The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.[56]
"Depending on your approach, [keto diets] can contribute to significant lean body mass loss along with fat loss," said Melinda Manore, a professor of nutrition at Oregon State University. (Typically, dieters want to shed only fat, not lean body mass, which includes muscle.) And as with other fad diets, people typically regain the weight once they go off the diet.

Access incision sites are small and it is advisable not to close them with sutures to permit drainage of the excess wetting solution and serous exudate. Larger canullae require larger incisions, but these must be sutured loosely. A delayed drainage of the blood tinged tumescent solution produces prolonged swelling, bruising and pain after liposuction.
Hi I’m new to Keto. I have been reading about it, and understanding what to eat and what not to eat. My problem is I’m not sure if I’m doing it correctly. I’m constantly hungry whereas information reads that I will never be hungry. I use fats as required along with topping up with vegetables in my meals yet this does not fill me up. I haven’t experienced the Keto flu and I’ve even put on weight! I have been doing this for about 3 weeks now. Any ideas where I am going wrong.
Yes! It seems that after puberty, we do not create new fat cells. When you gain weight, you expand the fat cells that you have. Tumescent liposuction permanently removes fat cells to improve your body's contour. Should you gain weight after liposuction, it goes to the fat cells that remain in your body. The localized fatty deposits that existed prior to liposuction can no longer balloon up out of proportion to the surrounding areas.
While many of our patients perform SmartLipo in conjunction with the tumescent liposuction that has been Dr. Schlessinger's hallmark treatment for more than 15 years, there are many patients who choose to undergo simple tumescent liposuction. This offers cost savings over the SmartLipo method, but there is also a bit less fat obtained when the SmartLipo isn't performed alongside the tumescent method.
When you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis. It's important to note that the ketogenic diet is a short term diet that's focussed on weight loss rather than the pursuit of health benefits. 
Aside from the various keto-friendly foods mentioned in this article, you may be wondering if there are other options that may help support your ketogenic diet. If you find that the ketogenic diet is limiting when you start out, don't worry. There's actually a lot you can add to your diet that's "keto" as long as consumption is controlled. Here are some commonly asked questions:
Excess fat is removed through tiny openings with a very small stainless steel cannula. The cannula is connected to a powerful suction pump and inserted through these openings. Because the cannulas are so small, there is virtually no discomfort, recovery time is lessened, and a better cosmetic result can be achieved. Additionally, Dr. Schlessinger has the finesse to get out just the right amount of fat so your results look good.
"Dr. Yaker, You performed my full body Liposuction. I'm speechless, but what I can say is, your work is beautiful! I look amazing!! It's rare to find a surgeon that cares, listens, understands, and delivers their word all in one. You felt my urgency for the surgery and got me in as soon as you could after my consult. I use to just feel motivated to make healthy lifestyle changes. I now know I will make healthy lifestyle changes. Thank you for that!"
Hi Gigi, Low carb and keto is about the balance of macronutrients eaten (fat, protein and carbs), not specifically meat or lack thereof. Most people on keto do eat meat, though some people do vegetarian keto. Fat is actually necessary for many body processes. There is no issue for the kidneys with a high fat diet, but if you eat too much protein that isn’t great for the kidneys. It’s a common misconception that keto is high protein (it isn’t). Keto is great for diabetics as it naturally helps stabilize insulin. All of this being said, please know I’m not a doctor and you should consult your doctor on any medical questions or before starting any diet. If you have more questions that aren’t medical questions, I recommend our low carb & keto support group here.
Dr. Ayoub performs liposuction on patients who are close to their ideal weight, so you should not substitute this procedure for weight loss. Instead, you will be a few pounds lighter, but have a body that is shaped the way you want it. Patients find that their clothes fit better and small bulges that once bothered them are completely gone.*While you will initially be swollen after your liposuction surgery, as your swelling subsides, your results will be more noticeable.
A daily run or Spin class is great for your heart, but cardio workouts alone won't do much for your waist. "You need to do a combination of weights and cardiovascular training," says Sangeeta Kashyap, MD, an endocrinologist at Cleveland Clinic. Strength training increases muscle mass, which sets your body up to burn more fat. "Muscle burns more calories than fat, and therefore you naturally burn more calories throughout the day by having more muscle," says Kate Patton, a registered dietitian at Cleveland Clinic. Patton recommends 250 minutes of moderate-intensity exercise or 125 minutes of high-intensity exercise a week.
The researchers explain that people who cook their own meals may simply have other good-for-you habits, like exercising more. However, they also concluded that home cooks ate more fruits and vegetables (along with a wider variety of foods), have healthier methods of prepping their food, and splurge less on foods high in calories and sugar. No clue where to start? Check out these 25 high-protein chicken recipes for weight loss.

