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 Obesity is the most important risk factor for obstructive sleep apnea ( OSA ) . However , although included in clinical guidelines , no r and omized controlled studies have been performed on the effects of weight reduction on mild OSA . OBJECTIVES The aim of this prospect i ve , r and omized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet ( VLCD ) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA . METHODS Seventy-two consecutive overweight patients ( body mass index , 28 - 40 ) with mild OSA were recruited . The intervention group ( n = 35 ) completed the VLCD program with supervised lifestyle modification , and the control group ( n = 37 ) received routine lifestyle counseling . The apnea-hypopnea index ( AHI ) was the main objective ly measured outcome variable . Change in symptoms and the 15D- Quality of Life tool were used as subjective measurements . MEASUREMENTS AND MAIN RESULTS The lifestyle intervention was found to effectively reduce body weight ( -10.7 + /- 6.5 kg ; body mass index , -3.5 + /- 2.1 [ mean + /- SD ] ) . There was a statistically significant difference in the mean change in AHI between the study groups ( P = 0.017 ) . The adjusted odds ratio for having mild OSA was markedly lowered ( odds ratio , 0.24 [ 95 % confidence interval , 0.08 - 0.72 ] ; P = 0.011 ) in the intervention group . All common symptoms related to OSA , and some features of 15D- Quality of Life improved after the lifestyle intervention . Changes in AHI were strongly associated with changes in weight and waist circumference . CONCLUSIONS VLCD combined with active lifestyle counseling result ing in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA , and the achieved beneficial outcomes are maintained at 1-year follow-up We studied the impact of a 6-wk supervised , multimodality endurance exercise training program ( EXT ) on strength and endurance of ventilatory and peripheral muscles in patients with chronic airflow limitation ( CAL ) , and determined whether potential improvements contributed to relief of exertional breathlessness ( B ) and perceived leg effort/discomfort ( LE ) , respectively . Twenty breathless patients with stable CAL ( FEV1 = 41 + /- 3 % predicted ; mean + /- SEM ) were tested at 6-wk intervals at baseline , after a nonintervention control period ( pre-EXT ) , and post-EXT . Measurements included : pulmonary function tests ( PFTs ) , maximal inspiratory/expiratory pressures ( MIP , MEP ) , inspiratory muscle endurance ( V(LIM ) ) , quadriceps strength and endurance , exercise endurance , and submaximal cycle exercise with cardioventilatory and symptom responses . Measurements at baseline and pre-EXT were identical . Post-EXT , PFTs did not change ; exercise endurance measured on the treadmill , cycle ergometer , arm ergometer , and by 6-min walk distance increased 40 + /- 8 % , 43 + /- 10 % , 12 + /- 5 % , and 34 + /- 9 % , respectively ( p < 0.05 ) ; quadriceps strength increased 21 + /- 5 % ( p < 0.01 ) ; MIP and MEP increased 29 + /- 11 % and 27 + /- 11 % , respectively ( p < 0.05 ) ; V(LIM ) increased almost threefold ( p < 0.05 ) . At isotime near end-exercise , B , LE , carbon dioxide production ( VCO2 ) , oxygen consumption ( VO2 ) , ventilation , and breathing frequency ( F ) all fell after EXT ( p < 0.05 ) : deltaB correlated with deltaF ( r = 0.58 , p < 0.01 ) . Increased MIP and V(LIM ) did not correlate with improved breathlessness or exercise endurance . Similarly , changes in quadriceps strength and endurance did not correlate with changes in LE or exercise endurance . In conclusion , general nonspecific EXT improved ventilatory and peripheral muscle function in severe CAL , but such improvements did not appear to contribute significantly to reduced exertional symptoms and enhanced exercise performance Objective To assess the effect of weight loss induced by a very low energy diet on  moderate and severe obstructive sleep apnoea in obese men . Design Single centre , two arm , parallel , r and omised , controlled , open label trial . Blocked r and omisation procedure used for treatment allocation . Setting Outpatient obesity clinic in a university hospital in Stockholm , Sweden . Participants 63 obese men ( body mass index 30 - 40 , age 30 - 65 years ) with moderate to severe obstructive sleep apnoea ( apnoea-hypopnoea index ( AHI ) ≥15 ) , treated with continuous positive airway pressure . Interventions The intervention group received a liquid very low energy diet ( 2.3 MJ/day ) for seven weeks to promote weight loss , followed by two weeks of gradual introduction of normal food , reaching 6.3 MJ/day at week 9 . The