human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: RATIONALE Continuous positive airway pressure ( CPAP ) and m and ibular advancement device ( MAD ) therapy are commonly used to treat obstructive sleep apnea ( OSA ) . Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes . OBJECTIVES To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA . METHODS In this r and omized crossover trial , we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes . MEASUREMENTS AND MAIN RESULTS Cardiovascular ( 24-h blood pressure , arterial stiffness ) , neurobehavioral ( subjective sleepiness , driving simulator performance ) , and quality of life ( Functional Outcomes of Sleep Question naire , Short Form-36 ) were compared between treatments . Our primary outcome was 24-hour mean arterial pressure .  A total of 126 patients with moderate-severe OSA ( apnea hypopnea index [ AHI ] , 25.6 [ SD 12.3 ] ) were r and omly assigned to a treatment order and 108 completed the trial with both devices . CPAP was more efficacious than MAD in reducing AHI ( CPAP AHI , 4.5 ± 6.6/h ; MAD AHI , 11.1 ± 12.1/h ; P < 0.01 ) but reported compliance was higher on MAD ( MAD , 6.50 ± 1.3 h per night vs. CPAP , 5.20 ± 2 h per night ; P < 0.00001 ) . The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP ( CPAP-MAD difference , 0.2 mm Hg [ 95 % confidence interval , -0.7 to 1.1 ] ) ; however , overall , neither treatment improved blood pressure . In contrast , sleepiness , driving simulator performance , and disease-specific quality of life improved on both treatments by similar amounts , although MAD was superior to CPAP for improving four general quality -of-life domains . CONCLUSIONS Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA . The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD , result ing in similar effectiveness . Clinical trial registered with https://www.anzctr.org.au ( ACTRN 12607000289415 ) OBJECTIVE : There are several treatments for obstructive sleep apnea syndrome , such as weight loss , use of an oral appliance and continuous positive airway pressure , that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome . Few studies have evaluated the effectiveness of a physical training program compared with other treatments . The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters , quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments . METHODS : Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were r and omly assigned to three groups : continuous positive airway pressure ( n = 9 ) , oral appliance ( n = 9 ) and physical exercise ( n = 7 ) . Polysomnographic recordings , blood sample s and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance . Clinical trials.gov : NCT01289392 RESULTS : After treatment with continuous positive airway pressure or an oral appliance , the patients presented with a significant reduction in the apnea-hypopnea index . We did not observe changes in the sleep parameters studied in the physical exercise group . However , this group presented reductions in the following parameters : T leukocytes , very-low-density lipoprotein and triglycerides . Two months of exercise training also had a positive impact on subjective daytime sleepiness . CONCLUSIONS : Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures .  Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index 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 In clinical practice , oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure ( CPAP ) therapy . We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively . We r and omly assigned 103 individuals to oral-appliance or CPAP therapy .  Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance ( 76.5 % ) and for 43 of 52 persons using CPAP ( 82.7 % ) . For the difference in effectiveness , a 95 % two-sided confidence interval was calculated . Non-inferiority of oral-appliance therapy  was considered to be established when the lower boundary of this interval exceeded −25 % . The lower boundary of the confidence interval was −21.7 % , indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea . However , subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease ( apnea-hypopnea index > 30 ) . Since these people could be at particular cardiovascular risk , primary oral-appliance therapy appears to be supported only for those with non-severe apnea 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 Introduction M and ibular advancement splints ( MAS ) allowing self-adjustment may be better tolerated , but the optimum titration protocol needs systematic study . Aim The aims of the study are to assess the effectiveness of a titratable MAS device in consecutive patients with body mass index ( BMI ) < 35 kg/m2 and obstructive sleep apnoea [ OSA , apnoea – hypopnoea index ( AHI ) 10–40/h ] and compare two methods of adjustment  [ self-adjustment  or adjustment after polysomnographic ( PSG ) feedback ] . Material s and methods Twenty-eight patients ( 24 M , mean age 49 years , mean BMI 27.6 kg/m2 ) with symptomatic ( Epworth Sleepiness score > 8/24 , snoring , choking or poor sleep quality ) OSA ( mean AHI 25.7/h , range 10–46/h ) had a MAS set at 70 % maximal protrusion and were r and omised to subjective self-adjustment for 6 weeks ( n = 16 ) or objective adjustment ( n = 12 ; fixed position for 3 weeks , then PSG based feedback at 3 weeks with