Rhinorrhea and watery eyes in infancy and risk of attention-deficit hyperactivity disorder in school-age children

Increased parasympathetic nervous system (PNS) activity is associated with attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms, but not hyperactive-impulsive symptoms, and may contribute to inattentive subtype etiology. Guided by prior work linking infant rhinorrhea and watery eyes without a cold (RWWC) to PNS dysregulation, we examined associations between infant RWWC and childhood ADHD symptoms in a longitudinal cohort of Black and Latinx children living in the context of economic disadvantage (N = 301 youth: 158 females, 143 males). Infant RWWC predicted higher inattentive (relative risk [RR] 2.16, p < .001) but not hyperactive-impulsive (RR 1.53, p = .065) ADHD symptoms (DuPaul scale), administered to caregivers at child age 8-14 years. Stratified analyses revealed that these associations were present in females but not males, who were three times more likely to have higher ADHD current total symptoms if they had infant RWWC than if they did not. Additionally, associations between RWWC and inattention symptoms were observed only in females. RWWC may thus serve as a novel risk marker of ADHD inattentive-type symptoms, especially for females.

Fungal diversity in homes and asthma morbidity among school-age children in New York City

BACKGROUND

Asthma development has been inversely associated with exposure to fungal diversity. However, the influence of fungi on measures of asthma morbidity is not well understood.

OBJECTIVES

This study aimed to test the hypothesis that fungal diversity is inversely associated with neighborhood asthma prevalence and identify specific fungal species associated with asthma morbidity.

METHODS

Children aged 7-8 years (n = 347) living in higher (11-18%) and lower (3-9%) asthma prevalence neighborhoods were recruited within an asthma case-control study. Fungal communities were analyzed from floor dust using high-throughput DNA sequencing. A subset of asthmatic children (n = 140) was followed to age 10-11 to determine asthma persistence.

RESULTS

Neighborhood asthma prevalence was inversely associated with fungal species richness (P = 0.010) and Shannon diversity (P = 0.059). Associations between neighborhood asthma prevalence and diversity indices were driven by differences in building type and presence of bedroom carpet. Among children with asthma at age 7-8 years, Shannon fungal diversity was inversely associated with frequent asthma symptoms at that age (OR 0.57, P = 0.025) and with asthma persistence to age 10-11 (OR 0.48, P = 0.043). Analyses of individual fungal species did not show significant associations with asthma outcomes when adjusted for false discovery rates.

DISCUSSION

Lower fungal diversity was associated with asthma symptoms in this urban setting. Individual fungal species associated with asthma morbidity were not detected. Further research is warranted into building type, carpeting, and other environmental characteristics which influence fungal exposures in homes.

Neonatal rhinorrhea, heart rate variability, and childhood exercise-induced wheeze

Background

There is increasing evidence linking infant rhinorrhea to school-age exercise-induced wheeze (EIW) via a parasympathetic nervous system pathway. The ratio of the root mean square of successive differences in heart beats (RMSSD) measured in quiet sleep versus active sleep (RMSSDQS:AS) is a novel biomarker in asthma.

Objective

We tested the hypotheses that (1) neonatal rhinorrhea predicts childhood EIW independent of other neonatal respiratory symptoms, (2) neonatal RMSSDQS:AS predicts childhood EIW, and (3) RMSSDQS:AS mediates the association between neonatal rhinorrhea and childhood EIW.

Methods

Participants from the Safe Passage/Environmental Influences on Child Health Outcomes (PASS/ECHO) prospective birth cohort had heart rate variability extracted from electrocardiogram traces acquired in the first month of life. Parents reported on rhinorrhea in their child at age 1 month and on EIW in their child at ages 4 to 11 years.

Results

In models (N = 831) adjusted for potential confounders and covariates, including neonatal wheeze, cough and fever, neonatal rhinorrhea-predicted childhood EIW (relative risk [RR] = 2.22; P = .040), specifically, among females (RR = 3.38; P = .018) but not males (RR = 1.39; P = .61). Among participants contributing data in both active and quiet sleep (n = 231), RMSSDQS:AS predicted EIW (RR = 2.36; P = .003) and mediated the effect estimate of neonatal rhinorrhea predicting EIW among females. Half of the females with a higher RMSSDQS:AS and neonatal rhinorrhea (n = 5 of 10) developed EIW as compared with 1.8% of the other females (n = 2 of 109) (P < .001).

