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BT
/F1 1 Tf
11.955 0 0 11.955 58.28 754.696 Tm
0.0203 Tc
[(EDIT)7.8(ORIAL)]TJ
/F2 1 Tf
14.944 0 0 14.944 194.853 721.814 Tm
0.0207 Tc
[(To)-332.7(sleep,)-335.6(p)1.2(erchance)-334(to)-332.7(leak)]TJ
/F3 1 Tf
10.959 0 0 10.959 226.658 684.453 Tm
0 Tc
[(D.O.)-329(Rodenstein)]TJ
/F4 1 Tf
7.4183 0 TD
0 Tw
(*)Tj
/F3 1 Tf
0.4966 0 TD
[(,)-334.6(P)0(.)-330.8(Levy)]TJ
/F4 1 Tf
3.9937 0 TD
(**)Tj
9.963 0 0 9.963 68.258 649.134 Tm
[(In)19.6(te)12.8(rm)16.5(it)16.5(te)18.4(nt)-590(po)15.5(si)17.7(ti)16.5(ve)-588.1(pr)14(es)19.6(su)20(re)-595.3(me)17.7(ch)15.1(an)20.8(ic)18.4(al)-596.1(ve)20.8(nt)18.9(il)16.5(at)18.4(io)13.2(n)]TJ
-1.0015 -1.0584 TD
[(\(I)18(PP)17.1(V\))-320(ca)20.4(n)-325.1(b)0(e)-314.9(a)0(p)15.1(p)0(l)18.9(i)0(e)18.4(d)-325.1(in)18.9(va)15.1(si)17.7(ve)20.8(ly)-316.9(\(t)17.3(hr)19.6(ou)15.5(gh)-314.5(a)-325.5(t)0(r)17.3(a)0(c)14.7(h)0(e)20.8(o)0(t)18.9(o)0(m)12.4(y)]TJ
T*
[(or)-219.4(an)-212.5(en)15.1(do)21.2(tr)17.3(ac)14.7(he)20.8(al)-220.6(tu)18.9(be)15.1(\))-224.3(o)0(r)-213.7(n)0(o)15.5(n)0(i)18.9(n)0(v)15.5(a)0(s)19.6(i)0(v)18.9(e)0(l)18.4(y)67.5(,)-222.3(u)0(s)20(i)0(n)13.2(g)-222.7(na)15.1(sa)19.6(l,)-214.1(or)14(al)]TJ
T*
[(or)-225.1(fa)19.2(ci)18.5(al)-226.2(in)18.8(te)12.8(rf)18(ac)20.4(es)13.9(.)-228(T)0(h)17.1(r)0(e)13.5(e)-234.5(di)18.9(f)20.4(f)0(e)19.2(r)0(e)13.5(n)0(t)-220.1(t)0(y)13.2(p)0(e)20.8(s)-235.3(of)-225.1(ph)21.2(ys)14.4(ic)18.4(ia)18.4(n)-234.1(h)0(a)20.8(v)0(e)]TJ
T*
[(be)15.1(en)-206.8(in)18.9(vo)15.5(lv)18.8(ed)-206.8(in)-208.8(tr)17.3(ea)14.7(ti)16.5(ng)-206.4(pa)15.1(ti)16.5(en)20.8(ts)-210(wi)14.9(th)-208.8(th)18.9(is)-210(ki)18.9(nd)-206.4(of)-213.7(th)18.8(er)19.2(ap)15.1(y:)]TJ
T*
[(in)18.9(te)18.4(ns)14.4(iv)18.9(e)-342.6(c)0(a)14.7(r)0(e)-333.6(s)0(p)20(e)0(c)14.7(i)0(a)18.4(l)0(i)16.5(s)0(t)17.7(s)0(,)-332.4(p)0(n)15.5(e)0(u)20.8(m)0(o)12.4(l)13.9(og)15.5(is)17.7(ts)-335.1(\(a)19.2(ls)17.7(o)-342.2(c)0(a)14.7(l)0(l)16.5(e)0(d)-332(p)0(u)15.5(l)0(-)]TJ
T*
[(mo)18.1(no)15.5(lo)18.9(gi)18.9(st)17.7(s)-462.9(o)0(r)-458.4(r)0(e)19.2(s)0(p)14.4(i)13.9(ra)13.5(to)18.9(ry)-452.7(ph)15.5(ys)20(ic)12.8(i)13.9(a)0(n)15.1(s)0(\))-453.9(a)0(n)15.1(d)-461.7(sl)17.7(ee)14.7(p)-461.7(p)0(h)21.2(y)0(s)14.4(i)0(-)]TJ
T*
[(ci)18.4(an)15.1(s.)-264.1(E)12.2(a)0(c)14.7(h)-273.9(gr)19.6(ou)15.5(p)-273.9(h)0(a)20.8(s)-275.1(it)16.5(s)-275.1(o)0(w)17.3(n)-273.9(ba)20.8(ck)15.1(gr)19.6(ou)15.5(nd)21.2(,)-273.5(p)0(o)15.5(i)0(n)18.9(t)0(s)-266.9(o)0(f)-264.9(v)0(i)18.9(e)0(w)]TJ
T*
[(an)15.1(d)-205.6(p)0(r)13.9(e)0(j)18.4(u)0(d)21.2(i)0(c)12.8(e)0(s)19.6(,)-210.9(w)12.4(h)0(i)13.2(c)0(h)20.8(,)-210.9(at)-203.5(l)13.9(e)0(a)14.7(s)0(t)-198.6(i)0(n)-203.1(p)0(a)15.1(r)0(t)17.3(,)-205.2(de)15.1(te)18.4(rm)16.5(in)18.9(e)-211.7(t)0(h)18.8(e)-211.7(wa)16.9(y)-211.3(i)0(n)]TJ
0 -1.0528 TD
[(wh)17.3(ic)18.4(h)-239.8(n)0(o)21.2(n)0(i)18.9(n)0(v)15.5(a)0(s)19.6(i)0(v)13.2(e)-234.5(me)17.7(ch)15.1(an)20.8(ic)18.4(al)-231.9(ve)20.8(nt)13.2(i)13.9(l)0(a)12.8(t)0(i)16.5(o)0(n)-223.5(i)0(s)-227(i)0(m)15.7(p)0(l)18.9(e)0(m)12(e)0(n)20.8(t)0(e)18.4(d)0(.)]TJ
1.0015 -1.0527 TD