self-adjustment instructions ) . Primary outcome variable ( AHI ) and OSA symptoms were compared by t tests and chi-squared tests at baseline and after 6 weeks . Resolution of apnoea was defined as AHI < 5/h ; improvement was defined as AHI decreased by > 50 % but still > 5/h . Results The groups had similar baseline demographics , OSA severity and occlusal type . MAS therapy improved or resolved OSA in 20 out of 28 ( 71 % ) and was reportedly used nightly by 91 % of the objective group and 63 % of the subjective group ( p = 0.04 ) . MAS were used all night by 75 % of the objective group and 69 % of the subjective group ( p > 0.05 ) . MAS adjustment following PSG feedback did not lower AHI further from 3 weeks ( baseline 26.5 ± 12.0/h , 3 weeks 15.3 ± 13.5/h p = 0.01 , 6 weeks 11.7 ± 10.0/h , p = 0.11 ) . The overall improvement was similar to that achieved with subjective adjustment ( baseline AHI 25.4 ± 7.4/h , 6 weeks 14.3 ± 10.7/h , p = 0.0002 ) . Symptomatic benefit was reported by both groups . Conclusion In selected patients , titratable MAS improved or resolved OSA in the majority of patients and was well tolerated . PSG-based feedback at 3 weeks allowed objective confirmation of efficacy and increased device use but did not result in greater improvement in AHI or symptoms . Neither titration method was significantly superior for us to provide firm endorsement . However , we recommend a follow-up sleep study to confirm MAS efficacy The aim of this study was to assess the effect of bite opening induced by a m and ibular advancement splint ( MAS ) on efficacy and side effects in the treatment of obstructive sleep apnea . In a r and omized crossover fashion , 23 adult patients received either MAS-1 ( 4 mm of interincisal opening ) or MAS-2 ( 14 mm of interincisal opening )  for 2 weeks , followed by the alternate treatment for 2 weeks , with an intervening 1-week washout . Complete response was defined as a resolution of symptoms and a reduction in apnea/hypopnea index ( AHI ) to less than 5 per hour . Partial response was defined as improved symptoms and a reduction in AHI of 50 % or more , with the AHI remaining at a value of 5 or more per hour . Both MAS-1 and MAS-2 produced similar reductions in mean ( + /- SEM ) AHI from baseline : 21 + /- 2 versus 8 + /- 1/hour and 21 + /- 2 versus 10 + /- 2/hour , respectively ( p < 0.001 ) . Either complete response or partial response occurred in 74 and 61 % of patients with MAS-1 and MAS-2 , respectively . Subjective improvements were reported with both appliances by the majority of patients . Patients preferred MAS-1 ( 78 versus 22 % , p = 0.007 ) . This study suggests that the amount of bite opening induced 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: RATIONALE Continuous positive airway pressure ( CPAP ) and m and ibular advancement device ( MAD ) therapy are commonly used to treat obstructive sleep apnea ( OSA ) . Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes . OBJECTIVES To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA . METHODS In this r and omized crossover trial , we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes . MEASUREMENTS AND MAIN RESULTS Cardiovascular ( 24-h blood pressure , arterial stiffness ) , neurobehavioral ( subjective sleepiness , driving simulator performance ) , and quality of life ( Functional Outcomes of Sleep Question naire , Short Form-36 ) were compared between treatments . Our primary outcome was 24-hour mean arterial pressure .  A total of 126 patients with moderate-severe OSA ( apnea hypopnea index [ AHI ] , 25.6 [ SD 12.3 ] ) were r and omly assigned to a treatment order and 108 completed the trial with both devices . CPAP was more efficacious than MAD in reducing AHI ( CPAP AHI , 4.5 ± 6.6/h ; MAD AHI , 11.1 ± 12.1/h ; P < 0.01 ) but reported compliance was higher on MAD ( MAD , 6.50 ± 1.3 h per night vs. CPAP , 5.20 ± 2 h per night ; P < 0.00001 ) . The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP ( CPAP-MAD difference , 0.2 mm Hg [ 95 % confidence interval , -0.7 to 1.1 ] ) ; however , overall , neither treatment improved blood pressure . In contrast , sleepiness , driving simulator performance , and disease-specific quality of life improved on both treatments by similar amounts , although MAD was superior to CPAP for improving four general quality -of-life domains . CONCLUSIONS Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA . The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD , result ing in similar effectiveness . Clinical trial registered with https://www.anzctr.org.au ( ACTRN 12607000289415 ) OBJECTIVE : There are several treatments for obstructive sleep apnea syndrome , such as weight loss , use of an oral appliance and continuous positive airway pressure , that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome . Few studies have evaluated the effectiveness of a physical training program compared with other treatments . The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters , quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments . METHODS : Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were r and omly assigned to three groups : continuous positive airway pressure ( n = 9 ) , oral appliance ( n = 9 ) and physical exercise ( n = 7 ) . Polysomnographic recordings , blood sample s and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance . Clinical trials.gov : NCT01289392 RESULTS : After treatment with continuous positive airway pressure or an oral appliance , the patients presented with a significant reduction in the apnea-hypopnea index . We did not observe changes in the sleep parameters studied in the physical exercise group . However , this group presented reductions in the following parameters : T leukocytes , very-low-density lipoprotein and triglycerides . Two months of exercise training also had a positive impact on subjective daytime sleepiness . CONCLUSIONS : Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures .  Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index 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 In clinical practice , oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure ( CPAP ) therapy . We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively . We r and omly assigned 103 individuals to oral-appliance or CPAP therapy .  Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance ( 76.5 % ) and for 43 of 52 persons using CPAP ( 82.7 % ) . For the difference in effectiveness , a 95 % two-sided confidence interval was calculated . Non-inferiority of oral-appliance therapy  was considered to be established when the lower boundary of this interval exceeded −25 % . The lower boundary of the confidence interval was −21.7 % , indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea . However , subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease ( apnea-hypopnea index > 30 ) . Since these people could be at particular cardiovascular risk , primary oral-appliance therapy appears to be supported only for those with non-severe apnea 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 Introduction M and ibular advancement splints ( MAS ) allowing self-adjustment may be better tolerated , but the optimum titration protocol needs systematic study . Aim The aims of the study are to assess the effectiveness of a titratable MAS device in consecutive patients with body mass index ( BMI ) < 35 kg/m2 and obstructive sleep apnoea [ OSA , apnoea – hypopnoea index ( AHI ) 10–40/h ] and compare two methods of adjustment  [ self-adjustment  or adjustment after polysomnographic ( PSG ) feedback ] . Material s and methods Twenty-eight patients ( 24 M , mean age 49 years , mean BMI 27.6 kg/m2 ) with symptomatic ( Epworth Sleepiness score > 8/24 , snoring , choking or poor sleep quality ) OSA ( mean AHI 25.7/h , range 10–46/h ) had a MAS set at 70 % maximal protrusion and were r and omised to subjective self-adjustment for 6 weeks ( n = 16 ) or objective adjustment ( n = 12 ; fixed position for 3 weeks , then PSG based feedback at 3 weeks with self-adjustment instructions ) . Primary outcome variable ( AHI ) and OSA symptoms were compared by t tests and chi-squared tests at baseline and after 6 weeks . Resolution of apnoea was defined as AHI < 5/h ; improvement was defined as AHI decreased by > 50 % but still > 5/h . Results The groups had similar baseline demographics , OSA severity and occlusal type . MAS therapy improved or resolved OSA in 20 out of 28 ( 71 % ) and was reportedly used nightly by 91 % of the objective group and 63 % of the subjective group ( p = 0.04 ) . MAS were used all night by 75 % of the objective group and 69 % of the subjective group ( p > 0.05 ) . MAS adjustment following PSG feedback did not lower AHI further from 3 weeks ( baseline 26.5 ± 12.0/h , 3 weeks 15.3 ± 13.5/h p = 0.01 , 6 weeks 11.7 ± 10.0/h , p = 0.11 ) . The overall improvement was similar to that achieved with subjective adjustment ( baseline AHI 25.4 ± 7.4/h , 6 weeks 14.3 ± 10.7/h , p = 0.0002 ) . Symptomatic benefit was reported by both groups . Conclusion In selected patients , titratable MAS improved or resolved OSA in the majority of patients and was well tolerated . PSG-based feedback at 3 weeks allowed objective confirmation of efficacy and increased device use but did not result in greater improvement in AHI or symptoms . Neither titration method was significantly superior for us to provide firm endorsement . However , we recommend a follow-up sleep study to confirm MAS efficacy The aim of this study was to assess the effect of bite opening induced by a m and ibular advancement splint ( MAS ) on efficacy and side effects in the treatment of obstructive sleep apnea . In a r and omized crossover fashion , 23 adult patients received either MAS-1 ( 4 mm of interincisal opening ) or MAS-2 ( 14 mm of interincisal opening )  for 2 weeks , followed by the alternate treatment for 2 weeks , with an intervening 1-week washout . Complete response was defined as a resolution of symptoms and a reduction in apnea/hypopnea index ( AHI ) to less than 5 per hour . Partial response was defined as improved symptoms and a reduction in AHI of 50 % or more , with the AHI remaining at a value of 5 or more per hour . Both MAS-1 and MAS-2 produced similar reductions in mean ( + /- SEM ) AHI from baseline : 21 + /- 2 versus 8 + /- 1/hour and 21 + /- 2 versus 10 + /- 2/hour , respectively ( p < 0.001 ) . Either complete response or partial response occurred in 74 and 61 % of patients with MAS-1 and MAS-2 , respectively . Subjective improvements were reported with both appliances by the majority of patients . Patients preferred MAS-1 ( 78 versus 22 % , p = 0.007 ) . This study suggests that the amount of bite opening induced 
    Output:
    