Conclusions

Our findings support dysregulation of the parasympathetic nervous system in infancy as one of the possible underlying mechanisms for the development of EIW later in childhood among females, which could aid in the development of future interventions.

Desmopressin as a Treatment in Patients With Von Willebrand Disease: A Systematic Review

Von Willebrand disease (VWD) and hemophilia A are the most common inherited bleeding disorders. Quantitative or qualitative von Willebrand factor (VWF) anomalies cause this disorder in men and women. VWF, a plasma glycoprotein, relies on platelets for primary hemostasis. It also carries and stabilizes factor VIII in the blood. VWD has several categories. Types 1 and 3 have partial or total VWF quantitative deficiencies. However, type 2 and its subtypes have VWF quality issues. The major treatment is desmopressin (DDAVP), which replaces endogenous VWF and factor VIII (FVIII). Plasma-derived VWF/FVIII products may also be substituted exogenously. Treatment with plasma-derived or recombinant VWF concentrates without FVIII is also possible. The purpose of this retrospective, single-center research was to evaluate DDAVP's efficacy in treating VWD based on many criteria established in the current literature. We looked at the results on Google Scholar, the Cochrane Library, and PubMed/Medline. There were a total of 10 papers found, evaluated, and accepted for inclusion in this study. A comprehensive analysis of DDVAP's role in VWD was compiled from the aforementioned papers. Various aspects of DDVAP were captured by including an analysis of complementary treatments used in surgical and clinical settings. We also describe the treatment's intended impact on the different variations of the disease. Given these results, further investigation is required to determine the most effective method for managing VWD so that it may be included in standard clinical practice.

Experimental studies of the 46Mn β+-decay channel and spectroscopy of 46Cr at LISE-GANIL

In this work we present the preliminary results of analysing the 46Mn β+ decay channel as a way to study the 45V(p, γ)46Cr reaction. 46Mn was selected among other species in the cocktail beam delivered by the LISE fragment separator at GANIL (Caen, France) in order to study its beta decay and the excited states of its daughter nucleus 46Cr. As part of the validation process we present the 46Mn half-life, the proton and gamma emission peaks related to the 46Mn decay and compare them with the results from previous works.

The 12C +16 O fusion reaction in carbon burning: Study at energies of astrophysical interest using the Trojan Horse Method

The carbon-burning process in massive stars mainly occurs via the 12C +12 C. However, at temperatures higher than 109K and considering the increased abundance of 16O produced during the later stages of the heliumburning,the 12C+16O fusion can also become relevant. Moreover, 12C+16O also plays a role in the scenario of explosive carbon burning. Thus, the astrophysical energy region of interest ranges from 3 to 7.2 MeV in the center-of-mass frame. However, the various measurements of the cross-section available in the literature stop around 4 MeV, making extrapolation necessary. To solve this uncertainty and corroborate direct measurement we applied the Trojan Horse Method to three-body processes 16O(14N, α24Mg)2H and 16O(14N, p27Al)2H to study the 12C(16O, α)24Mg and 12C(16O, p)27Al reactions in their entire energy region of astrophysical interest. In this contribution, after briefly describing the method used, the experiment and the preliminary phases of the data analysis will be presented and discussed.

Spring is associated with increased total and allergenic fungal concentrations in house dust from a pediatric asthma cohort in New York City

Introduction

Asthma and allergy symptoms vary seasonally due to exposure to environmental sources of allergen, including fungi. However, we need an improved understanding of seasonal influence on fungal exposures in the indoor environment. We hypothesized that concentrations of total fungi and allergenic species in vacuumed dust vary significantly by season.

Objective

Assess seasonal variation of indoor fungi with greater implications related to seasonal asthma control.

Methods

We combined next-generation sequencing with quantitative polymerase chain reaction (qPCR) to measure concentrations of fungal DNA in indoor floor dust samples (n = 298) collected from homes participating in the New York City Neighborhood Asthma and Allergy Study (NAAS).

