{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:15:37Z","timestamp":1782908137956,"version":"3.54.5"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T00:00:00Z","timestamp":1699056000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T00:00:00Z","timestamp":1699056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007642","name":"Universit\u00e0 degli Studi di Roma Tor Vergata","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007642","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sleep Breath"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>This study aimed to evaluate the functionality of the brainstem structures through the blink reflex (BR) test in patients with obstructive sleep apnoea (OSA) and to assess the effects of continuous positive airway pressure (CPAP) treatment on BR responses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients with moderate-severe OSA and controls underwent BR testing. Patients with OSA who were adherent to CPAP therapy repeated BR testing at 6\u00a0months\u00a0follow-up. CPAP adherence was defined as CPAP use for\u2009\u2265\u20094\u00a0hour per night on\u2009&gt;\u20095 nights per week with residual apnoea-hypopnea index less than 5 events per hour.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 22 patients with OSA (86% male, mean age 57.8\u2009\u00b1\u200910.6\u00a0years) and 20 controls (60% male, mean age 55.3\u2009\u00b1\u20099.3\u00a0years) were included. Patients with OSA showed longer right and left R1 latency, as well as delayed right ipsilateral and contralateral R2 latencies compared to controls. Patients with OSA who were compliant with CPAP treatment (<jats:italic>n<\/jats:italic>\u2009=\u200916; 88% men, mean age 58.8\u2009\u00b1\u20099.7\u00a0years) showed a significant decrease in latency of the right ipsilateral and contralateral R2 responses at 6\u00a0months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study showed an abnormal pattern of BR responses in patients with OSA, consistent with a significant impairment of brainstem functionality in OSA. CPAP treatment partially improved the BR responses, suggesting the importance of treating OSA.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11325-023-02944-8","type":"journal-article","created":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T04:44:16Z","timestamp":1699073056000},"page":"691-696","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Brainstem impairment in obstructive sleep apnoea and the effect of CPAP treatment: an electrophysiological blink reflex study"],"prefix":"10.1007","volume":"28","author":[{"given":"Claudio","family":"Liguori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Spanetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Zanovello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Pia","family":"Giambrone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clementina","family":"Lupo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Placidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Izzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola Biagio","family":"Mercuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Pierantozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,4]]},"reference":[{"key":"2944_CR1","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","volume":"7","author":"AV Benjafield","year":"2019","unstructured":"Benjafield AV, Ayas NT, Eastwood PR et al (2019) Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 7:687\u2013698. https:\/\/doi.org\/10.1016\/S2213-2600(19)30198-5","journal-title":"Lancet Respir Med"},{"key":"2944_CR2","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","volume":"3","author":"R Heinzer","year":"2015","unstructured":"Heinzer R, Vat S, Marques-Vidal P et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310\u2013318. https:\/\/doi.org\/10.1016\/S2213-2600(15)00043-0","journal-title":"Lancet Respir Med"},{"key":"2944_CR3","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1002\/jnr.23634","volume":"93","author":"MA Daulatzai","year":"2015","unstructured":"Daulatzai MA (2015) Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res 93:1778\u20131794. https:\/\/doi.org\/10.1002\/jnr.23634","journal-title":"J Neurosci Res"},{"key":"2944_CR4","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1016\/j.neurobiolaging.2013.12.030","volume":"35","author":"RS Osorio","year":"2014","unstructured":"Osorio RS, Ayappa I, Mantua J et al (2014) The interaction between sleep-disordered breathing and apolipoprotein E genotype on cerebrospinal fluid biomarkers for