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 trial was to evaluate the efficacy of a m and ibular advancement appliance ( MAA ) for obstructive sleep apnoea ( OSA ) . Ninety-three patients with OSA and a mean apnoea-hypopnoea index ( AHI ) of 34.7 were central ly r and omised into three , parallel groups : ( a ) MAA ; ( b ) m and ibular non-advancement appliance ( MNA ) ; and ( c ) no intervention . The appliances were custom made , in one piece . The MAAs had a mean protrusion of the m and ible of 74 % ( range 64 - 85 % ) . Outcome measures , assessed after continuous use for 4 weeks , were AHI ( polysomnography ) , daytime sleepiness ( Epworth ) and quality of life ( SF-36 ) . Eighty-one patients ( 87 % ) completed the trial . The MAA group achieved mean AHI and Epworth scores significantly lower ( P < 0.001 and P < 0.05 ) than the MNA group and the no-intervention group . No significant differences were found between the MNA group and the no-intervention group . The MAA group had a mean AHI reduction of 14.1 ( 95 % CI 7.4 - 20.8 ) , and a mean Epworth score reduction of 3.3 ( 95 % CI 1.8 - 4.8 ) . Eight MAA patients ( 30 % ) achieved a reduction in AHI > or = 75 % ending with an AHI < 5 , half of them having baseline AHI > 30 . Sensitivity analyses confirmed these results . MAA had a significant beneficial effect on the vitality domain of SF-36 . Four MAA patients ( 14.8 % ) and two MNA patients ( 8 % ) discontinued interventions because of adverse effects . Our conclusion is that MAA has significant beneficial effects on OSA , including cure in some cases of severe OSA . Protrusion of the m and ible is essential for the effect . MNA has no placebo effect . MAA may be a good alternative to CPAP in subsets of OSA patients The purpose of this study was to investigate the effects of an oral appliance ( OA ) , with and without m and ible advance , in the treatment of  obstructive sleep apnea syndrome ( OSA ) . Twenty-four patients diagnosed with OSA agreed to participate in this study . The patients were treated for 3 months ( with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening ) . Patients were selected , using a r and omized design , to receive an OA model either with ( 12 patients ) or without advance ( 12 patients ) . Before treatment , a snoring question naire , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , the Functional Outcomes of Sleep Question naire ( FOSQ ) , the Epworth Sleepiness Scale ( ESS ) , and polysomnography  were completed . Fifteen subjects completed the protocol ( 13 men , two women ) . With respect to basal values , the m and ible-advanced OA group presented a decrease in the mean apnea – hypopnea index ( AHI ) ( 33.8±4.7 versus 9.6±2.1 ; p<0.01 ) , number of arousals per hour ( 33.8±13.9 versus 16.0±1.5 ; p<0.05 ) , ESS score ( 14.7±5.1 versus 5.1±1.9 ; p<0.05 ) , snoring score ( 15.4±1.9 versus 10.1±3.2 ; p<0.05 ) , and total FOSQ score ( 78.1±22.6 versus 99.3±14.4 ; p<0.05 ) . After treatment , the non-advanced group presented a decrease in the mean AHI ( 24.0±12.2 versus . 11.7±7.9 ; p<0.05 ) . However , no significant differences were found in the number of arousals per hour , ESS score , snoring , and total FOSQ score in the non-advanced group . Neither study group showed significant difference in mean SF36 scores . Oral appliances , especially those that advance the m and ible , offer an effective treatment for OSA Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea – hypopnoea syndrome ( OSAHS ) patients . Although continuous positive airway pressure ( CPAP ) generally improves simulated driving performance , the effects of oral-appliance ( OA ) therapy are unknown . The aims of this study were to determine to what extent OSAHS patients have more difficulty with a monotonous simulated driving test when compared with control subjects and to compare the effects of OA with CPAP therapy .  