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 effects of treatment of obstructive sleep apnoea ( OSA ) on glucose metabolism have been investigated previously with conflicting results . This study evaluated the impact of nasal continuous positive airway pressure ( nCPAP ) treatment of OSA on insulin sensitivity . Males with moderate/severe OSA and no significant comorbidity were r and omised to a therapeutic or sham nCPAP treatment group for 1 week and then reassessed . Those who received therapeutic nCPAP were further evaluated at 12 weeks . Insulin sensitivity ( Kitt ) was estimated by the short insulin tolerance test . Other evaluations included blood pressure , metabolic profile , urinary catecholamines and intra-abdominal fat . In total , 61 Chinese subjects were r and omised . 31 subjects receiving therapeutic nCPAP showed an increase in Kitt ( 6.6±2.9 to 7.6±3.2 % · min−1 ; p = 0.017 ) , while the 30 patients on sham CPAP had no significant change , and the changes in Kitt were different between the two groups ( p = 0.022 ) . At 12 weeks , improvement in Kitt was seen in 20 subjects with BMI ≥25 kg·m−2 ( median ( interquartile range ) 28.3 ( 26.6–31.5 ) ; p = 0.044 ) , but not in the nine subjects with BMI < 25 kg·m−2 , or the entire group . The findings indicate that therapeutic nCPAP treatment of OSA for 1 week improved insulin sensitivity in nondiabetic males , and the improvement appeared to be maintained after 12 weeks of treatment in those with moderate obesity RATIONALE Cross-sectional association has been reported between sleep-disordered breathing ( SDB ) and insulin resistance , but no prospect i ve studies have been performed to determine whether SDB is causal in the development of diabetes . OBJECTIVES The purpose of our study was to investigate the prevalence and incidence of type II diabetes  in subjects with SDB and whether an independent relationship exists between them . METHODS A cross-sectional and longitudinal analysis was performed in 1,387 participants of the Wisconsin Sleep Cohort .  Full polysomnography was used to characterize SDB . Diabetes was defined in two ways : ( 1 ) physician-diagnosis alone or ( 2 ) for those with glucose measurements , either fasting glucose > or = 126 mg/dl or physician diagnosis . MEASUREMENTS AND MAIN RESULTS There was a greater prevalence of diabetes in subjects with increasing levels of SDB . A total of 14.7 % of subjects with an apnea-hypopnea index ( AHI ) of 15 or more had a diagnosis of diabetes compared with 2.8 % of subjects with an AHI of less than 5 . The odds ratio for having a physician diagnoses of diabetes mellitus with an AHI of 15 or greater versus an AHI of less than 5 was 2.30 ( 95 % confidence interval , 1.28 - 4.11 ; p = 0.005 ) after adjustment for age , sex , and body habitus . The odds ratio for developing diabetes mellitus within 4 yr with an AHI of 15 or more compared with an AHI of less than 5 was 1.62 ( 95 % confidence interval , 0.67 - 3.65 ; p = 0.24 ) when adjusting for age , sex , and body habitus . CONCLUSIONS Diabetes is more prevalent in SDB and this relationship is independent of other risk factors . However , it is not clear that SDB is causal in the development of diabetes Background : The effects of continuous positive airway pressure ( CPAP ) for obstructive sleep apnoea ( OSA ) on insulin resistance are not clear . Trials have found conflicting results and no appropriate control groups have been used . Methods : Forty-two men with known type 2 diabetes and newly diagnosed OSA ( > 10 dips/h in oxygen saturation of > 4 % ) were r and omised to receive therapeutic ( n = 20 ) or placebo CPAP ( n = 22 ) for 3 months . Baseline tests were performed and repeated after 3 months . The study was double blind . Results : Results are expressed as mean ( SD ) . CPAP  improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group ( −6.6 ( 4.5 ) vs −2.6 ( 4.9 ) , p = 0.01 ) . The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group ( + 10.6 ( 13.9 ) vs −4.7 ( 11.8 ) min , p = 0.001 ) . Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups : HbA1c ( −0.02 ( 1.5 ) vs + 0.1 ( 0.7 ) , p = 0.7 , 95 % CI −0.6 % to + 0.9 % ) , euglycaemic clamp ( M/I : + 1.7 ( 14.1 ) vs −5.7 ( 14.8 ) , p = 0.2 , 95 % CI −1.8 to + 0.3 l/kg/min1000 ) , HOMA-%S ( −1.5 ( 2.3 ) vs −1.1 ( 1.8 ) , p = 0.2 , 95 % CI −0.3 % to + 0.08 % ) and adiponectin ( −1.1 ( 1.2 ) vs −1.1 ( 1.3 ) , p = 0.2 , 95 % CI −0.7 to + 0.6 & mgr;g/ml ) . Body mass index , bioimpedance and anthropometric measurements were unchanged . Hours of CPAP use per night were 3.6 ( 2.8 ) in the treatment group and 3.3 ( 3.0 ) in the placebo group ( p = 0.8 ) . There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance . Conclusion : Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA BACKGROUND Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) report improved sleepiness , cognitive function , and psychological well being after continuous positive airway pressure ( CPAP ) therapy , and it is for these daytime features that CPAP is usually given . However , few r and omised or controlled studies exist on the effects of CPAP on daytime function . METHODS A prospect i ve , r and omised , single blind , placebo controlled , crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS , all with ⩾15 apnoeas+hypopnoeas/hour and ⩾2 symptoms of SAHS . All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment , following r and omisation to treatment order . With ethics committee approval , patients were told the placebo tablet might improve upper airway function . Average effective CPAP use was monitored using hidden time clocks . Assessment s of objective and subjective sleepiness , symptoms , cognitive performance , and psychological well being were performed on the last day of each treatment and compared . RESULTS Objective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP ( mean difference from placebo + 2.4 min , 95 % CI 0.8 to 4.0 ; p<0.001 ) as did subjective sleepiness on the Epworth scale ( mean difference –6 , 95 % CI –3 to –9 ; p = 0.001 ) . Symptom total score also fell with CPAP ( mean difference –1.6 , 95 % CI –2.2 to –1.0 ; p<0.001 ) . No determinants of these changes with active treatment were identified , and no significant enhancements to cognitive function or psychosocial well being were found in this small sample . CONCLUSIONS These findings provide further evidence for clinical ly significant benefits to daytime function  from CPAP Background : Obstructive sleep apnoea syndrome ( OSAS ) has been associated with cardiovascular disease in epidemiological and observational studies . Continuous positive airway pressure ( CPAP ) is the treatment of choice for OSAS , but the impact of this intervention on systemic inflammation involved in the atherosclerotic process remains unclear . Methods : 100 men with moderate – severe OSAS were r and omised to therapeutic ( n = 51 ) or subtherapeutic ( n = 49 ) CPAP treatment for 4 weeks to investigate the effects of active treatment on inflammatory markers such as highly sensitive C reactive protein ( hsCRP ) , interleukin (IL)6 , interferon γ ( IFNγ ) and anti-inflammatory adiponectin . Results : 4 weeks of therapeutic CPAP did not significantly change blood levels of hsCRP compared with the subtherapeutic control group ( difference between median changes −0.24 mg/l ( 95 % CI −0.88 to + 0.24 ) ; p = 0.30 ) . Plasma levels of IL6 and IFNγ did not change significantly following therapeutic compared with subtherapeutic CPAP ( difference between median changes + 0.52 and −0.07 pg/ml ( 95 % CI −0.72 to + 1.94 and −0.81 to + 0.44 ) ; p = 0.45 and p = 0.82 , respectively ) . Furthermore , 4 weeks of therapeutic CPAP did not significantly change levels of adiponectin in plasma compared with the subtherapeutic control group ( difference between median changes + 0.05 pg/ml ( 95 % CI −0.36 to + 0.47 ) ; p = 0.84 ) . If patients with hsCRP values above 8 mg/l at baseline were excluded , differences between the changes in hsCRP , IL6 , IFNγ and adiponectin after 4 weeks of CPAP were smaller , and again not statistically different between groups . Conclusions : 4 weeks of CPAP treatment has no beneficial effect on blood markers of inflammation and adiponectin in patients with moderate – severe obstructive sleep apnoea 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 Background Previous , largely uncontrolled studies demonstrated the substantial effects of continuous positive airway pressure ventilation ( CPAP ) on a variety of physiologic and biochemical markers known to be risk factors for cardiovascular disease in patients with obstructive sleep apnea ( OSA ) . In this pilot crossover study , we assessed ( 1 ) the feasibility of using CPAP in a group of minimally symptomatic patients with OSA , assessed through patient compliance and ( 2 ) CPAP therapy ’s effect on biomarkers in these patients . Methods We studied patients with minimal daytime sleepiness who were referred to the University of British Columbia ’s Hospital Sleep Clinic with suspected OSA and an apnea-hypopnea index ( AHI ) > 15 events/h . Patients were r and omized to either CPAP or no therapy for 4 weeks followed by a washout of 4 weeks , and then a crossover to the other intervention . Fasting morning blood and urine , 24-h blood pressure ( BP ) measurements , and endothelial function ( peak flow-mediated dilation to nitroglycerin-mediated dilation ratio ) were assessed before and after each study intervention . Results Nine adult male and four female patients were studied . Mean ( SD ) age was 55 ( 7 ) years , mean AHI = 27.9/h , mean Epworth Sleepiness Score = 6.8 ( 11/13 had a score < 10 ) , and mean BMI = 31.1 kg/m2 .  Mean compliance with CPAP therapy was 5.53 h/night . Compared to no therapy , potential improvements were observed with CPAP for urinary micro 
    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 effects of treatment of obstructive sleep apnoea ( OSA ) on glucose metabolism have been investigated previously with conflicting results . This study evaluated the impact of nasal continuous positive airway pressure ( nCPAP ) treatment of OSA on insulin sensitivity . Males with moderate/severe OSA and no significant comorbidity were r and omised to a therapeutic or sham nCPAP treatment group for 1 week and then reassessed . Those who received therapeutic nCPAP were further evaluated at 12 weeks . Insulin sensitivity ( Kitt ) was estimated by the short insulin tolerance test . Other evaluations included blood pressure , metabolic profile , urinary catecholamines and intra-abdominal fat . In total , 61 Chinese subjects were r and omised . 31 subjects receiving therapeutic nCPAP showed an increase in Kitt ( 6.6±2.9 to 7.6±3.2 % · min−1 ; p = 0.017 ) , while the 30 patients on sham CPAP had no significant change , and the changes in Kitt were different between the two groups ( p = 0.022 ) . At 12 weeks , improvement in Kitt was seen in 20 subjects with BMI ≥25 kg·m−2 ( median ( interquartile range ) 28.3 ( 26.6–31.5 ) ; p = 0.044 ) , but not in the nine subjects with BMI < 25 kg·m−2 , or the entire group . The findings indicate that therapeutic nCPAP treatment of OSA for 1 week improved insulin sensitivity in nondiabetic males , and the improvement appeared to be maintained after 12 weeks of treatment in those with moderate obesity RATIONALE Cross-sectional association has been reported between sleep-disordered breathing ( SDB ) and insulin resistance , but no prospect i ve studies have been performed to determine whether SDB is causal in the development of diabetes . OBJECTIVES The purpose of our study was to investigate the prevalence and incidence of type II diabetes  in subjects with SDB and whether an independent relationship exists between them . METHODS A cross-sectional and longitudinal analysis was performed in 1,387 participants of the Wisconsin Sleep Cohort .  