Results

Total fungal concentration in spring was significantly higher than the other three seasons (p ≤ 0.005). Mean concentrations for 78% of fungal species were elevated in the spring (26% were significantly highest in spring, p < 0.05). Concentrations of 8 allergenic fungal species were significantly (p < 0.5) higher in spring compared to at least two other seasons. Indoor relative humidity and temperature were significantly highest in spring (p < 0.05) and were associated with total fungal concentration (R2 = 0.049, R2 = 0.11, respectively).

Conclusion

There is significant seasonal variation in total fungal concentration and concentration of select allergenic species. Indoor relative humidity and temperature may underlie these associations.

A New PLV-Spatial Filtering to Improve the Classification Performance in BCI Systems

OBJECTIVE

The performance of an EEG-based brain-computer interface (BCI) system is highly dependent on signal preprocessing. This manuscript presents a filtering method to improve the feature classification algorithms typically used in BCI.

METHODS

A graph Laplacian quadratic form using the Phase Locking Value (PLV) is applied to generate a new filtered signal in the preprocessing stage.

RESULTS

The accuracy of the classification algorithms improved significantly (up to 27.18% in the BCI Competition IV dataset, and up to 42.56% with records made with an Emotiv EPOC+). In addition, the proposed filtering algorithm has similar or better results when compared with the Filter Bank Common Spatial Pattern (FBCSP), which has disadvantages in a multiclass classification.

CONCLUSION

This paper shows how our PLV-based filtering between EEG channels could improve the performance of a BCI.

The impact of stable 27Al in 26Al/10Be meteoric ratio in PM2.5 from an urban area

Meteoric ¹⁰Be and ²⁶Al radionuclides are produced in the atmosphere, and the relationship between them has potential applications in atmospheric and climate research. In particular, the meteoric ²⁶Al/¹⁰Be ratio has potential applications such as a chronometer for old ice, a tracer for the air exchange between the lower stratosphere and upper troposphere, production and distribution in the atmosphere of both radionuclides, and the study on solar activity. In this work, their concentrations in the fine fraction of airborne particulate matter from an urban area have been precisely determined using Accelerator Mass Spectrometry (AMS). To obtain new data about the ²⁶Al/¹⁰Be ratio and its subsequent applications, PM_2.5 in aerosol samples has been analyzed. The average ratio in samples from Mexico City was significantly higher than those previously reported by other authors. The high enrichment factors for stable Aluminum indicate that both resuspended and anthropogenic ²⁷Al content in PM_2.5 contributes significantly to the high values of ²⁶Al in the ²⁶Al/¹⁰Be ratio. An adjustment of ²⁷Al concentrations from external contributions was carried out, and the corrected ²⁶Al/¹⁰Be ratios were similar to those previously reported. In this study, a precise assessment of the possible contribution of other Aluminum sources to the aerosol samples has been carried out. Finally, the obtained ratios indicate the possibility of its future use in applications such as the dating of glaciers.

Vishniacozyma victoriae (syn. Cryptococcus victoriae) in the homes of asthmatic and non-asthmatic children in New York City

BACKGROUND

Indoor environments contain a broad diversity of non-pathogenic Basidiomycota yeasts, but their role in exacerbating adverse health effects has remained unclear.

OBJECTIVE

To understand the role of Vishniacozyma victoriae exposure and its impact on human health.

METHODS

A qPCR assay was developed to detect and quantify an abundant indoor yeast species, Vishniacozyma victoriae (syn. Cryptococcus victoriae), from homes participating in the New York City Neighborhood Asthma and Allergy Study (NAAS). We evaluated the associations between V. victoriae, housing characteristics, and asthma relevant health endpoints.

RESULTS

V. victoriae was quantified in 236 of the 256 bedroom floor dust samples ranging from less than 300-45,918 cell equivalents/mg of dust. Higher concentrations of V. victoriae were significantly associated with carpeted bedroom floors (P = 0.044), mean specific humidity (P = 0.004), winter (P < 0.0001) and spring (P = 0.001) seasons, and the presence of dog (P = 0.010) and dog allergen Can f 1 (P = 0.027). V. victoriae concentrations were lower in homes of children with asthma vs. without asthma (P = 0.027), an association observed only among the non-seroatopic children.