Simulated driving performance was evaluated in 20 OSAHS patients and 16 control subjects during a 25-min driving test . After r and omization , ten patients started OA and CPAP therapy , respectively . After 2 to 3 months of treatment , patients repeated the driving test . At baseline , the total number of lapses of attention during driving was significantly higher in OSAHS patients as compared with control subjects . As a result of treatment , the total number of lapses of attention was significantly decreased in both the OA and CPAP group . When comparing driving performance between the OA and CPAP group , no significant differences were noted . OSAHS patients  perform worse on a simulated driving test when compared with control subjects . When evaluating the effects of treatment , adequate OSAHS management with either OA or CPAP therapy usually result ed in substantial improvements of simulated driving . Conclusions beyond both treatments improving simulated driving performance are , however , not justified by the data in the present study This r and omized placebo-controlled cross-over trial assessed the effectiveness of a m and ibular advancement appliance ( MAA ) in managing  obstructive sleep apnoea ( OSA ) . Twenty-one adults , with confirmed OSA , were provided with a maxillary placebo appliance and a MAA for 4 - 6 weeks each , in a r and omized order . Question naires at baseline and after each appliance assessed bed-partners ' reports of snoring severity ( loudness and number of nights per week ) , and patients ' daytime sleepiness ( Epworth Sleepiness Score , ESS ) . The Apnoea Hypopnoea Index ( AHI ) and Oxygen Desaturation Index ( ODI ) were measured at baseline and with each appliance during single night sleep studies . Seventy-nine per cent of subjects wore their MAA for at least 4 hours at night . Sixty-eight per cent of subjects wore their MAA for 6 - 7 nights per week . Excessive salivation was the most commonly reported complication . One subject was unable to tolerate the MAA and withdrew from the study . Among the remaining 20 subjects , the MAA produced significantly lower AHI and ODI values than the placebo . However , although the reported frequency and loudness of snoring and the ESS values were lower with the MAA than the placebo , these differences were not statistically significant . When wearing the MAA , 35 per cent of the OSA subjects had a reduction in the pre-treatment ODI to 10 or less , while 33 per cent had an AHI of 10 or less . The MAA was less effective in the subjects with the most severe OSA ( pre-treatment ODI > 50 and /or pre-treatment AHI > 50 ) The objective of this study was to evaluate the effect of 2 different degrees of m and ibular advancement , 50 % vs. 75 % of maximum protrusive capacity , on somnographic variables after 1 year of dental appliance treatment in patients with mild to moderate obstructive sleep apnea ( OSA ) . A further purpose was to compare the number of adverse events on the stomatognathic system . In a prospect i ve study , 74 male patients were r and omly allocated to receive a dental appliance with either 50 % ( 38 patients ) or 75 % m and ibular advancement ( 36 patients ) . After 1 year of treatment , 55 patients completed the follow‐up . Somnography was performed to measure treatment effects before and 12 months post‐treatment . The apnea , apnea/hypopnea , and oxygen desaturation indices decreased significantly in both groups after 1 year ( P<0.001 ) ; however , there were no differences between the groups . Normalization ( apnea index < 5 and apnea/hypopnea index < 10 ) was observed in 79 % in group 50 and in 73 % in group 75 . Few patients ( < 5 % ) reported symptoms from the stomatognathic system except for headache ( > once a week ) , which was reported in one‐third of the patients . Headache was significantly more infrequent after 1 year of treatment in both groups ( P<0.001 ) . No serious complications were observed except for 2 patients who reported a painful condition from the temporom and ibular joint in either group . In conclusion , m and ibular advancement with a dental appliance effectively reduces the sleep‐breathing disorder measured as frequency of apneas , and a pronounced m and ibular advancement did not show a greater improvement of the medical problem compared to less advancement for patients with mild to moderate OSA . On the basis of few adverse events in the stomatognathic system or other complications we can recommend dental appliance treatment and , for patients with mild to moderate obstructive sleep apnea , not starting treatment by more than 50 % m and ibular advancement Our purpose was to compare the effectiveness and side effects of a novel , single-piece m and ibular advancement device ( OSA-Monobloc ) for sleep apnea therapy with those of a two-piece appliance with lateral Herbst attachments ( OSA-Herbst ) as used in previous studies . An OSA-Monobloc and an OSA-Herbst with equal protrusion were fitted in 24 obstructive sleep apnea patients unable to use continuous positive airway pressure ( CPAP ) therapy . After an adaptation period of 156 + /- 14 d ( mean + /- SE ) , patients used the OSA-Monobloc , the OSA-Herbst , and no appliance in r and om order , using each appliance for 1 wk . Symptom scores were recorded and sleep studies were done at the end of each week . Several symptom scores were significantly improved with both appliances , but to a greater degree with the OSA-Monobloc .  