Alzheimer\u2019s disease in cognitively normal elderly individuals. Neurobiol Aging 35:1318\u20131324. https:\/\/doi.org\/10.1016\/j.neurobiolaging.2013.12.030","journal-title":"Neurobiol Aging"},{"key":"2944_CR5","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.sleep.2019.01.003","volume":"56","author":"C Liguori","year":"2019","unstructured":"Liguori C, Mercuri NB, Nuccetelli M et al (2019) Obstructive sleep apnea may induce orexinergic system and cerebral \u03b2-amyloid metabolism dysregulation: is it a further proof for Alzheimer\u2019s disease risk? Sleep Med 56:171\u2013176. https:\/\/doi.org\/10.1016\/j.sleep.2019.01.003","journal-title":"Sleep Med"},{"key":"2944_CR6","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1378\/chest.127.5.1674","volume":"127","author":"M Yamauchi","year":"2005","unstructured":"Yamauchi M, Nakano H, Maekawa J et al (2005) Oxidative stress in obstructive sleep apnea. Chest 127:1674\u20131679. https:\/\/doi.org\/10.1378\/chest.127.5.1674","journal-title":"Chest"},{"key":"2944_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2019.101250","volume":"50","author":"OM Bubu","year":"2020","unstructured":"Bubu OM, Andrade AG, Umasabor-Bubu OQ et al (2020) Obstructive sleep apnea, cognition and Alzheimer\u2019s disease: a systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 50:101250. https:\/\/doi.org\/10.1016\/j.smrv.2019.101250","journal-title":"Sleep Med Rev"},{"key":"2944_CR8","doi-asserted-by":"publisher","first-page":"5356","DOI":"10.1007\/s00415-022-11182-z","volume":"269","author":"M Fernandes","year":"2022","unstructured":"Fernandes M, Mari L, Chiaravalloti A et al (2022) 18F-FDG PET, cognitive functioning, and CSF biomarkers in patients with obstructive sleep apnoea before and after continuous positive airway pressure treatment. J Neurol 269:5356\u20135367. https:\/\/doi.org\/10.1007\/s00415-022-11182-z","journal-title":"J Neurol"},{"key":"2944_CR9","doi-asserted-by":"publisher","unstructured":"Tav\u015fanl\u0131 ME, K\u0131nay D (2022) Effect of sleep on epileptic discharges in patients with idiopathic generalized epilepsy. Clin EEG Neurosci 15500594221083256. https:\/\/doi.org\/10.1177\/15500594221083256","DOI":"10.1177\/15500594221083256"},{"key":"2944_CR10","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/BF02444011","volume":"243","author":"PP Urban","year":"1996","unstructured":"Urban PP, Schlegel J, Ellrich J et al (1996) Electrophysiological brainstem investigations in obstructive sleep apnoea syndrome. J Neurol 243:171\u2013174. https:\/\/doi.org\/10.1007\/BF02444011","journal-title":"J Neurol"},{"key":"2944_CR11","first-page":"2012","volume":"176","author":"RB Berry","year":"2012","unstructured":"Berry RB, Brooks R, Gamaldo CE et al (2012) The AASM manual for the scoring of sleep and associated events. Rules Terminol Tech Specif Darien Illinois Am Acad Sleep Med 176:2012","journal-title":"Rules Terminol Tech Specif Darien Illinois Am Acad Sleep Med"},{"key":"2944_CR12","unstructured":"American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien, IL"},{"key":"2944_CR13","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1164\/ajrccm.149.1.8111574","volume":"149","author":"MK Reeves-Hoche","year":"1994","unstructured":"Reeves-Hoche MK, Meck R, Zwillich CW (1994) Nasal CPAP: an objective evaluation of patient compliance. Am J Respir Crit Care Med 149:149\u2013154. https:\/\/doi.org\/10.1164\/ajrccm.149.1.8111574","journal-title":"Am J Respir Crit Care Med"},{"key":"2944_CR14","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/S1389-9457(00)00011-3","volume":"1","author":"JM Parish","year":"2000","unstructured":"Parish JM, Lyng PJ, Wisbey J (2000) Compliance with CPAP in elderly patients with OSA. Sleep Med 1:209\u2013214. https:\/\/doi.org\/10.1016\/S1389-9457(00)00011-3","journal-title":"Sleep Med"},{"key":"2944_CR15","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1097\/01.JGP.0000192484.12684.cd","volume":"14","author":"L Ayalon","year":"2006","unstructured":"Ayalon L, Ancoli-Israel S, Stepnowsky C et al (2006) Adherence to continuous positive airway pressure treatment in patients with Alzheimer disease and obstructive sleep apnea. Am J Geriatr Psychiatry 14:176\u2013180. https:\/\/doi.org\/10.1097\/01.JGP.0000192484.12684.cd","journal-title":"Am J Geriatr Psychiatry"},{"key":"2944_CR16","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","volume":"14","author":"MW Johns","year":"1991","unstructured":"Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540\u2013545. https:\/\/doi.org\/10.1093\/sleep\/14.6.540","journal-title":"Sleep"},{"key":"2944_CR17","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s100720300004","volume":"23","author":"L