[(A)-255.1(s)0(t)17.7(e)0(r)13.5(e)0(o)20.8(t)0(y)18.8(p)0(i)13.2(c)0(a)20.4(l)-259.2(\(t)17.3(ho)21.2(ug)15.5(h)-251.2(n)0(o)15.5(t)-253.5(fa)13.5(r)-252.7(f)0(r)18(o)0(m)-249.4(r)0(e)13.5(a)0(l)18.4(\))-252.7(in)18.9(te)12.8(ns)20(iv)18.9(e)-257.2(c)0(a)14.7(r)0(e)]TJ
-1.0015 -1.0584 TD
[(un)15.5(it)-353.4(pa)20.8(ti)16.5(en)15.1(ts)-352.2(is)-357.9(a)-365.4(n)0(a)20.8(k)0(e)15.1(d)-359.3(hu)15.5(ma)17.7(n)-365(b)0(e)15.1(i)13.9(ng)15.5(,)-364.6(l)0(y)18.9(i)0(n)18.9(g)-365(fl)17.3(at)-357.1(on)-354.3(a)-359.7(r)0(e)13.5(-)]TJ
T*
[(la)18.4(ti)16.5(ve)15.1(ly)-442.1(so)14.4(ph)21.2(is)17.7(ti)16.5(ca)14.7(te)18.4(d)-456(b)0(e)20.8(d)0(,)-445(u)0(n)15.5(a)0(w)16.9(a)0(r)19.2(e)-456.4(of)-447(th)18.9(e)-456.4(e)0(n)20.8(v)0(i)13.2(r)0(o)19.6(n)0(m)18.1(e)0(n)15.1(t)0(.)]TJ
T*
[(T)40.6(u)0(b)15.5(e)0(s)-395.8(a)0(r)19.2(e)-405.2(in)18.9(se)19.6(rt)17.3(ed)-394.6(in)18.9(to)-396.6(mo)18.1(st)-397.7(na)20.8(tu)13.2(ra)19.2(l)-401.5(o)0(r)13.9(i)0(f)17.3(i)0(c)18.4(e)0(s)19.6(,)-404.4(so)20(me)12(ti)16.5(m)13.2(e)0(s)]TJ
T*
[(mo)18.1(re)-384.8(th)18.8(an)-377.5(on)15.5(e)-388.1(t)0(u)18.9(b)0(e)-383.2(i)0(n)18.9(t)0(o)-379.5(a)-393.8(si)17.7(ng)21.2(le)-379.9(or)14(if)17.3(ic)18.4(e.)-382.8(T)40.6(u)0(b)21.2(e)0(s)-384.4(a)0(r)19.2(e)-388.1(al)12.8(so)]TJ
0 -1.0527 TD
[(in)18.9(se)13.9(rt)17.3(ed)-394.6(th)18.9(ro)19.6(ug)15.5(h)-404.8(t)13.9(he)-400.3(sk)20(in)18.9(.)-404.4(S)11.4(om)12.4(e)-399.5(o)0(f)-395.8(t)0(h)18.9(e)0(s)13.9(e)-399.5(tu)13.2(be)20.8(s)-406(a)0(r)19.2(e)-405.2(co)20.8(n-)]TJ
0 -1.0584 TD
[(ne)15.1(ct)18.5(ed)-309.2(to)-311.2(ma)17.7(ch)15.1(in)18.9(es)-310.4(an)15.1(d)-319.4(s)0(o)20(m)0(e)-312.4(t)0(o)-311.2(b)0(o)21.2(t)0(t)16.5(l)0(e)18.4(s)0(,)-309.6(p)0(l)13.2(a)0(s)19.6(t)0(i)16.5(c)-319.8(ba)20.8(gs)-315.7(or)-310.4(a)]TJ
T*
[(se)19.6(ri)17.3(es)-435.6(of)-441.3(sy)20(ri)17.3(ng)15.5(es)-435.6(an)20.8(d)-444.6(p)0(u)15.5(m)0(p)-437.2(i)0(n)18.9(j)0(e)18.4(c)0(t)18.4(o)0(r)13.9(s)0(.)-434.8(S)11.4(en)15.1(so)20(rs)-436.8(ar)19.2(e)-445(a)0(l)18.4(s)0(o)]TJ
T*
[(ta)18.4(pe)15.1(d)-347.9(o)0(v)21.2(e)0(r)-339.3(t)0(h)13.2(e)-342.6(ch)15.1(es)19.6(t,)-339.3(or)-338.9(on)15.5(e)-348.3(f)0(i)17.3(n)0(g)21.2(e)0(r)47.7(,)-347.5(an)15.1(d)-347.9(a)0(r)19.2(o)0(u)15.5(n)0(d)-337.3(o)0(n)21.2(e)-348.3(ar)13.5(m.)]TJ
T*
[(Th)17.1(e)-262.9(b)0(e)15.1(d)-268.2(i)13.9(t)0(s)12(e)0(l)18.4(f)-264.1(is)-255.5(ge)15.1(ne)20.8(ra)13.5(ll)16.5(y)-262.5(s)0(u)14.4(r)0(r)18(o)0(u)21.2(n)0(d)15.5(e)0(d)-258(b)0(y)-257.6(m)0(o)18.1(n)0(i)18.9(t)0(o)18.9(r)0(i)17.3(n)0(g)-257.6(s)0(c)19.6(r)0(e)13.5(-)]TJ
T*
[(en)15.1(s)-309.2(d)0(i)18.9(s)0(p)20(l)0(a)18.4(y)0(i)13.2(n)0(g)-297.4(n)0(u)15.5(m)0(b)18.1(e)0(r)19.2(s)-309.2(an)15.1(d)-308.1(p)0(h)15.5(y)0(s)20(i)0(o)18.9(l)0(o)13.2(g)0(i)18.9(c)0(a)20.4(l)-310.4(cu)15.1(rv)19.6(es)19.6(,)-313.4(a)0(s)-299(w)0(e)16.9(l)0(l)]TJ
T*
[(as)-333.2(at)-334.4(l)13.9(e)0(a)14.7(s)0(t)-335.2(o)0(n)21.2(e)-342.6(br)19.6(ea)14.7(th)18.9(in)18.9(g)-342.2(m)0(a)17.7(c)0(h)15.1(i)0(n)18.9(e)-342.6(an)20.8(d)-342.2(s)0(o)20(m)0(e)12(t)0(i)22.2(m)0(e)12(s)-337.7(al)18.4(so)-332.8(an)]TJ
T*