control group adhered to their usual diet during the nine weeks of follow-up . Main outcome measure AHI , the major disease severity index for obstructive sleep apnoea . Data from all r and omised patients were included in an intention to treat analysis ( baseline carried forward for missing data ) . Results Of the 63 eligible patients , 30 were r and omised to intervention and 33 to control . Two patients in the control group were dissatisfied with allocation and immediately discontinued . All other patients completed the trial . Both groups had a mean AHI of 37 events/h ( SD 15 ) at baseline . At week 9 , the intervention group ’s mean body weight was 20 kg ( 95 % confidence interval 18 to 21 ) lower than that of the control group , while its mean AHI was 23 events/h ( 15 to 30 ) lower . In the intervention group , five of 30 ( 17 % ) were disease free after the energy restricted diet ( AHI < 5 ) , with 15 of 30 ( 50 % ) having mild disease ( AHI 5 - 14.9 ) , whereas the AHI of all patients in the control group except one remained at 15 or higher . In a subgroup analysis of the intervention group , baseline AHI significantly modified the effectiveness of treatment , with a greater improvement in AHI in patients with severe obstructive sleep apnoea ( AHI > 30 ) at baseline compared with those with moderate ( AHI 15 - 30 ) sleep apnoea ( AHI −38 v −12 , P<0.001 ) , despite similar weight loss ( −19.2 v −18.2 kg , P=0.55 ) . Conclusion Treatment with a low energy diet improved  obstructive sleep apnoea in obese men , with the greatest effect in patients with severe disease . Long term treatment studies are needed to vali date weight loss as a primary treatment strategy for obstructive sleep apnoea . Trial registration Current Controlled Trials IS RCT N70090382 Objective To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea . Design Single centre , prospect i ve observational follow-up study . Setting Outpatient obesity clinic in a university hospital in Stockholm , Sweden . Participants 63 men aged 30 - 65 with body mass index ( BMI ) 30 - 40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥15 ( events/hour ) , all treated with continuous positive airway pressure . Intervention A one year weight loss programme , consisting of an initial very low energy diet for nine weeks ( seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food ) followed by a weight loss maintenance programme . Main outcome measure Apnoea-hypopnoea index , the main index for severity of obstructive sleep apnoea . Data from all patients were analysed ( baseline carried forward for missing data ) . Results Of 63 eligible patients , 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme ; 49 had complete measurements at one year . At baseline the mean apnoea-hypopnoea index was 36 events/hour . After the very low energy diet  period , apnoea-hypopnoea index was improved by −21 events/hour ( 95 % confidence interval −17 to −25 ) and weight by −18 kg ( −16 to −19 ; both P<0.001 ) . After one year the apnoea-hypopnoea index had improved by −17 events/hour ( −13 to −21 ) and body weight by −12 kg ( −10 to −14 ) compared with baseline ( both P<0.001 ) . Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index ( −25 events/hour ) compared with patients with moderate disease ( −7 events/hour , P<0.001 ) . At one year , 30/63 ( 48 % , 95 % confidence interval 35 % to 60 % ) no longer required continuous positive airway pressure and 6/63 ( 10 % , 2 % to 17 % ) had total remission of obstructive sleep apnoea ( apnoea-hypopnoea index < 5 events/hour ) . There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up ( β=0.50 events/kg , 0.11 to 0.88 ; P=0.013 ) . Conclusion Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease . Those who lose the most weight or have severe sleep apnoea at baseline benefit most . Trial registration Current Controlled Trials 70090382 AIM The aim of this long-term prospect i ve study was to evaluate the effect of treating obstructive sleep apnoea ( OSA ) on the rate of cardiovascular events in coronary artery disease ( CAD ) . METHODS AND RESULTS We prospect ively studied 54 patients ( mean age 57.3 + /- 10.1 years ) with both CAD ( > or = 70 % coronary artery stenosis ) and OSA ( apnoea-hypopnoea index > or = 15 ) . In 25 patients , OSA was treated with continuous positive airway pressure ( n=21 ) or upper airway surgery ( n=4 ) ; the remaining 29 patients declined treatment for their OSA . The median follow-up was 86.5 + /- 39 months . The two groups were similar at baseline in age , body mass index , smoking history , hypertension , hypercholesterolaemia , diabetes mellitus , number of diseased vessels , left