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Perhaps the best nut to consume if you’re trying to burn belly fat, almonds are full of polyunsaturated and monounsaturated fats, which are the good kind that we want, and which help to eliminate visceral fat through anti-inflammatory and cholesterol-balancing activities. Also, these nuts have high concentrations of fiber and magnesium, which help build muscle and burn fat.
Avocados are a double-whammy to belly fat. First, they’re packed with heart-healthy monounsaturated fats that dim your hunger switches; a study in Nutrition Journal found that participants who ate half a fresh avocado with lunch reported a 40 percent decreased desire to eat for hours afterwards. Second, healthy fats like the unsaturated fats found in avocados seem to prevent the storage of belly fat.
The approximate prevalence of the metabolic syndrome in patients with coronary artery disease (CAD) is 50%, with a prevalence of 37% in patients with premature coronary artery disease (age 45), particularly in women. With appropriate cardiac rehabilitation and changes in lifestyle (e.g., nutrition, physical activity, weight reduction, and, in some cases, drugs), the prevalence of the syndrome can be reduced.[27]

Metabolic syndrome, also known as Insulin Resistance Syndrome (IRS) and Syndrome X, is a cluster of metabolic and anthropometric traits including glucose intolerance, upper body fat distribution (increased intra-abdominal fat mass), hypertension, dysfibrinolysis, and a dyslipidemia (characterized by high triglycerides, low high-density lipoprotein [HDL] cholesterol, and small dense low-density lipoprotein [LDL] particles).1 Metabolic syndrome constitutes a powerful risk factor complex to identify individuals at increased risk for future Type 2 diabetes and cardiovascular disease (CVD). Insulin resistance and abdominal obesity are two central components of the syndrome and are integrally involved in its pathogenesis. Insulin resistance is a metabolic abnormality in which peripheral tissues exhibit a subnormal biologic response to the glucose-lowering action of insulin. Insulin resistance not only antedates the development of diabetes but is also a major metabolic defect (together with impaired insulin secretion and elevated hepatic glucose production) that maintains hyperglycemia in patients with overt disease. The central role of abdominal adiposity underscores the importance of body fat distribution regarding the metabolic consequences of obesity. Individuals with metabolic syndrome are also more prone to develop other pathologic conditions including polycystic ovary syndrome, non-alcoholic steatohepatitis (NASH), cholesterol gallstones, sleep disorders, and some types of cancer. Thus, metabolic syndrome is responsible for a tremendous burden of human disease and social costs, and nutritional therapy is key to both its prevention and limiting its progression to Type 2 diabetes and CVD.
When your cortisol levels are through the roof, it triggers the release of insulin, and this is where things go awry. Initially, the ‘fight-or-flight’ response shuts down your digestive system so you can deal with the “threat”, like a very hungry lion or, more realistically, heavy traffic on your way to work. Once the danger has passed, your body seeks to replenish the hundreds of calories you burned fighting to the death/swearing at rush hour traffic and makes you ravenously hungry.
Connective tissue and muscle are essentially unaffected by this process as they are more dense but an accumulation of secondary thermal energy and micromechanical trauma on sustained application of ultrasound after complete emulsification by microcavitation may result in damage. Thus direct micromechanical trauma and secondary thermal effects of persistent ultrasound energy is the mechanism of action for external UAL.

Polycystic ovarian syndrome. Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and — in the long-term — diabetes, heart disease, and cancer.


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Ultrasonic-assisted liposuction is thought to result in greater fat removal with less blood loss, less trauma to the body and a faster recovery. It is also thought to result in greater skin contraction. It has been particularly helpful in the removal of large volumes of fat as well as from fibrous areas where fat traditionally has been difficult to remove such as the love handles, flanks and back.

The long-term results of liposuction depend on the preoperative condition of the patient's skin, the patient's overall health and expectations and the ability of the patient to maintain a healthy weight and lifestyle postoperatively. In difficult cases and for large volume liposuction, it is prudent to be wise and a staged or a combined procedure is safer for both the patient as well as the surgeon.
In the post operative period following abdominal liposuction, the patients are advised to avoid prolonged sitting for 3 to 4 weeks to prevent development of skin folds and creases. Pressure garments are to be religiously worn for 3 to 6 months. While, a regular finger tip pressure massage in the indurated areas is fine with small areas of induration, an ultrasound massage works well for lumpy areas and sites with persistent pain or edema.
Not so anymore. Thanks to the rising obesity epidemic in young people, kids and teens are getting these conditions — and they're getting them earlier than ever before. Some estimates say that nearly 1 in 10 teens — and over a third of obese teens — have metabolic syndrome. And a study of 375 second- and third-graders found that 5% had metabolic syndrome and 45% had one or two risk factors for it.
Ultrasound-assisted liposuction (UAL). This type of liposuction is sometimes used in conjunction with traditional liposuction. During UAL, the surgeon inserts a metal rod that emits ultrasonic energy under your skin. This ruptures the fat-cell walls and breaks down the fat for easier removal. A new generation of UAL called VASER-assisted liposuction uses a device that may improve skin contouring and reduce the chance of skin injuries.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]