The AMS technique as an important tool for the measurement of astrophysical cross sections

Accelerator Mass Spectrometry is a technique commonly used to approach low concentrations of certain long half-life radioisotopes. The most important contribution of the technique is the accurate measure of organic sample ages, by separating masses 12,13 and 14 in the case of carbon allocated in such samples. However, the reach of AMS could cover many other scientific scopes, since it can give us a precise measure of a very small concentration of a radioisotope. On this direction, AMS can be used to approach reactions of interest for astrophysics, if we spot an specific radioisotope which concentration can be measure with AMS. Starting with this, we have selected specific reactions involving 14C, 10Be and 26Al, produced with slow neutrons from a reactor and positive ions at an accelerator. The main idea is to produce a particular reaction and later to measure the radioisotopic concentration using AMS. In this study our first results for 14C and 10Be nuclei produced with neutrons, and the preliminary results for 26Al nuclei produced with deuterium are shown.

Recent experimental activity on heavy-ion induced reactions within the NUMEN project

The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The strategies adopted in the experimental campaigns performed at INFN - Laboratori Nazionali del Sud are briefly described, emphasizing the advantages of the multi-channel approach to nuclear reaction data analysis.

Searching for treasures at sub-barrier energies: the case of 8B and 7Be

Unexpected and challenging experimental results, at below barrier energies for weakly bound nuclei, are briefly reviewed in this article. The emphasis will be on our recent breakup results for 8B+208Pb at deep sub-barrier energies, indicating a dominance of direct mechanisms at this low energy regime. We will also present, a preliminary analysis of the 4He and 3He - particle production events for the 7Be + 208Pb reaction. These data were collected at the same experiment and at similar deep sub-barrier energies, exhibiting large yields compatible with cluster transfer processes. To confirm these results a new experiment to be performed at TriSol is planned, as soon as the upgrading of this facility will be completed.

Elemental sulfur-based autotrophic denitrification in stoichiometric S0/N ratio: Calibration and validation of a kinetic model

The inclusion of S⁰ hydrolysis in a kinetic model of autotrophic denitrification has been recently proposed; however the model has not been calibrated or validated yet. Thus, a new methodology was developed and applied to calibrate and validate this kinetic model for the first time. An inoculum adapted from a poultry wastewater treatment plant at stoichiometric S⁰/NO₃^- ratio was used. The model was calibrated with batch data (initial nitrate concentrations of 50 and 6.25 mg NO₃^--N/L) at an S⁰/N ratio = 2.29 mg S/mg N and validated with seven different batch data. The sensitivity analysis showed that the most sensitive parameters are related to S⁰ hydrolysis. The kinetic model was successfully calibrated with the new methodology and validated, with Theil inequality coefficient values lower than 0.21. Thus, the proposed model and methodology were proved to be well suited for the simulation of elemental sulfur-based autotrophic denitrification in batch systems.

Preliminary results for the 19F(ρ,α)16O reaction cross section measured at INFN-LNS

The 19F(ρ,α)16O reaction is an important fluorine destruction chan- nel in the proton-rich outer layers of asymptotic giant branch (AGB) stars and it might also play a role in hydrogen-deficient post-AGB star nucleosynthesis. At present, theoretical models overproduce F abundances in AGB stars with re-spect to the observed values, thus calling for further investigation of the nuclear reaction rates involved in the production and destruction of fluorine. In the last years, new direct and indirect measurements improved significantly the knowl- edge of 19F(ρ,α)16O cross section at deeply sub-Coulomb energies (below 0.8 MeV). However, those data are larger by a factor of 1.4 with respect the previ- ous data reported in the NACRE compilation in the energy region 0.6-0.8 MeV. Using the Large High resolution Array of Silicons for Astrophysics (LHASA), we performed a new direct measurement of the 19F(ρ,α)16O. The goal of this experiment is to reduce the uncertainties in the nuclear reaction rate of the 19F(ρ,α)16O reaction. Here, experimental details, the calibration procedure and angular distributions are presented.

2661. Sarcopenia Increases Risk of Post-Surgical Infections in Kidney Transplant Recipients

Background

Sarcopenia (reduced skeletal muscle mass) has been associated with serious infection in liver transplant recipients. We analyzed the association of sarcopenia and early post-surgical infections in kidney transplant recipients.