ventricular ejection fraction , and CAD therapy . Treatment of risk factors other than OSA was similar in the two groups . The endpoint ( a composite of cardiovascular death , acute coronary syndrome , hospitalisation for heart failure , or need for coronary revascularisation ) was reached in 6 ( 6/25 , 24 % ) and 17 ( 17/29 , 58 % ) patients with and without OSA treatment , respectively ( P<0.01 ) . OSA treatment significantly reduced the risk of occurrence of the composite endpoint ( hazard ratio 0.24 ; 95 % confidence interval , 0.09 - 0.62 ; p<0.01 ) and of each of its components . CONCLUSIONS Our data indicate that the treatment of OSA in CAD patients is associated with a decrease in the occurrence of new cardiovascular events , and an increase in the time to such events STUDY OBJECTIVES To evaluate the efficacy of a 12-week exercise training program for reducing  obstructive sleep apnea ( OSA ) severity  and improving sleep quality , and to explore possible mechanisms by which exercise may reduce OSA severity . DESIGN R and omized controlled trial . SETTING Clinical exercise physiology center , sleep laboratory . PARTICIPANTS Forty-three sedentary and overweight/obese adults aged 18 - 55 years with at least moderate-severity untreated OSA ( screening apnea-hypopnea index [ AHI ] ≥ 15 ) . INTERVENTIONS Participants r and omized to exercise training ( n = 27 ) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity , followed by resistance training twice/week . Participants r and omized to a stretching control ( n = 16 ) met twice weekly for 12 weeks to perform low-intensity exercises design ed to increase whole-body flexibility . MEASUREMENTS AND RESULTS OSA severity was assessed with one night of laboratory polysomnography ( PSG ) before and following the 12-week intervention . Measures of sleep quality included PSG , actigraphy ( 7 - 10 days ) , and the Pittsburgh Sleep Quality Index . Compared with stretching , exercise result ed in a significant AHI reduction  ( exercise : 32.2 ± 5.6 to 24.6 ± 4.4 , stretching : 24.4 ± 5.6 to 28.9 ± 6.4 ; P < 0.01 ) as well as significant changes in oxygen desaturation index ( ODI ; P = 0.03 ) and stage N3 sleep ( P = 0.03 ) . Reductions in AHI and ODI were achieved without a significant decrease in body weight . Improvements in actigraphic sleep and 
    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 Obesity is the most important risk factor for obstructive sleep apnea ( OSA ) . However , although included in clinical guidelines , no r and omized controlled studies have been performed on the effects of weight reduction on mild OSA . OBJECTIVES The aim of this prospect i ve , r and omized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet ( VLCD ) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA . METHODS Seventy-two consecutive overweight patients ( body mass index , 28 - 40 ) with mild OSA were recruited . The intervention group ( n = 35 ) completed the VLCD program with supervised lifestyle modification , and the control group ( n = 37 ) received routine lifestyle counseling . The apnea-hypopnea index ( AHI ) was the main objective ly measured outcome variable . Change in symptoms and the 15D- Quality of Life tool were used as subjective measurements . MEASUREMENTS AND MAIN RESULTS The lifestyle intervention was found to effectively reduce body weight ( -10.7 + /- 6.5 kg ; body mass index , -3.5 + /- 2.1 [ mean + /- SD ] ) . There was a statistically significant difference in the mean change in AHI between the study groups ( P = 0.017 ) . The adjusted odds ratio for having mild OSA was markedly lowered ( odds ratio , 0.24 [ 95 % confidence interval , 0.08 - 0.72 ] ; P = 0.011 ) in the intervention group . All common symptoms related to OSA , and some features of 15D- Quality of Life improved after the lifestyle intervention . Changes in AHI were strongly associated with changes in weight and waist circumference . CONCLUSIONS VLCD combined with active lifestyle counseling result ing in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA , and the achieved beneficial outcomes are maintained at 1-year follow-up We studied the impact of a 6-wk supervised , multimodality endurance exercise training program ( EXT ) on strength and endurance of ventilatory and peripheral muscles in patients with chronic airflow limitation ( CAL ) , and determined whether potential improvements contributed to relief of exertional breathlessness ( B ) and perceived leg effort/discomfort ( LE ) , respectively . Twenty breathless patients with stable CAL ( FEV1 = 41 + /- 3 % predicted ; mean + /- SEM ) were tested at 6-wk intervals at baseline , after a nonintervention