 and apnea/hypopnea index < 10 ) with 75 % MA was 52 % , which was significantly higher ( p = 0.04 ) than the 31 % achieved with 50 % MA . The dental appliance had few adverse events on the stomatognathic system regardless of group , and the number of adverse events did not differ between the two groups . Finally , the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up ( p < 0.001 ) . No significant difference was observed between the two groups . The results indicate that a dental appliance could be an alternative treatment for some patients with severe OSA The aim of this study was to evaluate the effect of a m and ibular advancement splint ( MAS ) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea ( OSA ) .  Using a r and omized crossover design , patients received 4 weeks of treatment with MAS and a control device ( inactive oral appliance ) , with an intervening 1-week washout . At the end of each treatment period , patients were reassessed by question naire , polysomnography , and multiple sleep latency test .  Fifty-nine men and 14 women with a mean ( + /- SD ) age of 48 + /- 11 years and proven OSA experienced a significantly improved mean ( + /- SEM ) sleep latency on the multiple sleep latency test ( 10.3 + /- 0.5 versus 9.1 + /- 0.5 minutes , p = 0.01 ) and Epworth sleepiness scale score ( 7 + /- 1 versus 9 + /- 1 , p < 0.0001 ) with the MAS compared with the control device after 4 weeks . The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device ( 82 versus 62 % , p < 0.01 ) , but this was not so for objective sleepiness ( 48 versus 34 % , p = 0.08 ) . Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device . MAS therapy improves a range of symptoms associated with OSA The present study objective was to establish whether pretreatment social cognitive variables may contribute to the explanation of variance in adherence to continuous positive airway pressure ( CPAP ) treatment for patients with obstructive sleep apnoea/hypopnoea syndrome ( OSAHS ) . A total of 119 of 180 consecutive OSAHS patients were recruited to the study prior to initial CPAP titration . Patients completed psychological measures of health value , health locus of control ( incorporating internality , chance , powerful others ) and self-efficacy prior to CPAP titration . Objective adherence data were measured by CPAP unit time clocks and collected at 3-month follow-up . Average nightly use was calculated over this period . Logistic regression of prospect i ve predictors of adherence produced a model comprising psychological ( health value , internality , powerful others ) , as well as clinical variables ( Epworth score , body mass index , apnoea/hypopnoea index , CPAP pressure ) . This model explained 24 % of the variance in CPAP use , and correctly identified 75 % of adherers and 53 % of nonadherers . Although the psychological variables explained only a small amount of the overall variance in adherence behaviour , this result provides further support for the hypothesis that psychological variables contribute , in part , to continuous positive airway pressure adherence . Future research should focus on highlighting discrete variables , which may helpfully inform psychologically based interventions aim ed at improving the use of continuous positive airway pressure by patients with obstructive sleep apnoea/hypopnoea syndrome at risk of discontinuance M and ibular repositioning splints ( MRSs ) and continuous positive airway pressure ( CPAP ) are used to treat the sleep apnea/hypopnea syndrome ( SAHS ) . There are some data suggesting that patients with milder symptoms prefer MRS , but there are few comparative data on outcomes . Therefore , we performed a r and omized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new out patients diagnosed with SAHS ( apnea/hypopnea index [ AHI ] > or= 5/hour , and > or= 2 symptoms including sleepiness ) . Assessment s at the end of both limbs comprised home sleep study , subjective ratings of treatment value , sleepiness , symptoms , and well-being , and objective tests of sleepiness and cognition .  Forty-eight of 51 recruited patients completed the trial ( 12 women ; age [ mean + /- SD ] , 46 + /- 9 years ; Epworth 14 + /- 4 ; median AHI , 22/hour ; interquartile ratio [ IQR ] , 11 - 43/hour ) . Significant ( p < or= 0.01 ) differences between MRS and CPAP were observed for 7 of 21 variables ( effect sizes , 0.3 - 0.6 SDs ) , all favoring CPAP , including AHI ( 15 + /- 16 and 8 + /- 6/hour , respectively ) , effectiveness rating , symptoms , Epworth ( 12 + /- 5 and 8 + /- 5 , respectively ) , functional outcomes of sleepiness question naire , short-form 36 health survey mental component , and health transition scores . Objective sleepiness , cognitive performance , and preference for treatments were not different . In patients experiencing a mild form of the syndrome ( AHI < 15 , n = 18 ) , symptoms , treatment efficacy and satisfaction , and subjective sleepiness were also better with CPAP than with MRS ( effect sizes , 0.7 - 1.1 SDs ) . These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS Background : Patients with mild to moderate obstructive sleep apnoea ( OSA ) may be managed with different treatment options . This study compared the effectiveness of three commonly used non-surgical treatment modalities . Methods : Subjects with mild to moderate OSA were r and omised to one of three treatment groups for 10 weeks : conservative measures ( sleep hygiene ) only , continuous positive airways pressure ( CPAP ) in addition to conservative measures or an oral appliance in addition to conservative measures .  