[(ar)19.2(ti)16.5(fi)17.3(ci)18.4(al)-249(ki)13.2(dn)21.2(ey)77.7(,)-256.5(o)0(r)-247.8(a)-257.2(se)19.6(co)15.1(nd)-246.2(re)13.5(sp)20(ir)17.3(at)18.4(or)13.9(y)-256.8(m)0(a)17.7(c)0(h)20.8(i)0(n)13.2(e)-257.2(pu)21.2(mp)18.1(in)13.2(g)]TJ
T*
[(bl)18.9(oo)15.5(d)-245.5(f)0(r)12.4(o)0(m)18.1(,)-245.1(an)15.1(d)-245.5(b)0(a)15.1(c)0(k)-240.9(i)0(n)18.9(t)0(o)18.9(,)-250.8(th)18.9(e)-251.6(b)0(o)21.2(d)0(y)-240.5(o)0(f)-242.1(t)13.9(he)-240.9(pa)15.1(ti)16.5(en)20.8(t.)-242.5(Al)20.6(l)-253.5(t)0(h)18.9(i)0(s)]TJ
T*
[(eq)15.1(ui)18.9(pm)18.1(en)15.1(t)-407.2(i)0(s)-403.4(p)0(r)13.9(o)0(v)21.2(i)0(d)13.2(e)0(d)-400.3(w)0(i)14.9(t)0(h)-402.2(a)0(l)18.4(a)0(r)13.5(m)0(s)-404.2(a)0(n)20.8(d)-410.5(be)15.1(ep)15.1(s;)-403.4(th)18.8(us)20(,)-410.1(t)0(h)13.2(e)]TJ
0 -1.0528 TD
[(ro)19.6(om)-317.7(is)-318.1(fa)19.2(r)-326.7(f)0(r)18(o)0(m)-317.7(s)0(i)17.7(l)0(e)18.4(n)0(t)18.9(.)]TJ
1.0015 -1.0528 TD
[(T)69.1(o)-199.9(ke)20.8(ep)-189.7(pa)15.1(ti)16.5(en)20.8(ts)-192.9(al)18.4(iv)18.9(e)-200.3(d)0(u)15.5(r)0(i)17.3(n)0(g)-189.3(t)0(h)18.9(e)-200.3(or)31(ga)15.1(n\()19.6(s\))-192.1(fa)19.2(il)16.5(ur)13.9(e)-194.6(e)0(p)15.1(i)0(s)17.7(o)0(d)15.5(e)]TJ
-1.0015 -1.0584 TD
[(th)18.9(at)-260.4(br)19.6(ou)15.5(gh)15.5(t)-264.9(t)0(h)18.9(e)0(m)-261.2(t)0(o)-260(i)0(n)18.9(t)0(e)18.4(n)0(s)14.4(i)0(v)18.9(e)-268.6(ca)20.4(re)-259.6(in)-260(th)18.9(e)-268.6(f)0(i)17.3(r)0(s)18.4(t)-270.6(pl)18.9(ac)14.7(e,)-257.6(al)18.4(l)-270.6(o)0(f)]TJ
T*
[(th)18.9(is)-261.2(pa)20.8(ra)13.5(ph)21.2(er)13.5(na)20.8(li)16.5(a)-268.6(i)0(s)-255.5(r)0(e)19.2(q)0(u)15.5(i)0(r)17.3(e)0(d)-258(f)0(o)19.6(r)-269.8(ho)21.2(ur)14(s,)-258.4(da)20.8(ys)-258.8(or)-259.2(w)12.4(e)0(e)14.7(k)0(s)20(.)-267.8(T)69.1(o)]TJ
T*
[(ma)17.7(ke)-229.6(li)16.5(fe)-225.5(be)15.1(ar)19.2(ab)20.8(le)12.8(,)-233.7(p)0(a)20.8(t)0(i)16.5(e)0(n)15.1(t)0(s)-227(a)0(r)19.2(e)-240.2(he)20.8(av)15.1(il)22.2(y)-239.8(s)0(e)19.6(d)0(a)15.1(t)0(e)18.4(d)-234.1(an)15.1(d,)-223.1(so)14.4(me)17.7(-)]TJ
T*
[(ti)16.5(me)17.7(s)-326.3(a)0(l)12.8(s)0(o)-315.7(p)0(a)15.1(r)0(a)19.2(l)0(y)18.9(s)0(e)13.9(d)0(.)-314.1(H)0(o)17.3(u)0(r)13.9(s)-326.3(go)-320.2(by)83.8(,)-330.4(t)0(h)18.9(e)-325.5(su)14.4(n)-325.1(s)0(e)13.9(t)0(s)17.7(,)-324.7(an)15.1(d)-325.1(t)0(h)18.8(e)0(n)]TJ
T*
[(ri)17.3(se)19.6(s)-218.2(a)0(g)15.1(a)0(i)18.5(n)-217(as)-208(el)18.5(ec)14.7(tr)17.3(ic)-209.2(li)16.5(gh)21.2(ti)16.5(ng)-206.4(ma)17.7(ke)15.1(s)-218.2(n)0(i)18.9(g)0(h)15.5(t)-213.7(th)18.9(e)-217.4(s)0(a)13.9(m)0(e)-209.9(a)0(s)-208(d)0(a)20.8(y)67.5(.)]TJ
0 -1.0527 TD
[(F)11.4(o)0(r)-327.5(t)0(h)13.2(e)-336.9(at)18.5(te)18.4(nd)15.5(i)13.9(n)0(g)-331.6(i)0(n)18.9(t)0(e)18.4(n)0(s)20(i)0(v)13.2(e)-336.9(ca)20.4(re)-327.9(sp)14.4(ec)20.4(ia)18.4(li)16.5(st)-329.5(wh)17.3(o)-336.5(c)0(o)20.8(n)0(t)13.2(r)0(o)19.6(l)0(s)-329.5(a)]TJ
0 -1.0584 TD
[(pa)15.1(ti)22.2(en)15.1(t)]TJ
/F5 1 Tf
2.6233 0 TD
(')Tj
/F4 1 Tf
0.2106 0 TD
[(s)-451.5(b)0(r)19.6(e)0(a)14.7(t)13.9(hi)13.2(ng)-439.7(by)-445.4(me)17.7(an)20.8(s)-451.5(o)0(f)-447(a)0(n)-440.1(e)0(x)20.8(t)0(e)12.8(r)0(n)19.6(a)0(l)-442.5(m)0(e)17.7(c)0(h)15.1(a)0(n)20.8(i)0(c)12.8(a)0(l)]TJ
-2.8339 -1.0584 TD