control period ( pre-EXT ) , and post-EXT . Measurements included : pulmonary function tests ( PFTs ) , maximal inspiratory/expiratory pressures ( MIP , MEP ) , inspiratory muscle endurance ( V(LIM ) ) , quadriceps strength and endurance , exercise endurance , and submaximal cycle exercise with cardioventilatory and symptom responses . Measurements at baseline and pre-EXT were identical . Post-EXT , PFTs did not change ; exercise endurance measured on the treadmill , cycle ergometer , arm ergometer , and by 6-min walk distance increased 40 + /- 8 % , 43 + /- 10 % , 12 + /- 5 % , and 34 + /- 9 % , respectively ( p < 0.05 ) ; quadriceps strength increased 21 + /- 5 % ( p < 0.01 ) ; MIP and MEP increased 29 + /- 11 % and 27 + /- 11 % , respectively ( p < 0.05 ) ; V(LIM ) increased almost threefold ( p < 0.05 ) . At isotime near end-exercise , B , LE , carbon dioxide production ( VCO2 ) , oxygen consumption ( VO2 ) , ventilation , and breathing frequency ( F ) all fell after EXT ( p < 0.05 ) : deltaB correlated with deltaF ( r = 0.58 , p < 0.01 ) . Increased MIP and V(LIM ) did not correlate with improved breathlessness or exercise endurance . Similarly , changes in quadriceps strength and endurance did not correlate with changes in LE or exercise endurance . In conclusion , general nonspecific EXT improved ventilatory and peripheral muscle function in severe CAL , but such improvements did not appear to contribute significantly to reduced exertional symptoms and enhanced exercise performance Objective To assess the effect of weight loss induced by a very low energy diet on  moderate and severe obstructive sleep apnoea in obese men . Design Single centre , two arm , parallel , r and omised , controlled , open label trial . Blocked r and omisation procedure used for treatment allocation . Setting Outpatient obesity clinic in a university hospital in Stockholm , Sweden . Participants 63 obese men ( body mass index 30 - 40 , age 30 - 65 years ) with moderate to severe obstructive sleep apnoea ( apnoea-hypopnoea index ( AHI ) ≥15 ) , treated with continuous positive airway pressure . Interventions The intervention group received a liquid very low energy diet ( 2.3 MJ/day ) for seven weeks to promote weight loss , followed by two weeks of gradual introduction of normal food , reaching 6.3 MJ/day at week 9 . The control group adhered to their usual diet during the nine weeks of follow-up . Main outcome measure AHI , the major disease severity index for obstructive sleep apnoea . Data from all r and omised patients were included in an intention to treat analysis ( baseline carried forward for missing data ) . Results Of the 63 eligible patients , 30 were r and omised to intervention and 33 to control . Two patients in the control group were dissatisfied with allocation and immediately discontinued . All other patients completed the trial . Both groups had a mean AHI of 37 events/h ( SD 15 ) at baseline . At week 9 , the intervention group ’s mean body weight was 20 kg ( 95 % confidence interval 18 to 21 ) lower than that of the control group , while its mean AHI was 23 events/h ( 15 to 30 ) lower . In the intervention group , five of 30 ( 17 % ) were disease free after the energy restricted diet ( AHI < 5 ) , with 15 of 30 ( 50 % ) having mild disease ( AHI 5 - 14.9 ) , whereas the AHI of all patients in the control group except one remained at 15 or higher . In a subgroup analysis of the intervention group , baseline AHI significantly modified the effectiveness of treatment , with a greater improvement in AHI in patients with severe obstructive sleep apnoea ( AHI > 30 ) at baseline compared with those with moderate ( AHI 15 - 30 ) sleep apnoea ( AHI −38 v −12 , P<0.001 ) , despite similar weight loss ( −19.2 v −18.2 kg , P=0.55 ) . Conclusion Treatment with a low energy diet improved  obstructive sleep apnoea in obese men , with the greatest effect in patients with severe disease . Long term treatment studies are needed to vali date weight loss as a primary treatment strategy for obstructive sleep apnoea . Trial registration Current Controlled Trials IS RCT N70090382 Objective To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea . Design Single centre , prospect i ve observational follow-up study . Setting Outpatient obesity clinic in a university hospital in Stockholm , Sweden . Participants 63 men aged 30 - 65 with body mass index ( BMI ) 30 - 40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥15 ( events/hour ) , all treated with continuous positive airway pressure . Intervention A one year weight loss programme , consisting of an initial very low energy diet for nine weeks ( seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food ) followed by a weight loss maintenance programme . Main outcome measure Apnoea-hypopnoea index , the main index for severity of obstructive sleep apnoea . Data from all patients were analysed ( baseline carried forward for missing data ) . Results Of 63 eligible patients , 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme ; 49 had complete measurements at one year . At baseline the mean apnoea-hypopnoea index was 36 events/hour . After the very low energy diet  period , apnoea-hypopnoea index was improved by −21 events/hour ( 95 % confidence interval −17 to −25 ) and weight by −18 kg ( −16 to −19 ; both P<0.001 ) . After one year the apnoea-hypopnoea index had improved by −17 events/hour ( −13 to −21 ) and body weight by −12 kg ( −10 to −14 ) compared with baseline ( both P<0.001 ) . Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index ( −25 events/hour ) compared with patients with moderate disease ( −7 events/hour , P<0.001 ) . At one year , 30/63 ( 48 % , 95 % confidence interval 35 % to 60 % ) no longer required continuous positive airway pressure and 6/63 ( 10 % , 2 % to 17 % ) had total remission of obstructive sleep apnoea ( apnoea-hypopnoea index < 5 events/hour ) . There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up ( β=0.50 events/kg , 0.11 to 0.88 ; P=0.013 ) . Conclusion Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease . Those who lose the most weight or have severe sleep apnoea at baseline benefit most . Trial registration Current Controlled Trials 70090382 AIM The aim of this long-term prospect i ve study was to evaluate the effect of treating obstructive sleep apnoea ( OSA ) on the rate of cardiovascular events in coronary artery disease ( CAD ) . METHODS AND RESULTS We prospect ively studied 54 patients ( mean age 57.3 + /- 10.1 years ) with both CAD ( > or = 70 % coronary artery stenosis ) and OSA ( apnoea-hypopnoea index > or = 15 ) . In 25 patients , OSA was treated with continuous positive airway pressure ( n=21 ) or upper airway surgery ( n=4 ) ; the remaining 29 patients declined treatment for their OSA . The median follow-up was 86.5 + /- 39 months . The two groups were similar at baseline in age , body mass index , smoking history , hypertension , hypercholesterolaemia , diabetes mellitus , number of diseased vessels , left ventricular ejection fraction , and CAD therapy . Treatment of risk factors other than OSA was similar in the two groups . The endpoint ( a composite of cardiovascular death , acute coronary syndrome , hospitalisation for heart failure , or need for coronary revascularisation ) was reached in 6 ( 6/25 , 24 % ) and 17 ( 17/29 , 58 % ) patients with and without OSA treatment , respectively ( P<0.01 ) . OSA treatment significantly reduced the risk of occurrence of the composite endpoint ( hazard ratio 0.24 ; 95 % confidence interval , 0.09 - 0.62 ; p<0.01 ) and of each of its components . CONCLUSIONS Our data indicate that the treatment of OSA in CAD patients is associated with a decrease in the occurrence of new cardiovascular events , and an increase in the time to such events STUDY OBJECTIVES To evaluate the efficacy of a 12-week exercise training program for reducing  obstructive sleep apnea ( OSA ) severity  and improving sleep quality , and to explore possible mechanisms by which exercise may reduce OSA severity . DESIGN R and omized controlled trial . SETTING Clinical exercise physiology center , sleep laboratory . PARTICIPANTS Forty-three sedentary and overweight/obese adults aged 18 - 55 years with at least moderate-severity untreated OSA ( screening apnea-hypopnea index [ AHI ] ≥ 15 ) . INTERVENTIONS Participants r and omized to exercise training ( n = 27 ) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity , followed by resistance training twice/week . Participants r and omized to a stretching control ( n = 16 ) met twice weekly for 12 weeks to perform low-intensity exercises design ed to increase whole-body flexibility . MEASUREMENTS AND RESULTS OSA severity was assessed with one night of laboratory polysomnography ( PSG ) before and following the 12-week intervention . Measures of sleep quality included PSG , actigraphy ( 7 - 10 days ) , and the Pittsburgh Sleep Quality Index . Compared with stretching , exercise result ed in a significant AHI reduction  ( exercise : 32.2 ± 5.6 to 24.6 ± 4.4 , stretching : 24.4 ± 5.6 to 28.9 ± 6.4 ; P < 0.01 ) as well as significant changes in oxygen desaturation index ( ODI ; P = 0.03 ) and stage N3 sleep ( P = 0.03 ) . Reductions in AHI and ODI were achieved without a significant decrease in body weight . Improvements in actigraphic sleep and 
    Output:
    