All overweight subjects were referred to a weight-reduction class . OSA  was assessed by polysomnography .  Blood pressure was recorded in the morning and evening in the sleep laboratory . Daytime sleepiness was assessed with the Epworth Sleepiness Scale . Health-related quality of life ( HRQOL ) was assessed with the 36-Item Short-Form Health Survey ( SF-36 ) and Sleep Apnoea Quality of Life Index ( SAQLI ) . Results : 101 subjects with a mean ( SEM ) apnoea – hypopnoea index ( AHI ) of 21.4 ( 1.1 ) were r and omised to one of the three groups . The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group , and the CPAP group was significantly better than the oral appliance group . Relief from sleepiness was significantly better in the CPAP group . CPAP was also better than the oral appliance or conservative measures in improving the “ bodily pain ” domain , and better than conservative measures in improving the “ physical function ” domain of SF-36 . Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI , although no difference was detected between the CPAP and oral appliance groups . CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values , but there was no difference in the changes in blood pressure between the groups . There was also a linear relationship between the changes in AHI and body weight . Conclusion : CPAP produced the best improvement in terms of physiological , symptomatic and HRQOL measures , while the oral appliance was slightly less effective . Weight loss , if achieved , result ed in an improvement in sleep parameters , but weight control alone was not uniformly effective AIM To assess the efficacy of a m and ibular advancement splint ( MAS ) in the treatment of  obstructive sleep apnoea syndrome ( OSAS ) .  METHODS Nineteen patients using a MAS for symptomatic OSAS underwent  polysomnography  , with MAS use r and omised to one half of the night . Indices of snoring and OSAS  were compared . Side effects , compliance and treatment response were evaluated by question naire . RESULTS Use of the MAS improved total respiratory disturbance index ( RDI ) from 22.2 + /- 19.8 ( SD ) events per hour to 16.5 + /- 21.4/hr ( p = 0.03 ) , supine RDI ( 30.8 + /- 23.8/hr to 18.8 + /- 22.1/hr , p = 0.01 ) , arousal index ( 25.2 + /- 18.9/hr to 19.3 + /- 14.2/hr , p = 0.01 ) and snoring intensity ( 52.7 + /- 4.1 to 50.7 + /- 2.7 dB , p = 0.02 ) but not total snore frequency ( p > 0.05 ) . Using polysomnographic criteria , MAS treatment was completely successful in four ( 21 % ) patients , partially successful in ten ( 52.6 % ) and a failure in five ( 26.3 % ) . Treatment over a median of 6.5 weeks ( range 2 - 48 ) was perceived as beneficial by ten of eleven partners . Fifteen patients ( 79 % ) reported side effects , 9 ( 46 % ) did not use the device every night and four ( 21 % ) used the device less than three nights per week . CONCLUSION The use of the MAS result ed in significant reductions in indices of OSAS and snoring . However , a significant number of patients had difficulty tolerating and regularly using the device The enthusiasm for uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnoea ( OSA ) has declined in recent years , partly because of a lower success rate over time and partly because of adverse effects . Reports on the beneficial effects of dental appliances exist , but only one prospect i ve r and omized study has been published comparing dental appliances with nasal continuous positive airway pressure ( CPAP ) treatment . No study has been published comparing dental appliance treatment with UPPP .  Ninety-five male patients with confirmed OSA , subjective daytime sleepiness and an apnoea index ( AI ) > 5 were r and omized for subsequent treatment with either a dental appliance or UPPP . There were 49 patients in the dental appliance group and 46 in the UPPP group . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up . The success rate ( rate of patients with at least a 50 % reduction in AI ) for the dental appliance group was 95 % , which was significantly higher ( p < 0.01 ) than the 70 % success rate for the UPPP group . According to the criteria for OSA ( apnoea index > or = 5 or apnoea/hypopnoea index > or = 10 ) , 78 % of the dental appliance group and 51 % of the UPPP group were normalized after 12 months . The difference between the groups was significant ( p < 0.05 ) . These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA 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 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to compare the effect of two different degrees of m and ibular advancement ( MA ) , 75 % versus 50 % , on somnographic variables after 6 months of dental appliance treatment in patients with severe obstructive sleep apnea ( OSA ) . A further purpose was to compare the number of adverse events on the stomatognathic system and the effects of dental appliance