[(re)19.2(pi)13.2(ra)19.2(to)18.9(r)-332.4(a)0(n)20.8(d)-330.8(en)20.8(do)15.5(tr)17.3(ac)20.4(he)15.1(al)-317.3(tu)13.2(be)20.8(,)-330.4(t)0(i)22.2(d)0(a)15.1(l)-327.5(vo)15.5(lu)18.9(me)-318.1(is)-323.8(ti)16.5(da)20.8(l)-327.5(v)0(o)15.5(l)0(-)]TJ
T*
[(um)18.1(e,)-314.5(ir)17.3(re)13.5(sp)20(ec)14.7(ti)16.5(ve)-314.9(of)-310.4(th)13.2(e)-319.8(h)0(o)15.5(u)0(r)70.9(.)]TJ
1.0015 -1.0527 TD
[(Ou)17.3(ts)17.7(id)18.9(e)-325.5(i)13.9(nt)13.2(en)20.8(si)17.7(ve)-314.9(ca)20.4(re)-310.8(un)15.5(it)16.5(s,)-309.6(hu)15.5(ma)17.7(n)-319.4(b)0(e)20.8(i)0(n)13.2(g)0(s)-310(m)0(a)17.7(y)-319.4(so)14.4(me)17.7(-)]TJ
-1.0015 -1.0584 TD
[(ti)16.5(me)17.7(s)-320.6(b)0(e)-303.5(i)0(l)16.5(l)-321.8(en)20.8(ou)15.5(gh)-308.8(t)13.9(o)-319.4(ju)18.9(st)17.7(if)17.3(y)-319.4(t)0(h)18.9(e)-319.8(re)19.2(pl)18.9(ac)14.7(em)17.7(en)15.1(t)-316.1(o)0(f)-310.4(a)-314.2(fa)13.5(il)22.2(in)13.2(g)]TJ
0 -1.0528 TD
[(or)25.3(ga)20.8(n)-421.9(w)0(i)14.9(t)0(h)-413.6(a)0(n)-417.3(e)0(x)20.8(t)0(e)18.4(r)0(n)13.9(a)0(l)-414(m)0(e)17.7(c)0(h)15.1(a)0(n)20.8(i)0(c)18.4(a)0(l)-414(d)0(e)15.1(v)0(i)18.9(c)0(e)14.7(.)-421.5(Ex)17.1(am)17.7(pl)18.9(es)-412.8(of)]TJ
0 -1.0584 TD
[(su)20(ch)-314.9(de)20.8(vi)13.2(ce)20.4(s)-320.6(a)0(r)13.5(e)-319.8(ar)19.2(ti)16.5(fi)17.3(ci)18.5(al)-311.6(ki)18.9(dn)15.5(ey)15.1(s,)-309.6(or)-310.4(a)-319.8(m)0(e)17.7(c)0(h)15.1(a)0(n)15.1(i)13.9(ca)14.7(l)-321.8(h)0(e)20.8(a)0(r)13.5(t)0(.)]TJ
T*
[(Di)14.9(al)18.4(ys)20(is)-301(al)18.5(lo)18.9(ws)-302.6(fo)19.6(r)-309.7(e)0(x)20.8(t)0(e)18.4(n)0(d)15.5(e)0(d)-297.8(l)0(i)16.5(f)0(e)-299.4(e)0(x)20.8(p)0(e)15.1(c)0(t)18.4(a)0(n)15.1(c)0(y)83.4(,)-307.7(ye)15.1(t)-304.7(i)0(t)-296.5(i)0(s)-301(c)0(a)14.7(r)20.4(-)]TJ
T*
[(ri)17.3(ed)-406(ou)15.5(t)-412.9(p)0(e)15.1(r)0(i)17.3(o)0(d)15.5(i)0(c)18.4(a)0(l)18.5(l)0(y)18.9(;)-418.6(th)18.9(e)-416.6(p)0(a)15.1(t)0(i)22.2(e)0(n)15.1(t)-418.6(is)-403.4(co)15.1(nn)21.2(ec)14.7(te)18.4(d)-416.2(t)0(o)-407.9(t)0(h)18.9(e)-416.6(ar)24.9(-)]TJ
25.1977 43.4986 TD
[(ti)16.5(fi)17.3(ci)12.8(al)-192.1(ki)18.9(dn)21.2(ey)-195.4(ma)17.7(ch)20.8(in)13.2(e)-200.3(a)0(p)20.8(p)0(r)13.9(o)0(x)21.2(i)0(m)15.7(a)0(t)18.4(e)0(l)18.4(y)-205.6(th)18.8(re)19.2(e)-200.3(t)0(i)16.5(m)0(e)17.7(s)-201.1(pe)15.1(r)-201.5(w)12.4(ee)14.7(k)]TJ
0 -1.0584 TD
[(fo)13.9(r)-241.4(s)0(e)19.6(v)0(e)15.1(r)0(a)19.2(l)-242.1(ho)21.2(ur)13.9(s.)-230(T)12.2(h)0(e)-235.2(r)0(e)19.2(s)0(t)-232.7(o)0(f)-230.7(t)0(h)18.9(e)-240.2(ti)16.5(me)17.7(,)-239.4(t)0(h)13.2(e)-240.2(pa)20.8(ti)16.5(en)15.1(t)13.9(s)-241(ca)14.7(n)-239.8(l)0(i)16.5(v)0(e)]TJ
T*
[(a)-405.2(q)0(u)15.5(i)0(t)16.5(e)-399.5(no)15.5(rm)16.5(al)-397(li)16.5(fe)-396.2(on)-394.2(th)18.9(ei)18.4(r)-406.4(o)0(w)17.3(n)0(.)-393.8(T)69.1(o)-404.8(i)13.9(nc)15.1(re)19.2(as)13.9(e)-405.2(f)0(r)18(e)0(e)-395(t)0(i)16.5(m)0(e)17.7(,)]TJ
0 -1.0641 TD
[(so)14.4(me)-397.7(pa)15.1(ti)16.5(en)20.8(ts)-397.8(ar)13.5(e)-405.2(d)0(i)18.9(a)0(l)18.4(y)0(s)14.4(e)0(d)-394.6(w)0(h)17.3(i)0(l)16.5(e)-410.9(th)18.8(ey)-394.6(sl)12(ee)20.4(p,)-399.5(in)-396.6(or)19.6(de)15.1(r)-406.4(t)0(o)]TJ
0 -1.0584 TD