Full polysomnography was used to characterize SDB . Diabetes was defined in two ways : ( 1 ) physician-diagnosis alone or ( 2 ) for those with glucose measurements , either fasting glucose > or = 126 mg/dl or physician diagnosis . MEASUREMENTS AND MAIN RESULTS There was a greater prevalence of diabetes in subjects with increasing levels of SDB . A total of 14.7 % of subjects with an apnea-hypopnea index ( AHI ) of 15 or more had a diagnosis of diabetes compared with 2.8 % of subjects with an AHI of less than 5 . The odds ratio for having a physician diagnoses of diabetes mellitus with an AHI of 15 or greater versus an AHI of less than 5 was 2.30 ( 95 % confidence interval , 1.28 - 4.11 ; p = 0.005 ) after adjustment for age , sex , and body habitus . The odds ratio for developing diabetes mellitus within 4 yr with an AHI of 15 or more compared with an AHI of less than 5 was 1.62 ( 95 % confidence interval , 0.67 - 3.65 ; p = 0.24 ) when adjusting for age , sex , and body habitus . CONCLUSIONS Diabetes is more prevalent in SDB and this relationship is independent of other risk factors . However , it is not clear that SDB is causal in the development of diabetes Background : The effects of continuous positive airway pressure ( CPAP ) for obstructive sleep apnoea ( OSA ) on insulin resistance are not clear . Trials have found conflicting results and no appropriate control groups have been used . Methods : Forty-two men with known type 2 diabetes and newly diagnosed OSA ( > 10 dips/h in oxygen saturation of > 4 % ) were r and omised to receive therapeutic ( n = 20 ) or placebo CPAP ( n = 22 ) for 3 months . Baseline tests were performed and repeated after 3 months . The study was double blind . Results : Results are expressed as mean ( SD ) . CPAP  improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group ( −6.6 ( 4.5 ) vs −2.6 ( 4.9 ) , p = 0.01 ) . The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group ( + 10.6 ( 13.9 ) vs −4.7 ( 11.8 ) min , p = 0.001 ) . Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups : HbA1c ( −0.02 ( 1.5 ) vs + 0.1 ( 0.7 ) , p = 0.7 , 95 % CI −0.6 % to + 0.9 % ) , euglycaemic clamp ( M/I : + 1.7 ( 14.1 ) vs −5.7 ( 14.8 ) , p = 0.2 , 95 % CI −1.8 to + 0.3 l/kg/min1000 ) , HOMA-%S ( −1.5 ( 2.3 ) vs −1.1 ( 1.8 ) , p = 0.2 , 95 % CI −0.3 % to + 0.08 % ) and adiponectin ( −1.1 ( 1.2 ) vs −1.1 ( 1.3 ) , p = 0.2 , 95 % CI −0.7 to + 0.6 & mgr;g/ml ) . Body mass index , bioimpedance and anthropometric measurements were unchanged . Hours of CPAP use per night were 3.6 ( 2.8 ) in the treatment group and 3.3 ( 3.0 ) in the placebo group ( p = 0.8 ) . There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance . Conclusion : Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA BACKGROUND Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) report improved sleepiness , cognitive function , and psychological well being after continuous positive airway pressure ( CPAP ) therapy , and it is for these daytime features that CPAP is usually given . However , few r and omised or controlled studies exist on the effects of CPAP on daytime function . METHODS A prospect i ve , r and omised , single blind , placebo controlled , crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS , all with ⩾15 apnoeas+hypopnoeas/hour and ⩾2 symptoms of SAHS . All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment , following r and omisation to treatment order . With ethics committee approval , patients were told the placebo tablet might improve upper airway function . Average effective CPAP use was monitored using hidden time clocks . Assessment s of objective and subjective sleepiness , symptoms , cognitive performance , and psychological well being were performed on the last day of each treatment and compared . RESULTS Objective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP ( mean difference from placebo + 2.4 min , 95 % CI 0.8 to 4.0 ; p<0.001 ) as did subjective sleepiness on the Epworth scale ( mean difference –6 , 95 % CI –3 to –9 ; p = 0.001 ) . Symptom total score also fell with CPAP ( mean difference –1.6 , 95 % CI –2.2 to –1.0 ; p<0.001 ) . No determinants of these changes with active treatment were identified , and no significant enhancements to cognitive function or psychosocial well being were found in this small sample . CONCLUSIONS These findings provide further evidence for clinical ly significant benefits to daytime function  from CPAP Background : Obstructive sleep apnoea syndrome ( OSAS ) has been associated with cardiovascular disease in epidemiological and observational studies . Continuous positive airway pressure ( CPAP ) is the treatment of choice for OSAS , but the impact of this intervention on systemic inflammation involved in the atherosclerotic process remains unclear . Methods : 100 men with moderate – severe OSAS were r and omised to therapeutic ( n = 51 ) or subtherapeutic ( n = 49 ) CPAP treatment for 4 weeks to investigate the effects of active treatment on inflammatory markers such as highly sensitive C reactive protein ( hsCRP ) , interleukin (IL)6 , interferon γ ( IFNγ ) and anti-inflammatory adiponectin . Results : 4 weeks of therapeutic CPAP did not significantly change blood levels of hsCRP compared with the subtherapeutic control group ( difference between median changes −0.24 mg/l ( 95 % CI −0.88 to + 0.24 ) ; p = 0.30 ) . Plasma levels of IL6 and IFNγ did not change significantly following therapeutic compared with subtherapeutic CPAP ( difference between median changes + 0.52 and −0.07 pg/ml ( 95 % CI −0.72 to + 1.94 and −0.81 to + 0.44 ) ; p = 0.45 and p = 0.82 , respectively ) . Furthermore , 4 weeks of therapeutic CPAP did not significantly change levels of adiponectin in plasma compared with the subtherapeutic control group ( difference between median changes + 0.05 pg/ml ( 95 % CI −0.36 to + 0.47 ) ; p = 0.84 ) . If patients with hsCRP values above 8 mg/l at baseline were excluded , differences between the changes in hsCRP , IL6 , IFNγ and adiponectin after 4 weeks of CPAP were smaller , and again not statistically different between groups . Conclusions : 4 weeks of CPAP treatment has no beneficial effect on blood markers of inflammation and adiponectin in patients with moderate – severe obstructive sleep apnoea 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 Background Previous , largely uncontrolled studies demonstrated the substantial effects of continuous positive airway pressure ventilation ( CPAP ) on a variety of physiologic and biochemical markers known to be risk factors for cardiovascular disease in patients with obstructive sleep apnea ( OSA ) . In this pilot crossover study , we assessed ( 1 ) the feasibility of using CPAP in a group of minimally symptomatic patients with OSA , assessed through patient compliance and ( 2 ) CPAP therapy ’s effect on biomarkers in these patients . Methods We studied patients with minimal daytime sleepiness who were referred to the University of British Columbia ’s Hospital Sleep Clinic with suspected OSA and an apnea-hypopnea index ( AHI ) > 15 events/h . Patients were r and omized to either CPAP or no therapy for 4 weeks followed by a washout of 4 weeks , and then a crossover to the other intervention . Fasting morning blood and urine , 24-h blood pressure ( BP ) measurements , and endothelial function ( peak flow-mediated dilation to nitroglycerin-mediated dilation ratio ) were assessed before and after each study intervention . Results Nine adult male and four female patients were studied . Mean ( SD ) age was 55 ( 7 ) years , mean AHI = 27.9/h , mean Epworth Sleepiness Score = 6.8 ( 11/13 had a score < 10 ) , and mean BMI = 31.1 kg/m2 .  Mean compliance with CPAP therapy was 5.53 h/night . Compared to no therapy , potential improvements were observed with CPAP for urinary micro 
    Output:
    