Vignatelli","year":"2003","unstructured":"Vignatelli L, Plazzi G, Barbato A et al (2003) Italian version of the Epworth sleepiness scale: external validity. Neurol Sci 23:295\u2013300. https:\/\/doi.org\/10.1007\/s100720300004","journal-title":"Neurol Sci"},{"key":"2944_CR18","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1093\/brain\/awh366","volume":"128","author":"G Cruccu","year":"2005","unstructured":"Cruccu G, Iannetti GD, Marx JJ et al (2005) Brainstem reflex circuits revisited. Brain 128:386\u2013394","journal-title":"Brain"},{"key":"2944_CR19","unstructured":"Preston DC, Shapiro BE (2020) Electromyography and neuromuscular disorders e-book: clinical-electrophysiologic-ultrasound correlations. Elsevier Health Sciences, Philadelphia, PA"},{"key":"2944_CR20","unstructured":"IBM (2020) SPSS - Statistical package for social sciences [computer software]. IBM Corp"},{"key":"2944_CR21","doi-asserted-by":"publisher","first-page":"723","DOI":"10.5665\/sleep.3578","volume":"37","author":"R Kumar","year":"2014","unstructured":"Kumar R, Pham TT, Macey PM et al (2014) Abnormal myelin and axonal integrity in recently diagnosed patients with obstructive sleep apnea. Sleep 37:723\u2013732","journal-title":"Sleep"},{"key":"2944_CR22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070481","volume":"8","author":"SM Abbott","year":"2013","unstructured":"Abbott SM, Arnold JM, Chang Q et al (2013) Signals from the brainstem sleep\/wake centers regulate behavioral timing via the circadian clock. PLoS ONE 8:e70481","journal-title":"PLoS ONE"},{"key":"2944_CR23","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/mds.21236","volume":"22","author":"EE Benarroch","year":"2007","unstructured":"Benarroch EE (2007) Brainstem respiratory control: substrates of respiratory failure of multiple system atrophy. Mov Disord Off J Mov Disord Soc 22:155\u2013161","journal-title":"Mov Disord Off J Mov Disord Soc"},{"key":"2944_CR24","doi-asserted-by":"publisher","first-page":"10080","DOI":"10.1523\/JNEUROSCI.0598-18.2018","volume":"38","author":"Y Takata","year":"2018","unstructured":"Takata Y, Oishi Y, Zhou X-Z et al (2018) Sleep and wakefulness are controlled by ventral medial midbrain\/pons GABAergic neurons in mice. J Neurosci 38:10080\u201310092","journal-title":"J Neurosci"},{"key":"2944_CR25","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/0006-8993(91)91029-Z","volume":"541","author":"C Jiang","year":"1991","unstructured":"Jiang C, Shen E (1991) Respiratory neurons in the medulla of the rabbit: distribution, discharge patterns and spinal projections. Brain Res 541:284\u2013292","journal-title":"Brain Res"},{"key":"2944_CR26","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.clinph.2011.07.004","volume":"123","author":"A Vakulin","year":"2012","unstructured":"Vakulin A, Catcheside PG, Baulk SD et al (2012) Auditory evoked potentials remain abnormal after CPAP treatment in patients with severe obstructive sleep apnoea. Clin Neurophysiol Off J Int Fed Clin Neurophysiol 123:310\u2013317. https:\/\/doi.org\/10.1016\/j.clinph.2011.07.004","journal-title":"Clin Neurophysiol Off J Int Fed Clin Neurophysiol"},{"key":"2944_CR27","doi-asserted-by":"publisher","first-page":"953","DOI":"10.5664\/jcsm.7158","volume":"14","author":"C Liguori","year":"2018","unstructured":"Liguori C, Placidi F, Palmieri MG et al (2018) Continuous positive airway pressure treatment may improve optic nerve function in obstructive sleep apnea: an electrophysiological study. J Clin Sleep Med 14:953\u2013958. https:\/\/doi.org\/10.5664\/jcsm.7158","journal-title":"J Clin Sleep Med"},{"key":"2944_CR28","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/S0022-510X(98)00131-2","volume":"159","author":"S Kotterba","year":"1998","unstructured":"Kotterba S, Rasche K, Widdig W et al (1998) Neuropsychological investigations and event-related potentials in obstructive sleep apnea syndrome before and during CPAP-therapy. J Neurol Sci 159:45\u201350. https:\/\/doi.org\/10.1016\/S0022-510X(98)00131-2","journal-title":"J Neurol Sci"},{"key":"2944_CR29","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/0168-5597(91)90094-E","volume":"80","author":"L Rumbach","year":"1991","unstructured":"Rumbach L, Krieger J, Kurtz D (1991) Auditory event-related potentials in obstructive sleep apnea: effects of treatment with nasal continuous positive airway pressure. Electroencephalogr Clin Neurophysiol Potentials Sect 