[(ma)12(xi)18.9(mi)15.7(ze)-423.4(th)18.9(e)-433.7(t)0(i)22.2(m)0(e)-426.2(a)0(v)15.1(a)0(i)18.4(l)0(a)18.4(b)0(l)18.9(e)-433.7(fo)19.6(r)-434.8(t)0(h)18.9(e)-433.7(pu)21.2(rs)18.4(ui)13.2(t)-429.9(o)0(f)-424.2(p)0(e)20.8(r)0(s)12.8(o)0(n)21.2(a)0(l)]TJ
T*
[(go)15.5(al)18.4(s)-349.1(w)0(h)17.3(i)0(l)16.5(e)-348.3(aw)16.9(ak)15.1(e.)-337.3(Re)16.1(sp)14.4(ir)17.3(at)18.5(or)19.6(y)-353.6(f)0(a)19.2(i)0(l)16.5(u)0(r)19.6(e)-348.3(is)-340.8(of)13.9(te)18.5(n)-347.9(t)0(r)17.3(e)0(a)14.7(t)0(e)18.4(d)-347.9(in)]TJ
T*
[(th)13.2(e)-371.1(f)0(o)13.9(l)0(l)22.2(o)0(w)11.6(i)13.9(ng)-365.7(wa)16.9(y:)-368.1(pa)20.8(ti)16.5(en)15.1(ts)-363.6(ar)13.5(e)-371.1(c)0(o)15.1(n)0(n)21.2(e)0(c)14.7(t)0(e)18.4(d)-376.3(to)-362.4(an)-366.1(ex)15.1(t)13.9(e)0(r)13.5(n)0(a)20.8(l)]TJ
T*
[(me)12(ch)20.8(an)15.1(ic)18.4(al)-283.2(de)20.8(vi)18.9(ce)-281.2(du)15.5(ri)17.3(ng)-280.4(sl)17.7(ee)20.4(p,)-280(th)13.2(us)-275.9(le)12.8(av)20.8(in)18.9(g)-291(t)0(h)18.8(e)0(m)-283.9(f)0(r)18(e)0(e)-281.2(o)0(f)]TJ
T*
[(re)13.5(sp)20(ir)17.3(at)18.5(or)14(y)-325.1(a)0(s)13.9(s)0(i)17.7(s)0(t)17.7(a)0(n)20.8(c)0(e)-321(d)0(u)15.5(r)0(i)17.3(n)0(g)-314.5(w)0(a)16.9(k)0(e)15.1(f)0(u)19.6(l)0(n)13.2(e)0(s)19.6(s)0(.)-321(H)12.4(ow)17.3(ev)15.1(er)47.7(,)-324.7(c)0(o)15.1(n)0(-)]TJ
0 -1.0641 TD
[(tr)17.3(ar)13.5(y)-404.8(t)0(o)-402.3(d)0(i)18.9(a)0(l)18.4(y)0(s)14.4(i)0(s)17.7(,)-404.4(fr)18(ee)-400.7(ti)16.5(me)-403.4(w)12.4(h)0(i)13.2(l)0(e)-397(a)0(w)16.9(a)0(k)15.1(e)0(,)-399.9(i)0(s)-397.8(n)0(o)15.5(t)-407.2(th)18.9(e)-405.2(o)0(n)15.5(l)0(y)]TJ
0 -1.0584 TD
[(re)13.5(as)19.6(on)-274.7(fo)13.9(r)-281.2(u)0(s)14.4(i)0(n)18.9(g)-285.3(th)18.9(is)-278.2(ad)20.8(ap)15.1(te)18.4(d)-285.3(m)0(e)17.7(t)0(h)18.9(o)0(d)15.5(.)-284.9(It)-278.6(is)-272.6(ju)18.8(st)12(i)13.9(f)0(i)17.3(e)0(d)-280.8(b)0(y)-274.7(t)0(h)18.9(e)]TJ
T*
[(sp)14.4(ec)20.4(if)17.3(ic)-300.2(ef)30.6(fe)13.5(ct)18.5(s)-303.6(o)0(f)-299(s)0(l)17.7(e)0(e)20.4(p)-308.1(on)-291.7(re)13.5(sp)20(ir)17.3(at)18.5(io)18.9(n.)-297.1(P)11.4(h)0(y)15.5(s)0(i)17.7(c)0(i)18.4(a)0(n)15.1(s)-303.6(ex)15.1(pe)20.8(rt)17.3(s)]TJ
T*
[(in)-294.1(th)18.8(is)-295.3(t)13.9(y)0(p)15.5(e)-302.8(of)-287.7(kn)15.5(ow)17.3(le)18.4(dg)15.5(e)-297.1(a)0(r)13.5(e)-297.1(ge)15.1(ne)20.8(ra)13.5(ll)16.5(y)-296.7(f)0(a)13.5(r)-298.3(re)19.2(mo)12.4(ve)20.8(d)-302.4(f)0(r)18(o)0(m)]TJ
T*
[(in)13.2(te)18.4(ns)20(iv)18.9(e)-314.2(c)0(a)14.7(r)0(e)-305.1(m)0(e)17.7(d)0(i)13.2(c)0(i)18.4(n)0(e)20.8(,)-313.4(an)15.1(d)-313.8(p)0(e)20.8(r)0(t)11.6(a)0(i)18.4(n)0(,)-302.7(f)0(o)19.6(r)-315.3(th)18.8(e)-314.1(m)0(o)12.4(s)0(t)-306.7(p)0(a)20.8(r)0(t)17.3(,)-313.4(to)]TJ
T*
[(th)13.2(e)-331.2(d)0(o)21.2(m)0(a)17.7(i)0(n)-322.6(o)0(f)-321.8(r)0(e)13.5(s)0(p)20(i)0(r)17.3(a)0(t)18.5(o)0(r)14(y)-330.8(an)20.8(d/)13.2(or)-321.8(sl)17.7(ee)20.4(p)-330.8(m)0(e)12(d)0(i)18.9(c)0(i)18.5(n)0(e)20.8(.)-330.4(Fo)16.3(r)-332.4(t)0(h)18.9(i)0(s)]TJ
T*
[(ty)13.2(pe)-297.8(of)-299(sp)20(ec)20.4(ia)12.8(li)16.5(st)17.7(s,)-292.6(ti)16.5(da)15.1(l)-304.7(v)0(o)15.5(l)0(u)18.8(m)0(e)-301(a)0(t)-294.5(0)0(:)13.2(0)0(0)-297.4(m)0(a)17.7(y)-308.1(be)-297.8(qu)21.2(it)16.5(e)-308.5(d)0(i)18.9(f)0(-)]TJ