treatment on the presence of daytime sleepiness . Eighty-six males with severe OSA ( apnea index ≥ 20 ) were r and omly allocated to either 75 % or 50 % MA . Forty patients in the 75 % MA group and 37 patients in the 50 % MA group completed the 6-month follow-up . The effectiveness of treatment in terms of normalization ( apnea index < 5 and apnea/hypopnea index < 10 ) with 75 % MA was 52 % , which was significantly higher ( p = 0.04 ) than the 31 % achieved with 50 % MA . The dental appliance had few adverse events on the stomatognathic system regardless of group , and the number of adverse events did not differ between the two groups . Finally , the mean value of Epworth Sleepiness Scale scores decreased significantly from 11.6 at baseline to 8.0 at follow-up ( p < 0.001 ) . No significant difference was observed between the two groups . The results indicate that a dental appliance could be an alternative treatment for some patients with severe OSA The aim of this study was to evaluate the effect of a m and ibular advancement splint ( MAS ) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea ( OSA ) .  Using a r and omized crossover design , patients received 4 weeks of treatment with MAS and a control device ( inactive oral appliance ) , with an intervening 1-week washout . At the end of each treatment period , patients were reassessed by question naire , polysomnography , and multiple sleep latency test .  Fifty-nine men and 14 women with a mean ( + /- SD ) age of 48 + /- 11 years and proven OSA experienced a significantly improved mean ( + /- SEM ) sleep latency on the multiple sleep latency test ( 10.3 + /- 0.5 versus 9.1 + /- 0.5 minutes , p = 0.01 ) and Epworth sleepiness scale score ( 7 + /- 1 versus 9 + /- 1 , p < 0.0001 ) with the MAS compared with the control device after 4 weeks . The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device ( 82 versus 62 % , p < 0.01 ) , but this was not so for objective sleepiness ( 48 versus 34 % , p = 0.08 ) . Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device . MAS therapy improves a range of symptoms associated with OSA The present study objective was to establish whether pretreatment social cognitive variables may contribute to the explanation of variance in adherence to continuous positive airway pressure ( CPAP ) treatment for patients with obstructive sleep apnoea/hypopnoea syndrome ( OSAHS ) . A total of 119 of 180 consecutive OSAHS patients were recruited to the study prior to initial CPAP titration . Patients completed psychological measures of health value , health locus of control ( incorporating internality , chance , powerful others ) and self-efficacy prior to CPAP titration . Objective adherence data were measured by CPAP unit time clocks and collected at 3-month follow-up . Average nightly use was calculated over this period . Logistic regression of prospect i ve predictors of adherence produced a model comprising psychological ( health value , internality , powerful others ) , as well as clinical variables ( Epworth score , body mass index , apnoea/hypopnoea index , CPAP pressure ) . This model explained 24 % of the variance in CPAP use , and correctly identified 75 % of adherers and 53 % of nonadherers . Although the psychological variables explained only a small amount of the overall variance in adherence behaviour , this result provides further support for the hypothesis that psychological variables contribute , in part , to continuous positive airway pressure adherence . Future research should focus on highlighting discrete variables , which may helpfully inform psychologically based interventions aim ed at improving the use of continuous positive airway pressure by patients with obstructive sleep apnoea/hypopnoea syndrome at risk of discontinuance M and ibular repositioning splints ( MRSs ) and continuous positive airway pressure ( CPAP ) are used to treat the sleep apnea/hypopnea syndrome ( SAHS ) . There are some data suggesting that patients with milder symptoms prefer MRS , but there are few comparative data on outcomes . Therefore , we performed a r and omized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new out patients diagnosed with SAHS ( apnea/hypopnea index [ AHI ] > or= 5/hour , and > or= 2 symptoms including sleepiness ) . Assessment s at the end of both limbs comprised home sleep study , subjective ratings of treatment value , sleepiness , symptoms , and well-being , and objective tests of sleepiness and cognition .  Forty-eight of 51 recruited patients completed the trial ( 12 women ; age [ mean + /- SD ] , 46 + /- 9 years ; Epworth 14 + /- 4 ; median AHI , 22/hour ; interquartile ratio [ IQR ] , 11 - 43/hour ) . Significant ( p < or= 0.01 ) differences between MRS and CPAP were observed for 7 of 21 variables ( effect sizes , 0.3 - 0.6 SDs ) , all favoring CPAP , including AHI ( 15 + /- 16 and 8 + /- 6/hour , respectively ) , effectiveness rating , symptoms , Epworth ( 12 + /- 5 and 8 + /- 5 , respectively ) , functional outcomes of sleepiness question naire , short-form 36 health survey mental component , and health transition scores . Objective sleepiness , cognitive performance , and preference for treatments were not different . In patients experiencing a mild form of the syndrome ( AHI < 15 , n = 18 ) , symptoms , treatment efficacy and satisfaction , and subjective sleepiness were also better with CPAP than with MRS ( effect sizes , 0.7 - 1.1 SDs ) . These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS Background : Patients with mild to moderate obstructive sleep apnoea ( OSA ) may be managed with different treatment options . This study compared the effectiveness of three commonly used non-surgical treatment modalities . Methods : Subjects with mild to moderate OSA were r and omised to one of three treatment groups for 10 weeks : conservative measures ( sleep hygiene ) only , continuous positive airways pressure ( CPAP ) in addition to conservative measures or an oral appliance in addition to conservative measures .  