Methods

Retrospective cohort study of 125 patients underwent kidney transplantation from 2010 to 2014 at University of Kentucky Medical Center. Sarcopenia was diagnosed by measuring the skeletal muscle mass on computed tomography imaging obtained during the pre-transplant evaluation using SliceOmatic 5.0 software at L3 level (≤ 52.4 cm2/m2 in males and ≤ 38.5 cm2/m2 in females). Early post-transplant infections were confirmed by positive culture from blood, urine, and/or peritoneal fluid within 30 days after kidney transplantation. A generalized linear model (GLM) was used to identify variables predictive of post- surgical infection and Risk Ratio (RR) was obtained, with a P-value of < 0.05. The statistical analysis was performed with STATA version 12.0 (College Station, Texas).

Results

Among 125 patients, 52 (41.6%) were identified with sarcopenia, 110 (88.0%) patients were white, 76 (60.8%) male, with a median age of 56 (range 20–72) at the time of transplant. Diabetes was reported in 50 (40.0%) patients, obesity in 64 (51.6%) patients and smoking in 43 (34.6%) patients. Six (4.8%) patients had graft failure. Infections were identified in 22 (17.6%) patients, more than one source of infection was reported in 4 (3.2%) cases. The most common infections were urinary tract infection in 13 (10.4%) patients and bacteremia in 5 (4.0%) patients. The median time to development of infection was 9 days (range 1–27). In the bivariate analysis, sarcopenia was associated with high risk of post-surgical infections (RR 2.45; 95% CI 1.10–5.44). In multivariable analysis, sarcopenia was a significant independent predictor of infection (RR 2.58; 95% CI 1.20–5.52). None associations were found with other variables; age over 40 years, male sex, smoking, obesity and diabetes.

Conclusion

Our study suggested that sarcopenia was associated with an increased risk of early post-surgical infection in kidney transplant recipients.

Disclosures

All authors: No reported disclosures.

Towards the Limits of Existence of Nuclear Structure: Observation and First Spectroscopy of the Isotope ^{31}K by Measuring Its Three-Proton Decay

The most remote isotope from the proton dripline (by 4 atomic mass units) has been observed: ^{31}K. It is unbound with respect to three-proton (3p) emission, and its decays have been detected in flight by measuring the trajectories of all decay products using microstrip detectors. The 3p emission processes have been studied by the means of angular correlations of ^{28}S+3p and the respective decay vertices. The energies of the previously unknown ground and excited states of ^{31}K have been determined. This provides its 3p separation energy value S_{3p} of -4.6(2)  MeV. Upper half-life limits of 10 ps of the observed ^{31}K states have been derived from distributions of the measured decay vertices.

Recent results on heavy-ion induced reactions of interest for neutrinoless double beta decay at INFN-LNS

The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The methodology of the experimental campaign presently running at INFN - Laboratori Nazionali del Sud is reported andthe experimental challenges characterizing such activity are described.

Study of continuum excitation by light weakly bound projectiles on proton target

Elastic scattering and breakup angular distribution measurements for the systems 6,7Li + p were performed at the MAGNEX facility of the Istituto Nazionale di Fisica Nucleare-Laboratori Nazionali del Sud (INFN-LNS) in Catania, in the energy range of (2.3–5.4)AMeV. The breakup channel was identified and quantified adopting the algorithm MULTIP.Within this algorithm which is a Monte Carlo simulation code, the history of the breakup fragments can be tagged from the rest frame of the decay nucleus itself to the laboratory frame. Angular distribution data of both elastic scattering and breakup were analyzed under the same theoretical model and the influence of continuum on the elastic channel was investigated.