0 -1.0641 TD
[(fe)13.5(re)19.2(nt)-316.9(fr)18(om)-317.7(ti)16.5(da)20.8(l)-327.5(v)0(o)21.2(l)0(u)18.8(m)0(e)-318.1(a)0(t)-317.3(1)0(2)15.5(:)13.9(00)-320.2(h.)]TJ
1.0015 -1.0471 TD
[(A)-277.8(c)0(u)15.1(r)0(i)17.3(o)0(u)21.2(s)-275.1(\(b)13.9(ut)-265.7(tr)17.3(iv)18.9(ia)18.4(l\))-267.3(ob)21.2(se)13.9(rv)19.6(at)18.4(io)13.2(n)-273.9(i)0(s)-266.9(t)13.9(ha)15.1(t)-276.3(e)0(x)20.8(p)0(e)15.1(r)0(t)17.3(s)-275.1(in)-265.7(di)18.9(f-)]TJ
-1.0015 -1.0584 TD
[(fe)13.5(re)19.2(nt)-220.2(as)13.9(pe)20.8(ct)18.5(s)-229.6(o)0(f)-225.1(m)0(e)17.7(d)0(i)18.9(c)0(i)18.5(n)0(e)-223.9(r)0(a)19.2(r)0(e)19.2(l)0(y)-225.8(s)0(p)20(e)0(a)20.4(k)-234.1(to)-220.1(ea)20.4(ch)-223.9(ot)18.9(he)20.8(r)60.2(.)-233.7(Mo)19.3(re)]TJ
0 -1.0641 TD
[(tr)17.3(ou)15.5(bl)18.9(es)13.9(om)18.1(e)-354(i)0(s)-352.2(t)0(h)18.9(e)-359.7(fa)19.2(ct)-345.7(th)13.2(at)18.4(,)-353.2(w)0(h)17.3(e)0(n)-349.1(t)0(h)13.2(e)0(y)-343.4(s)0(p)14.4(e)0(a)20.4(k)-359.3(to)-345.3(on)15.5(e)-359.7(a)0(n)20.8(-)]TJ
0 -1.0584 TD
[(ot)13.2(he)20.8(r)37.5(,)-273.5(th)13.2(ey)-263.7(ra)13.5(re)19.2(ly)-271.4(un)21.2(de)15.1(rs)18.4(ta)18.4(nd)-269(wh)17.3(at)-271.8(th)18.8(e)-280(o)0(t)18.9(h)0(e)20.8(r)-281.2(pe)20.8(rs)12.8(on)-263.3(me)12(an)20.8(s)]TJ
T*
[(as)-264.9(th)18.9(e)-274.3(d)0(i)18.9(s)0(c)19.6(o)0(u)15.5(r)0(s)18.4(e)-268.6(go)15.5(es)-264.9(t)13.9(h)0(r)13.9(o)0(u)21.2(g)0(h)-263.3(t)0(h)18.9(e)-274.3(va)20.8(ri)17.3(ou)15.5(s)-269.4(f)0(i)17.3(l)0(t)16.5(e)0(r)19.2(s)-275.1(im)15.7(be)20.8(dd)15.5(ed)]TJ
T*
[(in)-351(th)18.9(e)-359.7(b)0(r)19.6(a)0(i)18.5(n)0(.)-348.3(T)0(h)17.1(u)0(s)20(,)-358.9(it)-347.7(co)15.1(me)17.7(s)-354.8(a)0(s)-350.2(n)0(o)-348.7(s)0(u)20(r)0(p)13.9(r)0(i)17.3(s)0(e)-344.6(t)0(h)18.9(a)0(t)-351.4(i)0(n)18.9(t)0(e)18.5(n)0(s)14.3(i)0(v)18.9(e)]TJ
T*
[(ca)14.7(re)-208.4(an)20.8(d)-217(s)0(l)17.7(e)0(e)20.4(p)-217(sp)20(ec)14.7(ia)18.4(li)16.5(st)17.7(s)-212.5(d)0(o)-206.4(n)0(o)21.2(t)-219.4(co)20.8(mm)14.9(un)15.5(ic)18.5(at)18.5(e.)-206.4(T)12.2(h)0(i)13.2(s)-212.5(la)18.4(ck)-206.8(of)]TJ
T*
[(di)13.2(al)18.4(og)21.2(ue)-303.5(is)-306.7(fa)19.2(ci)12.8(li)22.2(ta)12.8(te)18.4(d)-313.8(b)0(y)-303.1(t)0(h)18.9(e)-314.2(ex)20.8(ot)13.2(ic)-300.2(na)15.1(tu)18.9(re)-305.1(of)-304.7(ea)14.7(ch)-303.5(ot)18.9(he)20.8(r)]TJ
/F5 1 Tf
22.2045 0 TD
(')Tj
/F4 1 Tf
0.2106 0 TD
(s)Tj
-22.4151 -1.0584 TD
[(kn)15.5(ow)17.3(le)18.4(dg)15.5(e.)-229.2(F)11.4(o)0(r)-230.7(t)13.9(he)-229.6(in)18.8(te)12.8(ns)20(iv)18.8(e)-240.2(c)0(a)20.4(r)0(e)-231.2(s)0(p)20(e)0(c)14.7(i)0(a)18.5(l)0(i)16.5(s)0(t)17.7(,)-233.7(sl)17.7(ee)14.7(p)-234.1(l)0(i)16.5(e)0(s)-230.7(o)0(u)21.2(t)0(-)]TJ
0 -1.0641 TD
[(si)17.7(de)-360.4(hi)13.2(s)-366.1(f)0(i)17.3(e)0(l)18.4(d)-370.7(of)-361.6(pe)20.8(rs)18.4(on)15.5(al)-362.8(or)-355.9(pr)13.9(of)19.6(es)19.6(si)17.7(on)15.5(al)-362.8(ex)20.8(pe)15.1(ri)17.3(en)20.8(ce)14.7(.)-364.6(P)0(a)15.9(-)]TJ
0 -1.0584 TD
[(ti)16.5(en)15.1(ts)-323.8(sl)12(ee)20.4(p)-336.5(v)0(e)20.8(r)0(y)-327.5(b)0(a)15.1(d)0(l)18.9(y)-336.5(in)-328.3(th)18.9(e)-336.9(i)0(n)18.8(t)0(e)18.4(n)0(s)14.3(i)0(v)18.9(e)-336.9(ca)14.7(re)-322.2(un)15.5(it)16.5(,)-336.1(w)0(i)14.9(t)13.9(h)-336.5(i)0(t)16.5(s)]TJ
