{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T04:29:07Z","timestamp":1793852947731,"version":"4.6.1"},"reference-count":72,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T00:00:00Z","timestamp":1669248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Almost one billion people worldwide are affected by Obstructive Sleep Apnea (OSA). Affected individuals experience disordered breathing patterns during sleep, which results in fatigue, daytime drowsiness, and\/or sleep deprivation. Working under the influence of these symptoms significantly impairs work productivity and leads to occupational accidents and errors. This impact is seen in healthcare workers (HCWs) who are not immune to these conditions. However, poorly controlled OSA in this subset of individuals takes a heavy toll on patient care due to the increased risk of medical errors and can also alter the mental and physical well-being of the affected HCW in various ways. OSA and safety issues have been recognized and mitigated among the airline and transport industries; however, the healthcare industry lags in addressing these concerns. This article reviews hypersomnolence and sleep disorder as key clinical features of OSA and their effect on HCW safety.<\/jats:p>","DOI":"10.3390\/medicina58121723","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T02:29:23Z","timestamp":1669343363000},"page":"1723","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Sleep and Safety among Healthcare Workers: The Effect of Obstructive Sleep Apnea and Sleep Deprivation on Safety"],"prefix":"10.3390","volume":"58","author":[{"given":"Likhita","family":"Shaik","sequence":"first","affiliation":[{"name":"Hennepin Healthcare, Minneapolis, MN 55415, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3324-404X","authenticated-orcid":false,"given":"Mustafa S.","family":"Cheema","sequence":"additional","affiliation":[{"name":"G9QC+GGM CMH Lahore Medical College, Abdul Rehman Rd, Sarwar Colony, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Sutter Gould Medical Foundation, Tracy, CA 95376, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Kashyap","sequence":"additional","affiliation":[{"name":"Well Span Health, York, PA 17403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7105-4266","authenticated-orcid":false,"given":"Salim R.","family":"Surani","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1513\/pats.200709-155MG","article-title":"The epidemiology of adult OSA","volume":"5","author":"Punjabi","year":"2008","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1164\/rccm.202107-1761OC","article-title":"Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea","volume":"205","author":"Lechat","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000988","article-title":"Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association","volume":"144","author":"Yeghiazarians","year":"2021","journal-title":"Circulation"},{"key":"ref_4","first-page":"7","article-title":"Effects of Health Care Provider Work Hours and SD on Safety and Performance","volume":"33","author":"Lockley","year":"2007","journal-title":"Jt. Comm. J. Qual. Patient Saf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.smrv.2018.12.005","article-title":"Contribution of SD to suicidal behaviour: A systematic review","volume":"44","author":"Courtet","year":"2019","journal-title":"Sleep Med. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s11892-014-0507-z","article-title":"Metabolic consequences of sleep and circadian disorders","volume":"14","author":"Depner","year":"2014","journal-title":"Curr. Diab. Rep."},{"key":"ref_7","first-page":"e4843","article-title":"Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review","volume":"11","author":"Mak","year":"2019","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.5664\/jcsm.5078","article-title":"Physical Inactivity is Associated with Moderate-Severe Obstructive Sleep Apnea","volume":"11","author":"Simpson","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mayne, R.S., Hart, N.D., and Heron, N. (2021). Sedentary behaviour among general practitioners: A systematic review. BMC Fam. Pract., 22.","DOI":"10.1186\/s12875-020-01359-8"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"12631","DOI":"10.1038\/s41598-021-91996-5","article-title":"Stress in obstructive sleep apnea","volume":"11","author":"Wong","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s40279-013-0090-5","article-title":"The effects of stress on physical activity and exercise","volume":"44","author":"Sinha","year":"2014","journal-title":"Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12960-020-00544-1","article-title":"The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: A systematic review and meta-regression","volume":"18","author":"Salari","year":"2020","journal-title":"Hum. Resour. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100017","DOI":"10.1016\/j.sleepx.2020.100017","article-title":"Insomnia and stress of physicians during COVID-19 outbreak","volume":"2","author":"Abdulah","year":"2020","journal-title":"Sleep Med. X"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"197","DOI":"10.4103\/jnsm.jnsm_177_20","article-title":"Stress, sleep, and use of sleep aids among physicians during the COVID-19 pandemic","volume":"4","author":"AlAteeq","year":"2021","journal-title":"J. Nat. Sci. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.sleh.2015.10.004","article-title":"National Sleep Foundation\u2019s updated sleep duration recommendations: Final report","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref_16","unstructured":"National Center for Chronic Disease Prevention (2017). Health Promotion DoPH. CDC-Data and Statistics-Sleep and Sleep Disorders."},{"key":"ref_17","first-page":"1242","article-title":"The effect of SD on activity of the genioglossus muscle","volume":"132","author":"Leiter","year":"1985","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1093\/sleep\/26.8.1038","article-title":"Does SD worsen mild OSA?","volume":"26","author":"Desai","year":"2003","journal-title":"Sleep"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1378\/chest.109.3.645","article-title":"Comparison between diurnal and nocturnal polysomnography","volume":"109","author":"Persson","year":"1996","journal-title":"Chest"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jsmc.2013.04.004","article-title":"Insomnia and Obstructive Sleep Apnea","volume":"8","author":"Ong","year":"2013","journal-title":"Sleep Med. Clin."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4103\/1817-1737.105715","article-title":"Effect of on-call-related sleep deprivation on physicians\u2019 mood and alertness","volume":"8","author":"Wali","year":"2013","journal-title":"Ann. Thorac. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e2028111","DOI":"10.1001\/jamanetworkopen.2020.28111","article-title":"Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors","volume":"3","author":"Trockel","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_23","first-page":"97","article-title":"The association of sleep deprivation on the occurrence of errors by nurses who work the night shift","volume":"40","author":"Ramadan","year":"2014","journal-title":"Curr. Health Sci. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1093\/sleep\/28.11.1392","article-title":"Sleep loss and performance in residents and nonphysicians: A meta-analytic examination","volume":"28","author":"Philibert","year":"2005","journal-title":"Sleep"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/00001888-200405000-00007","article-title":"The effects of sleep loss and fatigue on resident-physicians: A multi-institutional, mixed-method study","volume":"79","author":"Papp","year":"2004","journal-title":"Acad. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1056\/NEJM197107222850405","article-title":"The intern and sleep loss","volume":"285","author":"Friedman","year":"1971","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/0022-4804(72)90125-4","article-title":"Stresses affecting surgical performance and learning. I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes","volume":"12","author":"Goldman","year":"1972","journal-title":"J. Surg. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.ejpsy.2021.03.005","article-title":"Psychological impact of the covid-19 pandemic and burnout severity in French residents: A national study","volume":"35","author":"Mion","year":"2021","journal-title":"Eur. J. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1056\/NEJMoa041406","article-title":"Effect of Reducing Interns\u2019 Work Hours on Serious Medical Errors in Intensive Care Units","volume":"351","author":"Landrigan","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1093\/sleep\/28.1.47","article-title":"The effects of sleep loss on medical residents\u2019 emotional reactions to work events: A cognitive-energy model","volume":"28","author":"Zohar","year":"2005","journal-title":"Sleep"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S0140-6736(98)00034-8","article-title":"Effect of sleep deprivation on surgeons\u2019 dexterity on laparoscopy simulator","volume":"352","author":"Taffinder","year":"1998","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3109\/10903120903524971","article-title":"Sleep quality and fatigue among prehospital providers","volume":"14","author":"Patterson","year":"2010","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_33","unstructured":"(2022, September 01). Lack of Sleep Symptoms in Healthcare Workers Leads to Safety Dangers. Available online: https:\/\/www.homeceuconnection.com\/blog\/lack-of-sleep-symptoms-in-healthcare-workers-safety\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2298\/MPNS1606183S","article-title":"Health effects of sleep deprivation on nurses working shifts","volume":"69","author":"Stanojevic","year":"2016","journal-title":"Med. Pregl."