Epworth Sleepiness Scale scores were 8.8 + /- 0.7 with the OSA-Herbst , and 8.6 + /- 0.8 with the OSA-Monobloc devices , and 13.1 + /- 0.9 without therapy ( p < 0.05 versus both appliances ) . The apnea/hypopnea index was 8.7 + /- 1.5/h with the OSA-Herbst and 7.9 + /- 1.6/h with the OSA-Monobloc device , and 22.6 + /- 3.1/h without therapy ( p < 0.05 versus both appliances ) . Side effects were mild and of equal prevalence with both appliances . Fifteen patients preferred the OSA-Monobloc , eight patients had no preference , and one patient preferred the OSA-Herbst device ( p < 0.008 versus OSA-Monobloc ) . We conclude that both the OSA-Herbst and the OSA-Monobloc are effective therapeutic devices for sleep apnea . The OSA-Monobloc relieved symptoms to a greater extent than the OSA-Herbst , and was preferred by the majority of patients on the basis of its simple application This prospect i ve , r and omized , cross-over trial was design ed to compare the efficacy of a m and ibular advancement splint ( MAS ) with that of nasal continuous positive airway pressure ( nCPAP ) in patients with obstructive sleep apnoea ( OSA ) . Twenty-four patients ( 20 males and four females ) with mild to moderate OSA ( AHI between 10 and 49 events per hour ) were enrolled in the study . Each patient used both MAS and nCPAP , with the initial therapy being allocated at r and om . Treatment periods lasted for two months with a two-week wash-out interval between .  Polysomnography  was performed prior to the study and after each clinical intervention . Patient and partner question naires 
    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 trial was to evaluate the efficacy of a m and ibular advancement appliance ( MAA ) for obstructive sleep apnoea ( OSA ) . Ninety-three patients with OSA and a mean apnoea-hypopnoea index ( AHI ) of 34.7 were central ly r and omised into three , parallel groups : ( a ) MAA ; ( b ) m and ibular non-advancement appliance ( MNA ) ; and ( c ) no intervention . The appliances were custom made , in one piece . The MAAs had a mean protrusion of the m and ible of 74 % ( range 64 - 85 % ) . Outcome measures , assessed after continuous use for 4 weeks , were AHI ( polysomnography ) , daytime sleepiness ( Epworth ) and quality of life ( SF-36 ) . Eighty-one patients ( 87 % ) completed the trial . The MAA group achieved mean AHI and Epworth scores significantly lower ( P < 0.001 and P < 0.05 ) than the MNA group and the no-intervention group . No significant differences were found between the MNA group and the no-intervention group . The MAA group had a mean AHI reduction of 14.1 ( 95 % CI 7.4 - 20.8 ) , and a mean Epworth score reduction of 3.3 ( 95 % CI 1.8 - 4.8 ) . Eight MAA patients ( 30 % ) achieved a reduction in AHI > or = 75 % ending with an AHI < 5 , half of them having baseline AHI > 30 . Sensitivity analyses confirmed these results . MAA had a significant beneficial effect on the vitality domain of SF-36 . Four MAA patients ( 14.8 % ) and two MNA patients ( 8 % ) discontinued interventions because of adverse effects . Our conclusion is that MAA has significant beneficial effects on OSA , including cure in some cases of severe OSA . Protrusion of the m and ible is essential for the effect . MNA has no placebo effect . MAA may be a good alternative to CPAP in subsets of OSA patients The purpose of this study was to investigate the effects of an oral appliance ( OA ) , with and without m and ible advance , in the treatment of  obstructive sleep apnea syndrome ( OSA ) . Twenty-four patients diagnosed with OSA agreed to participate in this study . The patients were treated for 3 months ( with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening ) . Patients were selected , using a r and omized design , to receive an OA