The nuclear matrix elements of 0νββ decay and the NUMEN project at INFN-LNS

The goal of NUMEN project is to access experimentally driven information on Nuclear Matrix Elements (NME) involved in the neutrinoless double beta decay (0νββ), by high-accuracy measurements of the cross sections of Heavy Ion (HI) induced Double Charge Exchange (DCE) reactions. The knowledge of the nuclear matrix elements is crucial to infer the neutrino average masses from the possible measurement of the half-life of 00νββ decay and to compare experiments on different isotopes. In particular, the (18O, 18Ne) and (20Ne, 20O) reactions are performed as tools for β+β+ and β-β- decays, respectively. The experiments are performed at INFN - Laboratory Nazionali del Sud (LNS) in Catania using the Superconducting Cyclotron (CS) to accelerate the beams and the MAGNEX magnetic spectrometer to detect the reaction products. The measured cross sections are very low, limiting the present exploration to few selected isotopes of interest in the context of typically low-yield experimental runs. In order to make feasible a systematic study of all the candidate nuclei, a major upgrade of the LNS facility is foreseen to increase the experimental yield of about two orders of magnitude. To this purpose, frontier technologies are going to be developed for both the accelerator and the detection systems. In parallel, advanced theoretical models will be developed to extract the nuclear structure information from the measured cross sections.

High-resolution hydrometeorological data from a network of headwater catchments in the tropical Andes

This article presents a hydrometeorological dataset from a network of paired instrumented catchments, obtained by participatory monitoring through a partnership of academic and non-governmental institutions. The network consists of 28 headwater catchments (<20 km²) covering three major biomes in 9 locations of the tropical Andes. The data consist of precipitation event records at 0.254 mm resolution or finer, water level and streamflow time series at 5 min intervals, data aggregations at hourly and daily scale, a set of hydrological indices derived from the daily time series, and catchment physiographic descriptors. The catchment network is designed to characterise the impacts of land-use and watershed interventions on the catchment hydrological response, with each catchment representing a typical land use and land cover practice within its location. As such, it aims to support evidence-based decision making on land management, in particular evaluating the effectiveness of catchment interventions, for which hydrometeorological data scarcity is a major bottleneck. The data will also be useful for broader research on Andean ecosystems, and their hydrology and meteorology.

The α-decay of the Hoyle state in 12C: a new high-precision investigation

The αdecay path of the Hoyle state in 12C (Ex = 7:654MeV) represents one ofthe most challenging questions of modern nuclear physics. Its knowledge can help in theunderstanding of cluster configurations in light nuclei and the possible existence of Bose-Einstein condensates in nuclei. In stars, it is involved in the so-called 3αprocess, wherethe 12C nucleosynthesis occurs. We studied the 14N(d; α2)12C(7:654) reaction at 10:5MeVincident energy to probe its direct decay component. We found, with a precision higherof a factor 5 than any other previous experiment, an almost total absence of direct decaysby-passing the ground state of 8Be. From our analysis, a new upper limit of such decayis found at 0:043% (95% C.L.). Astrophysical 3α process reaction rate calculations haveto be accordingly revised.

7Be and 8B reaction dynamics at Coulomb barrier energies

We investigated the reaction dynamics induced by the 7Be,8B+208Pb collisions at energies around the Coulomb barrier. Charged particles originated by both the col- lisions were detected by means of 6 ΔE-Eres telescopes of a newly developed detector array. Experimental data were analysed within the framework of the Optical Model and the total reaction cross-sections were compared together and with the 6,7Li+208Pb colli-sion data. According to the preliminary results, 7Be nucleus reactivity is rather similar to the 7Li one whereas the 8B+208Pb total reaction cross section appears to be much larger than those measured for reactions induced by the other weakly-bound projectiles on the same target.

Isospin effects on reaction dynamics at Fermi energies

The study of nuclei properties and of collision dynamics is a very active research field whose result have implications in different domains as for example astrophysics. The present and future facilities delivering radioactive ion beams with high intensity allow to extend these studies in the region far from the stability valley. New insight has thus been found on the effects of neutron richness on reaction mechanisms as well as on nuclear structure and nuclear matter properties, as for instance, the role of symmetry energy term of the nuclear Equation of State. The presence of diverse reaction products demands for highly performing and very specialized devices, also able to disentangle among different mechanisms, from fast dynamical processes to statistical emission from equilibrated sources. Numerous studies of the effects of N/Z ratio on fusion and associated processes can be found at different energies, together with many examples of the influence of neutron richness on the reaction time scale and the competition between equilibrated and prompt processes. A survey of very recent findings obtained with the CHIMERA and FARCOS devices is presented.

Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses' overall results showed a significant improvement in the post-treatment apnea-hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.