Now, there’s even evidence that a low-carb, high-fat regimen (as the keto diet is) helps you live longer, compared to a low-fat diet. In a study by the medical journal The Lancet that studied more than 135,000 adults from 18 countries, high carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction or cardiovascular disease mortality.
Recovery from SmartLipo depends on type of anesthetic used. While many physicians try to tell patients it is all about the SmartLipo, here is the secret: It's about the anesthetic that is used prior to doing the procedure. Tumescent liposuction, invented by a dermatologist, is the reason that dermatologists typically have patients up and about the day of the procedure and the reason that many of Dr. Schlessinger's patients go to work the next day or two after surgery.

Although you won't be able to completely transform your body or even lose more than a few pounds in a month, you can jump-start your weight-loss journey and be well on your way to achieving your goals. Just be mindful that while you can lose weight in a month, you can't specifically target your belly; there's no such thing as being able to spot-reduce fat (your body decides where the fat comes from - yay, genetics!). We tapped registered dietitian and ACSM-certified personal trainer Jim White, who owns Jim White Fitness and Nutrition Studios and helps clients reach their weight-loss goals, for insight on how to lose belly fat in 30 days.

Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
On a “strict” (standard) keto diet, fats typically provides about 70 percent to 80 percent of total daily calories, protein about 15 percent to 20 percent, and carbohydrates just around 5 percent. However, a more “moderate” approach to the keto diet is also a good option for many people that can allow for an easier transition into very low-carb eating and more flexibility (more on these types of plans below).
Sometimes, to whip your body into shape, you have to get a little nutty. While nuts are high in fat, it’s that very fat that makes them such powerful weapons in the war against a ballooning belly. In fact, a study published in Diabetes Care revealed that study participants who consumed a diet rich in monounsaturated fats, like those in nuts, over a 28-day period gained less belly fat than their saturated fat-consuming counterparts while improving their insulin sensitivity.
When Johns Hopkins researchers compared the effects on the heart of losing weight through a low-carbohydrate diet versus a low-fat diet for six months—each containing the same amount of calories—those on a low-carb diet lost an average of 10 pounds more than those on a low-fat diet—28.9 pounds versus 18.7 pounds. An extra benefit of the low-carb diet is that it produced a higher quality of weight loss, Stewart says. With weight loss, fat is reduced, but there is also often a loss of lean tissue (muscle), which is not desirable. On both diets, there was a loss of about 2 to 3 pounds of good lean tissue along with the fat, which means that the fat loss percentage was much higher on the low-carb diet.
The keto diet was originally designed not for weight loss, but for epilepsy. In the 1920s, doctors realized that keeping their patients on low-carb diets forced their bodies to use fat as the first-line source of fuel, instead of the usual glucose. When only fat is available for the body to burn, the body converts the fats into fatty acids, and then into compounds called ketones, which can be taken up and used to fuel the body's cells.
Regular follow-ups with the dietitian, and medical team, will monitor your or your child’s growth (height and weight, if applicable), health, their epilepsy, and if there is a need for any change to their anti-epileptic drugs (AEDs), such as changing to sugar-free versions. If the diet is followed carefully, individuals do not put on weight, or lose weight inappropriately.

The benefits above are the most common ones. But there are others that are potentially even more surprising and – at least for some people – life changing. Did you know that a keto diet can help treat high blood pressure, may result in less acne, may help control migraine, might help with certain mental health issues and could have a few other potential benefits?

Larger cannulae remove fat rapidly and there is a risk of removing too much fat and produce skin depressions and irregularities. An attempt to make a small change in the direction with a large canula results in a tendency to re-enter a pre-existing tunnel within the fat. This lack of precise control results in skin irregularities associated with the use of large cannulae. They are advocated only in those cases of LVL with access from sites from where the panniculus is to be sacrificed.


To make sure the diet is nutritionally balanced, an experienced dietitian works out exactly how much of which foods the person can eat each day. To help with this, people have individual recipes, are given support on how to plan meals, and are guided on which foods should be avoided. As the diet can be quite restrictive, the dietitian will recommend any vitamin and mineral supplements that are needed.