model either with ( 12 patients ) or without advance ( 12 patients ) . Before treatment , a snoring question naire , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , the Functional Outcomes of Sleep Question naire ( FOSQ ) , the Epworth Sleepiness Scale ( ESS ) , and polysomnography  were completed . Fifteen subjects completed the protocol ( 13 men , two women ) . With respect to basal values , the m and ible-advanced OA group presented a decrease in the mean apnea – hypopnea index ( AHI ) ( 33.8±4.7 versus 9.6±2.1 ; p<0.01 ) , number of arousals per hour ( 33.8±13.9 versus 16.0±1.5 ; p<0.05 ) , ESS score ( 14.7±5.1 versus 5.1±1.9 ; p<0.05 ) , snoring score ( 15.4±1.9 versus 10.1±3.2 ; p<0.05 ) , and total FOSQ score ( 78.1±22.6 versus 99.3±14.4 ; p<0.05 ) . After treatment , the non-advanced group presented a decrease in the mean AHI ( 24.0±12.2 versus . 11.7±7.9 ; p<0.05 ) . However , no significant differences were found in the number of arousals per hour , ESS score , snoring , and total FOSQ score in the non-advanced group . Neither study group showed significant difference in mean SF36 scores . Oral appliances , especially those that advance the m and ible , offer an effective treatment for OSA Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea – hypopnoea syndrome ( OSAHS ) patients . Although continuous positive airway pressure ( CPAP ) generally improves simulated driving performance , the effects of oral-appliance ( OA ) therapy are unknown . The aims of this study were to determine to what extent OSAHS patients have more difficulty with a monotonous simulated driving test when compared with control subjects and to compare the effects of OA with CPAP therapy .  Simulated driving performance was evaluated in 20 OSAHS patients and 16 control subjects during a 25-min driving test . After r and omization , ten patients started OA and CPAP therapy , respectively . After 2 to 3 months of treatment , patients repeated the driving test . At baseline , the total number of lapses of attention during driving was significantly higher in OSAHS patients as compared with control subjects . As a result of treatment , the total number of lapses of attention was significantly decreased in both the OA and CPAP group . When comparing driving performance between the OA and CPAP group , no significant differences were noted . OSAHS patients  perform worse on a simulated driving test when compared with control subjects . When evaluating the effects of treatment , adequate OSAHS management with either OA or CPAP therapy usually result ed in substantial improvements of simulated driving . Conclusions beyond both treatments improving simulated driving performance are , however , not justified by the data in the present study This r and omized placebo-controlled cross-over trial assessed the effectiveness of a m and ibular advancement appliance ( MAA ) in managing  obstructive sleep apnoea ( OSA ) . Twenty-one adults , with confirmed OSA , were provided with a maxillary placebo appliance and a MAA for 4 - 6 weeks each , in a r and omized order . Question naires at baseline and after each appliance assessed bed-partners ' reports of snoring severity ( loudness and number of nights per week ) , and patients ' daytime sleepiness ( Epworth Sleepiness Score , ESS ) . The Apnoea Hypopnoea Index ( AHI ) and Oxygen Desaturation Index ( ODI ) were measured at baseline and with each appliance during single night sleep studies . Seventy-nine per cent of subjects wore their MAA for at least 4 hours at night . Sixty-eight per cent of subjects wore their MAA for 6 - 7 nights per week . Excessive salivation was the most commonly reported complication . One subject was unable to tolerate the MAA and withdrew from the study . Among the remaining 20 subjects , the MAA produced significantly lower AHI and ODI values than the placebo . However , although the reported frequency and loudness of snoring and the ESS values were lower with the MAA than the placebo , these differences were not statistically significant . When wearing the MAA , 35 per cent of the OSA subjects had a reduction in the pre-treatment ODI to 10 or less , while 33 per cent had an AHI of 10 or less . The MAA was less effective in the subjects with the most severe OSA ( pre-treatment ODI > 50 and /or pre-treatment AHI > 50 ) The objective of this study was to evaluate the effect of 2 