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1080\/08998280.2005.11928045","article-title":"Sleep deprivation and physician performance: Why should I care?","volume":"18","author":"Howard","year":"2005","journal-title":"Proc. Bayl. Univ. Med. Cent."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1007\/s00420-021-01675-1","article-title":"The association between shift work and possible obstructive sleep apnea: A systematic review and meta-analysis","volume":"94","author":"Yang","year":"2021","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e12722","DOI":"10.1111\/jsr.12722","article-title":"Sleep disorders, depression and anxiety are associated with adverse safety outcomes in healthcare workers: A prospective cohort study","volume":"27","author":"Weaver","year":"2018","journal-title":"J. Sleep Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e027362","DOI":"10.1136\/bmjopen-2018-027362","article-title":"Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study","volume":"9","author":"Medisauskaite","year":"2019","journal-title":"BMJ Open"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Schmidt, R.E., Cullati, S., Mostofsky, E., Haller, G., Agoritsas, T., Mittleman, M.A., Perneger, T.V., and Courvoisier, D.S. (2015). Healthcare-Related Regret among Nurses and Physicians is Associated with Self-Rated Insomnia Severity: A Cross-Sectional Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139770"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1093\/sleep\/27.2.217","article-title":"Sleep deprivation and fatigue in residency training: Results of a national survey of first- and second-year residents","volume":"27","author":"Baldwin","year":"2004","journal-title":"Sleep"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.sleep.2014.05.015","article-title":"Job stress, burnout, and job satisfaction in sleep apnea patients","volume":"15","author":"Guglielmi","year":"2014","journal-title":"Sleep Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jhin.2018.04.026","article-title":"Do safety engineered devices reduce needlestick injuries?","volume":"100","author":"Schuurmans","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Dulon, M., Stranzinger, J., Wendeler, D., and Nienhaus, A. (2020). Causes of Needlestick and Sharps Injuries When Using Devices with and without Safety Features. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238721"},{"key":"ref_44","unstructured":"(2022, September 01). Sleep Deprived Doctors Concerned about Patient Safety\u2014The MDU. Available online: wwwthemducom."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1001\/jama.2018.12777","article-title":"Prevalence of Burnout Among Physicians: A Systematic Review","volume":"320","author":"Rotenstein","year":"2018","journal-title":"JAMA"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.chest.2019.07.008","article-title":"The Impact of Sleep and Circadian Disorders on Physician Burnout","volume":"156","author":"Stewart","year":"2019","journal-title":"Chest"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Patel, R.S., Bachu, R., Adikey, A., Malik, M., and Shah, M. (2018). Factors Related to Physician Burnout and Its Consequences: A Review. Behav. Sci., 8.","DOI":"10.3390\/bs8110098"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.smrv.2013.01.004","article-title":"Sleep problems and work injuries: A systematic review and meta-analysis","volume":"18","author":"Uehli","year":"2014","journal-title":"Sleep Med. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.5665\/sleep.5834","article-title":"Risk of Occupational Accidents in Workers with OSA: Systematic Review and Meta-analysis","volume":"39","author":"Garbarino","year":"2016","journal-title":"Sleep"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s11325-016-1380-6","article-title":"Uncovering the sleep disorders among young doctors","volume":"20","author":"Yasin","year":"2016","journal-title":"Sleep Breath"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1136\/bmj.323.7323.1222","article-title":"Laparoscopic performance after one night on call in a surgical department: Prospective study","volume":"323","author":"Grantcharov","year":"2001","journal-title":"Bmj"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Carvalho, V.P., Barcelos, K.A., Oliveira, E.P., Marins, S.N., Rocha, I.B.S., Sousa, D.F.M., Moreira, B.C., Almeida, G.A., Carneiro, M.L.S., and Silva, J.D.F. (2021). Poor Sleep Quality and Daytime Sleepiness in Health Professionals: Prevalence and Associated Factors. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18136864"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3810\/pgm.2012.07.2583","article-title":"Sleep deprivation in resident physicians, work hour limitations, and related outcomes: A systematic review of the literature","volume":"24","author":"Mansukhani","year":"2012","journal-title":"Postgrad. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5812\/asjsm.34719","article-title":"The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes","volume":"3","author":"Taheri","year":"2012","journal-title":"Asian J. Sports Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"5519","DOI":"10.1523\/JNEUROSCI.0733-08.2008","article-title":"Lapsing during Sleep Deprivation is Associated with Distributed Changes in Brain Activation","volume":"28","author":"Chee","year":"2008","journal-title":"J. Neurosci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1080\/15402002.2012.703628","article-title":"Sleep Loss and Risk-Taking Behavior: A Review of the Literature","volume":"11","author":"Womack","year":"2013","journal-title":"Behav. Sleep Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"745","DOI":"10.5665\/sleep.4668","article-title":"Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback","volume":"38","author":"Whitney","year":"2015","journal-title":"Sleep"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.wjorl.2015.08.001","article-title":"Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome","volume":"1","author":"Knauert","year":"2015","journal-title":"World J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_59","unstructured":"(2022, September 01). Report on the Methodology of the NTSB Most Wanted List, Available online: https:\/\/www.ntsb.gov\/about\/reports\/Documents\/NTSB-Most-Wanted-List-methodology-report-February-2019.pdf."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.bjoms.2018.08.001","article-title":"Sleep: Its importance and the effects of deprivation on surgeons and other healthcare professionals","volume":"56","author":"Parry","year":"2018","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1164\/ajrccm\/138.2.337","article-title":"Automobile accidents involving patients with obstructive sleep apnea","volume":"138","author":"Findley","year":"1988","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"447","DOI":"10.7326\/0003-4819-151-7-200910060-00005","article-title":"Effects of alcohol and sleep restriction on simulated driving performance in untreated patients with OSA","volume":"151","author":"Vakulin","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"341","DOI":"10.5665\/sleep.4486","article-title":"Sleep apnea-related risk of motor vehicle accidents is reduced by continuous positive airway pressure: Swedish Traffic Accident Registry data","volume":"38","author":"Karimi","year":"2015","journal-title":"Sleep"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0272-5231(21)00872-8","article-title":"Driving performance and automobile accidents in patients with sleep apnea","volume":"13","author":"Findley","year":"1992","journal-title":"Clin. Chest Med."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Gabryelska, A., Sochal, M., Wasik, B., Szczepanowski, P., and Bia\u0142asiewicz, P. (2022). Factors affecting long-term compliance od CPAP treatment-A single center experience. J. Clin. Med., 11.","DOI":"10.3390\/jcm11010139"},{"key":"ref_66","first-page":"1139","article-title":"Case report: OSA\u2014An air safety risk","volume":"68","author":"Panton","year":"1997","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_67","unstructured":"(2022, October 30). Sleep Apnea in Aviation|Federal Aviation Administration, Available online: https:\/\/www.faa.gov\/newsroom\/sleep-apnea-aviation."},{"key":"ref_68","unstructured":"(2022, October 30). Decision Considerations Disease Protocols\u2013OSA [OSA], Available online: https:\/\/www.faa.gov\/about\/office_org\/headquarters_offices\/avs\/offices\/aam\/ame\/guide\/dec_cons\/disease_prot\/osa\/."},{"key":"ref_69","first-page":"701","article-title":"Sleep-disordered breathing and self-reported general health status in the Wisconsin Sleep Cohort Study","volume":"21","author":"Finn","year":"1998","journal-title":"Sleep"},{"key":"ref_70","unstructured":"(2022, October 08). Driving When You Have Sleep Apnea, Available online: https:\/\/www.fmcsa.dot.gov\/driver-safety\/sleep-apnea\/driving-when-you-have-sleep-apnea."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40248-019-0172-9","article-title":"Obstructive sleep apnea and comorbidities: A dangerous liaison","volume":"14","author":"Bonsignore","year":"2019","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1378\/chest.121.1.164","article-title":"What are obstructive sleep apnea patients being treated for prior to this diagnosis?","volume":"121","author":"Smith","year":"2002","journal-title":"Chest"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/12\/1723\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:26:03Z","timestamp":1760145963000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/12\/1723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,24]]},"references-count":72,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["medicina58121723"],"URL":"https:\/\/doi.org\/10.3390\/medicina58121723","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,24]]}}}