Cannulae used today are extremely small, typically less than 6 mm, some are very small with an inside diameter of less than 0.6 mm. Blunt-tipped cannulae are standard as they decrease injury to blood vessels and reduce bleeding. The use of multiple side ports allows for efficient evacuation of fat. Manual systems consisting of syringes and canula tips have also been developed as some surgeons prefer the use of quiet and disposable instruments, they are more popular in small local aspirations of isolated fat bulges. They also became popular as a back-up system. Over time, aspiration units developed by manufacturers in consultation with surgeons have gradually become more powerful as well as quieter and allow for an efficient, pleasant surgical environment.

A daily run or Spin class is great for your heart, but cardio workouts alone won't do much for your waist. "You need to do a combination of weights and cardiovascular training," says Sangeeta Kashyap, MD, an endocrinologist at Cleveland Clinic. Strength training increases muscle mass, which sets your body up to burn more fat. "Muscle burns more calories than fat, and therefore you naturally burn more calories throughout the day by having more muscle," says Kate Patton, a registered dietitian at Cleveland Clinic. Patton recommends 250 minutes of moderate-intensity exercise or 125 minutes of high-intensity exercise a week.
On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.
Spinal anaesthesia is preferred as bulk of fat to be sucked out is situated in lower half of the torso and the duration of surgery is about three hours. It reduces the drugs administered to the patient as general anaesthesia is avoided. A 27 gauge needle avoids the often troublesome post spinal anaesthesia headaches. Fentanyl is additionally added to the high spinal because it has a bupivacaine sparing effect on spinal anaesthesia. This covers the subcostal areas as well and further reduces the need of lignocaine in the infiltrating solution.
Metabolic syndrome is a clustering of cardiovascular risk factors that leads to an increased risk for premature cardiovascular disease and increased susceptibility of developing type 2 diabetes mellitus. The syndrome represents a collection of multiple derangements that include elevated blood pressure, impaired glucose tolerance or insulin resistance, atherogenic dyslipidemia (i.e., high triglycerides, low high‐density lipoprotein [HDL] cholesterol, and small low‐density lipoprotein [LDL] particles), proinflammatory and prothrombotic properties, and obesity, with a particular contribution of abdominal obesity. There are two definitions for adults: World Health Organization, 1998 and the National Cholesterol Education Panel (NCEP), Third Adult Treatment Panel, 2001.

Essentially, the keto diet for beginners works by “tricking” the body into acting as if its fasting (while reaping intermittent fasting benefits), through a strict elimination of glucose that is found in carbohydrate foods. Today the standard keto diet goes by several different names, including the “low-carbohydrate” or “very-low-carbohydrate ketogenic diet”(LCKD or VLCKD for short).

Liposuction procedures can be performed on their own or in combination with other procedures, such as facelift, breast reduction and tummy tuck. In fact, liposuction is often part of a combination procedure known as mommy makeover, which typically also includes breast lift and tummy tuck, and is designed to help mothers regain their pre-pregnancy body shapes.
Tumescent liposuction. This is the most common type of liposuction. The surgeon injects a sterile solution — a mixture of salt water, which aids fat removal, an anesthetic (lidocaine) to relieve pain and a drug (epinephrine) that causes the blood vessels to constrict — into the area that's being treated. The fluid mixture causes the affected area to swell and stiffen.