different degrees of m and ibular advancement , 50 % vs. 75 % of maximum protrusive capacity , on somnographic variables after 1 year of dental appliance treatment in patients with mild to moderate obstructive sleep apnea ( OSA ) . A further purpose was to compare the number of adverse events on the stomatognathic system . In a prospect i ve study , 74 male patients were r and omly allocated to receive a dental appliance with either 50 % ( 38 patients ) or 75 % m and ibular advancement ( 36 patients ) . After 1 year of treatment , 55 patients completed the follow‐up . Somnography was performed to measure treatment effects before and 12 months post‐treatment . The apnea , apnea/hypopnea , and oxygen desaturation indices decreased significantly in both groups after 1 year ( P<0.001 ) ; however , there were no differences between the groups . Normalization ( apnea index < 5 and apnea/hypopnea index < 10 ) was observed in 79 % in group 50 and in 73 % in group 75 . Few patients ( < 5 % ) reported symptoms from the stomatognathic system except for headache ( > once a week ) , which was reported in one‐third of the patients . Headache was significantly more infrequent after 1 year of treatment in both groups ( P<0.001 ) . No serious complications were observed except for 2 patients who reported a painful condition from the temporom and ibular joint in either group . In conclusion , m and ibular advancement with a dental appliance effectively reduces the sleep‐breathing disorder measured as frequency of apneas , and a pronounced m and ibular advancement did not show a greater improvement of the medical problem compared to less advancement for patients with mild to moderate OSA . On the basis of few adverse events in the stomatognathic system or other complications we can recommend dental appliance treatment and , for patients with mild to moderate obstructive sleep apnea , not starting treatment by more than 50 % m and ibular advancement Our purpose was to compare the effectiveness and side effects of a novel , single-piece m and ibular advancement device ( OSA-Monobloc ) for sleep apnea therapy with those of a two-piece appliance with lateral Herbst attachments ( OSA-Herbst ) as used in previous studies . An OSA-Monobloc and an OSA-Herbst with equal protrusion were fitted in 24 obstructive sleep apnea patients unable to use continuous positive airway pressure ( CPAP ) therapy . After an adaptation period of 156 + /- 14 d ( mean + /- SE ) , patients used the OSA-Monobloc , the OSA-Herbst , and no appliance in r and om order , using each appliance for 1 wk . Symptom scores were recorded and sleep studies were done at the end of each week . Several symptom scores were significantly improved with both appliances , but to a greater degree with the OSA-Monobloc .  Epworth Sleepiness Scale scores were 8.8 + /- 0.7 with the OSA-Herbst , and 8.6 + /- 0.8 with the OSA-Monobloc devices , and 13.1 + /- 0.9 without therapy ( p < 0.05 versus both appliances ) . The apnea/hypopnea index was 8.7 + /- 1.5/h with the OSA-Herbst and 7.9 + /- 1.6/h with the OSA-Monobloc device , and 22.6 + /- 3.1/h without therapy ( p < 0.05 versus both appliances ) . Side effects were mild and of equal prevalence with both appliances . Fifteen patients preferred the OSA-Monobloc , eight patients had no preference , and one patient preferred the OSA-Herbst device ( p < 0.008 versus OSA-Monobloc ) . We conclude that both the OSA-Herbst and the OSA-Monobloc are effective therapeutic devices for sleep apnea . The OSA-Monobloc relieved symptoms to a greater extent than the OSA-Herbst , and was preferred by the majority of patients on the basis of its simple application This prospect i ve , r and omized , cross-over trial was design ed to compare the efficacy of a m and ibular advancement splint ( MAS ) with that of nasal continuous positive airway pressure ( nCPAP ) in patients with obstructive sleep apnoea ( OSA ) . Twenty-four patients ( 20 males and four females ) with mild to moderate OSA ( AHI between 10 and 49 events per hour ) were enrolled in the study . Each patient used both MAS and nCPAP , with the initial therapy being allocated at r and om . Treatment periods lasted for two months with a two-week wash-out interval between .  Polysomnography  was performed prior to the study and after each clinical intervention . Patient and partner question naires 
    Output:
    