T*
[(no)15.5(is)17.7(y)-495.8(e)0(n)15.1(v)0(i)18.9(r)0(o)13.9(n)0(m)18.1(e)0(n)20.8(t)-498.2(an)15.1(d)-495.8(p)0(e)15.1(r)0(m)16.5(a)0(n)20.8(e)0(n)15.1(t)-498.2(ar)19.2(ti)16.5(fi)17.3(ci)12.8(al)-488(li)16.5(gh)21.2(ti)16.5(ng)15.5(,)-495.5(i)0(n)]TJ
T*
[(wh)17.3(ic)12.8(h)-410.5(n)0(u)21.2(r)0(s)12.8(e)0(s)-401.5(a)0(n)20.8(d)-410.5(ph)15.5(ys)20(ic)12.8(al)-402.7(th)18.8(er)19.2(ap)15.1(is)17.7(ts)-403.4(fr)18(eq)20.8(ue)15.1(nt)18.9(ly)-402.2(pe)15.1(rf)18(or)19.6(m)]TJ
T*
[(va)15.1(ri)17.3(ou)15.5(s)-223.9(c)0(o)20.8(n)0(t)13.2(r)0(o)19.6(l)0(s)17.7(,)-222.3(ir)17.3(re)13.5(sp)20(ec)14.7(ti)16.5(ve)-212.5(of)-219.4(th)18.9(e)-223.1(t)0(i)16.5(m)0(e)-221.3(o)0(f)-213.7(d)0(a)15.1(y)-222.7(or)-219.4(ni)18.9(gh)15.5(t)-225.1([)0(1)19.6(,)]TJ
T*
[(2].)-362(For)-361.6(the)-357.9(tradi)-10.6(tional)-359.2(sleep)-366.7(specia)-9.4(list,)-358.9(organ)-352.9(failure)-366.9(and)]TJ
0 -1.0641 TD
[(suppor)-7.4(t,)-276.7(invasive)-280.3(moni)-8.6(toring,)-278.8(sedation)-280.3(and)-275.8(paral)-8.6(ysis,)-275.7(and)]TJ
0 -1.0584 TD
[(lif)-8.6(e)-354(and)-361.2(death)-365.5(are)-357.5(remo)-8.2(te)-357.1(no)-7.2(tions,)-363(rarely)-363.8(encount)-8.5(ered)-358.3(in)]TJ
T*
[(thei)-8.2(r)-366.6(everyda)-8.1(y)-370.7(profes)-9.4(sional)-375.1(experie)-10.5(nce.)-367.7(In)-373(the)-369.3(treat)-11(ment)]TJ
T*
[(of)-395.8(patients)-396.5(with)-393(respirato)-11.1(ry)-390.1(failure,)-401.4(this)-390.3(absence)-395.1(of)-390.1(dia-)]TJ
T*
[(logue)-342.3(may)-335.9(have)-339.6(deleterio)-11.1(us)-332.8(healt)-9.4(h)-330.8(consequ)-7.3(ences.)]TJ
1.0015 -1.0528 TD
[(Un)11.6(t)13.9(i)0(l)-222.5(v)0(e)15.1(r)0(y)-219.4(r)0(e)13.5(c)0(e)20.4(n)0(t)13.2(l)13.9(y)67.5(,)-228(th)18.9(e)-234.5(e)0(s)19.6(s)0(e)19.6(n)0(t)13.2(i)13.9(al)-226.2(di)18.9(f)20.4(f)0(e)13.5(r)0(e)19.2(n)0(c)20.8(e)-234.5(be)20.8(tw)14.9(ee)14.7(n)-228.4(m)0(e)17.7(-)]TJ
-1.0015 -1.0584 TD
[(ch)15.1(an)15.1(i)13.9(c)0(a)14.7(l)-276.3(ve)15.1(nt)18.9(il)16.5(at)18.5(io)18.9(n)-279.6(a)0(p)15.1(p)0(l)18.9(i)0(e)18.4(d)-279.6(in)18.9(si)17.7(de)-269.4(or)-270.6(ou)21.2(ts)17.7(id)18.9(e)-280(t)0(h)18.9(e)-280(in)18.9(te)18.5(ns)14.3(iv)18.9(e)]TJ
T*
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[(leakag)-8.2(e,)-291.8(and)-298.6(also)-291.6(found)-301.3(that)-292.7(sleep)-298.4(was)-298(of)-293.3(very)-295.3(p)-6.5(oor)-294.1(qua-)]TJ
0 -1.0471 TD
[(lity)58.1(,)-455.6(with)-461.3(excess)-8.2(ive)-460.3(sleep)-463.4(disruption)-467.1(by)-456.8(short)-458.5(arousa)-8.2(ls.)]TJ
0 -1.0528 TD
[(When)-294.8(mout)-8.6(h)-291(leaks)-298.4(wer)-8.2(e)-291.4(abolished)-303.8(\(with)-298.6(a)-291.4(quite)-299.2(efficient)]TJ
0 -1.0471 TD
[(though)-490.7(prim)-10.2(itive)-489.4(met)-8.2(hod:)-489.1(patients)-493.2(wer)-8.2(e)-484.9(gagged)-11.1(\),)-486.4(both)]TJ
0 -1.0528 TD
[(sleep)-264.3(and)-264.5(venti)-9(latory)-267.4(improved,)-270.1(and)-264.5(nIPPV)-263.8(bec)-8.8(ame)-262.3(more)]TJ
T*
[(efficient.)-246.4(T)]TJ
6.974 0 0 6.974 101.764 258.973 Tm
0.0001 Tc
[(ESCHL)-9.9(ER)]TJ
/F7 1 Tf
9.963 0 0 9.963 135.042 258.973 Tm
0 Tc
[(et)-243.3(al.)]TJ