80:454\u2013457. https:\/\/doi.org\/10.1016\/0168-5597(91)90094-E","journal-title":"Electroencephalogr Clin Neurophysiol Potentials Sect"},{"key":"2944_CR30","doi-asserted-by":"publisher","first-page":"18","DOI":"10.4103\/NSN.NSN_18_20","volume":"37","author":"ME Tavsanli","year":"2020","unstructured":"Tavsanli ME, Senel GB, Gunduz A et al (2020) Impact of intermittent hypoxia on peripheral nervous systems in obstructive sleep apnea syndrome. Neurol Sci Neurophysiol 37:18\u201323. https:\/\/doi.org\/10.4103\/NSN.NSN_18_20","journal-title":"Neurol Sci Neurophysiol"},{"key":"2944_CR31","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1515\/revneuro-2012-0027","volume":"23","author":"A Raggi","year":"2012","unstructured":"Raggi A, Ferri R (2012) Cognitive evoked potentials in obstructive sleep apnea syndrome: a review of the literature. Rev Neurosci 23:311\u2013323","journal-title":"Rev Neurosci"},{"key":"2944_CR32","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/jsr.12368","volume":"25","author":"M Mihalj","year":"2016","unstructured":"Mihalj M, Lu\u0161i\u0107 L, \u0110oga\u0161 Z (2016) Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients. J Sleep Res 25:287\u2013295. https:\/\/doi.org\/10.1111\/jsr.12368","journal-title":"J Sleep Res"},{"key":"2944_CR33","doi-asserted-by":"publisher","unstructured":"Martins CH, de Castro N, Costa Filho OA, de Souza Neto OM (2011) Obstructive sleep apnea and P300 evoked auditory potential. Brazilian J Otorhinolaryngol (English Ed) 77:700\u2013705. https:\/\/doi.org\/10.1590\/S1808-86942011000600004","DOI":"10.1590\/S1808-86942011000600004"},{"key":"2944_CR34","doi-asserted-by":"publisher","first-page":"19","DOI":"10.5665\/sleep.5308","volume":"39","author":"C Liguori","year":"2016","unstructured":"Liguori C, Palmieri MG, Pierantozzi M et al (2016) Optic Nerve dysfunction in obstructive sleep apnea: an electrophysiological study. Sleep 39:19\u201323. https:\/\/doi.org\/10.5665\/sleep.5308","journal-title":"Sleep"},{"key":"2944_CR35","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s11325-021-02406-z","volume":"26","author":"RM Pedre\u00f1o","year":"2022","unstructured":"Pedre\u00f1o RM, Matsumura E, Silva LAF et al (2022) Influence of obstructive sleep apnea on auditory event-related potentials. Sleep Breath 26:315\u2013323. https:\/\/doi.org\/10.1007\/s11325-021-02406-z","journal-title":"Sleep Breath"},{"key":"2944_CR36","first-page":"924","volume":"50","author":"S Kotterba","year":"1996","unstructured":"Kotterba S, Rasche K (1996) Acoustic evoked potentials (AEP) in obstructive sleep apnea syndrome. Pneumologie 50:924\u2013926","journal-title":"Pneumologie"},{"key":"2944_CR37","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1007\/s11325-016-1346-8","volume":"20","author":"W Wang","year":"2016","unstructured":"Wang W, Su J, Kong D et al (2016) Gender, nocturnal hypoxia, and arousal influence brainstem auditory evoked potentials in patients with obstructive sleep apnea. Sleep Breath 20:1239\u20131244. https:\/\/doi.org\/10.1007\/s11325-016-1346-8","journal-title":"Sleep Breath"},{"key":"2944_CR38","doi-asserted-by":"publisher","first-page":"263","DOI":"10.5664\/jcsm.27497","volume":"5","author":"LJ Epstein","year":"2009","unstructured":"Epstein LJ, Kristo D, Strollo PJ Jr et al (2009) Adult obstructive sleep apnea task force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263\u2013276","journal-title":"J Clin Sleep Med"},{"key":"2944_CR39","unstructured":"Stasche N (2006) Selective indication for positive airway pressure (PAP) in sleep-related breathing disorders with obstruction. GMS Curr Top Otorhinolaryngol Head Neck Surg 5:Doc06"}],"container-title":["Sleep and Breathing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-023-02944-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11325-023-02944-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11325-023-02944-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T16:31:08Z","timestamp":1717000268000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11325-023-02944-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,4]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["2944"],"URL":"https:\/\/doi.org\/10.1007\/s11325-023-02944-8","relation":{},"ISSN":["1520-9512","1522-1709"],"issn-type":[{"value":"1520-9512","type":"print"},{"value":"1522-1709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,4]]},"assertion":[{"value":"9 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the Independent Ethical Committee of the University Hospital of Rome \u201cTor Vergata,\u201d and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}