All overweight subjects were referred to a weight-reduction class . OSA  was assessed by polysomnography .  Blood pressure was recorded in the morning and evening in the sleep laboratory . Daytime sleepiness was assessed with the Epworth Sleepiness Scale . Health-related quality of life ( HRQOL ) was assessed with the 36-Item Short-Form Health Survey ( SF-36 ) and Sleep Apnoea Quality of Life Index ( SAQLI ) . Results : 101 subjects with a mean ( SEM ) apnoea – hypopnoea index ( AHI ) of 21.4 ( 1.1 ) were r and omised to one of the three groups . The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group , and the CPAP group was significantly better than the oral appliance group . Relief from sleepiness was significantly better in the CPAP group . CPAP was also better than the oral appliance or conservative measures in improving the “ bodily pain ” domain , and better than conservative measures in improving the “ physical function ” domain of SF-36 . Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI , although no difference was detected between the CPAP and oral appliance groups . CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values , but there was no difference in the changes in blood pressure between the groups . There was also a linear relationship between the changes in AHI and body weight . Conclusion : CPAP produced the best improvement in terms of physiological , symptomatic and HRQOL measures , while the oral appliance was slightly less effective . Weight loss , if achieved , result ed in an improvement in sleep parameters , but weight control alone was not uniformly effective AIM To assess the efficacy of a m and ibular advancement splint ( MAS ) in the treatment of  obstructive sleep apnoea syndrome ( OSAS ) .  METHODS Nineteen patients using a MAS for symptomatic OSAS underwent  polysomnography  , with MAS use r and omised to one half of the night . Indices of snoring and OSAS  were compared . Side effects , compliance and treatment response were evaluated by question naire . RESULTS Use of the MAS improved total respiratory disturbance index ( RDI ) from 22.2 + /- 19.8 ( SD ) events per hour to 16.5 + /- 21.4/hr ( p = 0.03 ) , supine RDI ( 30.8 + /- 23.8/hr to 18.8 + /- 22.1/hr , p = 0.01 ) , arousal index ( 25.2 + /- 18.9/hr to 19.3 + /- 14.2/hr , p = 0.01 ) and snoring intensity ( 52.7 + /- 4.1 to 50.7 + /- 2.7 dB , p = 0.02 ) but not total snore frequency ( p > 0.05 ) . Using polysomnographic criteria , MAS treatment was completely successful in four ( 21 % ) patients , partially successful in ten ( 52.6 % ) and a failure in five ( 26.3 % ) . Treatment over a median of 6.5 weeks ( range 2 - 48 ) was perceived as beneficial by ten of eleven partners . Fifteen patients ( 79 % ) reported side effects , 9 ( 46 % ) did not use the device every night and four ( 21 % ) used the device less than three nights per week . CONCLUSION The use of the MAS result ed in significant reductions in indices of OSAS and snoring . However , a significant number of patients had difficulty tolerating and regularly using the device The enthusiasm for uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnoea ( OSA ) has declined in recent years , partly because of a lower success rate over time and partly because of adverse effects . Reports on the beneficial effects of dental appliances exist , but only one prospect i ve r and omized study has been published comparing dental appliances with nasal continuous positive airway pressure ( CPAP ) treatment . No study has been published comparing dental appliance treatment with UPPP .  Ninety-five male patients with confirmed OSA , subjective daytime sleepiness and an apnoea index ( AI ) > 5 were r and omized for subsequent treatment with either a dental appliance or UPPP . There were 49 patients in the dental appliance group and 46 in the UPPP group . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up . The success rate ( rate of patients with at least a 50 % reduction in AI ) for the dental appliance group was 95 % , which was significantly higher ( p < 0.01 ) than the 70 % success rate for the UPPP group . According to the criteria for OSA ( apnoea index > or = 5 or apnoea/hypopnoea index > or = 10 ) , 78 % of the dental appliance group and 51 % of the UPPP group were normalized after 12 months . The difference between the groups was significant ( p < 0.05 ) . These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA 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 
    Output:
    