Fanatic? Someone with T2D, a disease usually claimed to be progressive and a never ending stream of problems and medications, was REVERSED. That’s something to shout from the rooftops. The drop in medication use alone, but the big pharma companies would prefer that people’s stories of reversing (well, putting it into remission) T2D get called fanatical instead of insightful.
Dr. Yaker specializes in liposuction surgery and offers this procedure to Plano area men and women who desire a slimmer appearance. Liposuction (“Lipo”) is a surgery that removes fat from the body. During this procedure, a small puncture is made in the skin and a “cannula” helps to loosen fat cells and suction them out. Common areas for fat removal include the stomach, hips, lower back, thighs, arms, neck and chest. Liposuction is ideal for those who are at a healthy weight and is not an alternative to a weight loss plan, nor is it a surgery to “treat” being overweight. Dr. Yaker offers various techniques including liposuction surgery, ultrasound assisted lipo and laser lipo procedures. Each of these will be discussed during the consultation. 
So rather than giving one-size-fits-all dietary advice or weaponizing the word “balanced” it might be better if the medical community suggested that there are Individual differences that need to be considered. This might also help those lay folk who have had success with one dietary lifestyle or another also realize that what’s valid for them may not be good advice for others.
Also, consider supplementing with the amino acid leucine, as it can be broken down directly into acetyl-CoA, making it one of the most important ketogenic amino acids in the body. While most other amino acids are converted into glucose, the acetyl-CoA formed from leucine can be used to make ketone bodies. It’s also present in keto friendly foods like eggs and cottage cheese.
Even small changes to your diet can make a difference when you're trying to lose weight, so don't feel like you have to follow a strict regimen or cut out entire food groups. If you like to bake, try low-calorie substitutions in your recipes. Cooking at home more often can help you lose weight, especially if you look for ways to reduce fat and calories in your meals. As you make changes like these, you may even find that you enjoy healthy eating.
Although you'll be cutting way back on carbohydrates and sugar, some fruits are still okay to eat on the keto diet (though you'll still want to be mindful about quantity in order to remain in ketosis). The fruits that make the cut contain far fewer carbs than their off-limits cousins such as apples, pears, bananas, pineapples, papayas, grapes, and fruit juices in general.
Tumescent liposuction is a common approach used by surgeons. It is a suction-assisted (SAL) form of lipo that first injects a liquid agent into the area that is to be treated. The liquid agent includes saline, Lidocaine (a numbing agent) and Epinephrine (a medication that controls bleeding). A cannula is then inserted and passed through the fat deposits, suctioning them out. An attached power-aided motor allows the surgeon to control the speed of the fat removal, which can be as great as a few pounds or as little as several ounces. 
These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.

First, I want to thank you for all of your dedication and work in providing this site. The difficulty of maintaining a healthy weight is a big problem for so many people. My personal question & issue in staying on Keto is my craving for fresh fruit. This a.m I had a large fresh peach along with my “Bullet Proof” coffee. Have I now sabotaged today’s Keto eating?
The patient is prepared circumferentially in the torso and the lower extremity as these can be treated without repeated pepping and repositioning. The patient's skin is painted with 5/10 percent Povidone Iodine solution while he/she stands next to a sterile draped operating table. Upon completion of the skin preparation, the patient lies on the table and is sedated or is given regional or general anaesthesia as required.
Ultrasound is used as an ablative tool in urology and neuro-surgery. Ultrasonic assisted liposuction (UAL) was developed and introduced in the early 1990s by Zocchi[12] in Italy. His interest in ultrasound was originally for harvesting collagen from aspirated fat. The chance observations that adipose tissues were effectively emulsified while connective tissue structures were preserved in vitro led to the concept of using ultrasound adjunctively in vivo.
Hi Kelly, All packaged foods will have a nutrition label that list the macros per serving, including fat, protein and cabrohydrates. Net carbs, which is what most people look at for low carb and keto, are total carbs (the amount on the label) minus fiber and sugar alcohols, as explained in the article above. I have a low carb food list here that gives you a full list of all the foods you can eat, and the net carbs in each. You can also sign up above to be notified about the meal plans, which are a great way to get started.
Fat layers are treated from deep to superficial in sequence and in parallel tracks. As the procedure is progresses more superficially, canula size can be decreased along with reduction in suction intensity to help decrease risk of irregularity to the surface layers. Most traditional liposuction treatment involves removal of the deeper layers of fat. Superficial liposuction is done in individuals with flaccid skin or Localised Fat Deposits (LFDs) as an aid to better skin retraction. It is accomplished with narrow cannulae that make multiple closely spaced passes in the sub-dermal fat to effect an undermining of the affected tissue.
Eating avocados in particular has been found to be clinically associated with lower metabolic syndrome in U.S. adults because avocado benefits your gut. (11) Think of a rainbow as you make your daily vegetable choices (red bell peppers to pumpkin to yellow squash to arugula to purple eggplant). This way, not only do you keep your meals interesting, but you obtain all of the great vitamins and nutrients vegetables can offer you!
Dr. Schlessinger will then do the SmartLipo part if you are doing that procedure in addition to the tumescent liposuction. This part takes about 30 minutes, and then Dr. Schlessinger will proceed to perform the tumescent liposuction part, which involves suctioning the additional fat. This part takes about 45 minutes. Then you will be taken to the recovery room to relax and eat the lunch of your choice prior to being discharged to a friend or family member, who will take you home to rest for the remainder of the day.
The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with "insulin resistance." Insulin resistance means that the body does not use insulin efficiently to lower glucose and triglyceride levels. Insulin resistance is a combination of genetic and lifestyle factors. Lifestyle factors include diet, activity and perhaps interrupted sleep patterns (such as sleep apnea).
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