/F4 1 Tf
2.2136 0 TD
[([10])-250.9(found)-244.4(that)-247.2(large)-241.9(leaks)-247.2(could)]TJ
-9.9186 -1.0471 TD
[(be)-212.5(o)-6.5(bserved,)-219.9(without)-221.3(obviou)-7(s)-212.5(openin)-7.4(g)-211.3(o)0(f)-219.4(the)-215.6(mouth,)-220.3(as)-213.7(air)]TJ
0 -1.0528 TD
[(escaped)-264.2(throu)-7.8(gh)-251.9(a)-257.2(corner)-264.7(of)-259.2(the)-255.5(apparen)-8.2(tly)-263.1(closed)-259.3(mout)-8.6(h.)]TJ
0 -1.0471 TD
[(It)-358.3(is)-352.2(unfort)-10.1(unate)-359.8(that)-355.3(the)-357.9(author)-9(s)-354.8(d)0(o)-354.3(not)-357.5(mention)-360.8(the)-357.9(re-)]TJ
0 -1.0528 TD
[(lationsh)-9.2(ip)-334(between)-337.2(leaks)-338.2(and)-332.7(arousa)-8.2(ls.)-335.5(They)-331.9(provi)-7.8(de)-332(the)]TJ
0 -1.0471 TD
[(informat)-11.9(ion)-357.5(that)-355.3(the)-357.9(arousa)-8.2(l)-350.3(index)-359.4(was)-360.6(excessivel)-10.7(y)-353.6(high)]TJ
0 -1.0527 TD
[(durin)-7.8(g)-336.5(the)-335.1(contr)-8.2(ol)-334(night)-8.6(,)-336.1(and)-332.8(was)-343.6(reduced)-343.9(by)-331.6(more)-343.9(than)]TJ
0 -1.0471 TD
[(half)-235.1(with)-233.7(mouth)-231.3(closu)-7.8(re.)-231.5(It)-227.4(woul)-9.4(d)-228.4(have)-231.5(been)-231.5(inte)-8.2(resting)-235.2(to)]TJ
0 -1.0527 TD
[(know)-416.7(whet)-9.8(her)-419.7(arousals)-423(were)-419.1(due)-418.1(to)-413.6(leaks)-8.2(,)]TJ
/F7 1 Tf
17.9821 0 TD
(i.e.)Tj
/F4 1 Tf
1.6218 0 TD
[(whet)-9.8(her)]TJ
-19.6039 -1.0471 TD
[(they)-273.3(wer)-8.2(e)-268.6(more)-281.3(prevalent)-281.9(during)-276(perio)-8.2(ds)-270.2(with)-279.2(lar)10.4(ge)-275.1(leaks)]TJ
0 -1.0527 TD
[(than)-426.9(durin)-7.8(g)-421.9(perio)-8.2(ds)-423.8(with)-427.2(less)-429.3(or)-424.2(no)-422.6(leaks)-8.2(.)-421.5(Simi)-10.2(larly)57.7(,)-421.5(i)0(t)]TJ
T*
[(would)-516.6(have)-521.7(been)-516(interest)-11.1(ing)-511.1(to)-516.1(know)-519.1(whether)-520.5(durin)-7.8(g)]TJ
0 -1.0471 TD
[(large)-264.7(leaks)-270(effective)-272.5(ventilat)-10.7(ion)-266.4(\(the)-274.9(ventilat)-10.7(ion)-266.4(effective-)]TJ
0 -1.0528 TD
[(ly)-499(reaching)-500.7(the)-500.2(lungs\))-499.1(decreas)-9.7(ed,)-497.4(or)-492.5(dropped)-502.4(to)-499(zero.)]TJ
0 -1.0471 TD
[(Since)-290.7(they)-290.4(measured)-292.1(ribca)-8.6(ge)-286.5(and)-287.2(abdom)-7.4(inal)-292.7(movement)-9.9(s,)]TJ
25.1977 66.1583 TD
[(this)-276.5(informat)-11.9(ion)-266.4(was)-275.3(available)-277.4(from)-276.8(their)-272.3(record)-8.6(ings.)-274.5(Gas)]TJ
0 -1.0471 TD
[(deli)-8.2(vered)-433(from)-441.9(the)-431.9(ventilat)-10.7(or)-429.9(can)-435.6(follow)-436(severa)-8.6(l)-435.6(routes)]TJ
0 -1.0528 TD
[(durin)-7.8(g)-416.2(nIPPV)66.2(:)-412.9(1)0(\))-412.8(i)0(t)-416(can)-418.5(leak)-416(betw)-9.8(een)-412.8(the)-414.8(skin)-422(and)-412.4(the)]TJ
T*
[(mask)-7.8(;)-304.7(2)0(\))-310.4(i)0(t)-307.9(can)-304.7(leak)-307.8(throu)-7.8(gh)-308.8(the)-306.7(mouth,)-311.3(flowin)-9.2(g)-302.4(throu)-7.8(gh)]TJ
0 -1.0471 TD
[(the)-357.9(verol)-8.2(ingual)-356.9(sphin)-7.4(cter)26.3(,)-353.2(the)-357.9(virtual)-361.6(oral)-360.2(cavity)-357.3(and)-355.5(the)]TJ
0 -1.0527 TD
[(lips)-9(;)-424.2(3)0(\))-429.9(i)0(t)-427.4(can)-429.9("leak")-429.1(into)-428.9(the)-431.9(pharynx)-7.3(,)-427.2(pushin)-8.1(g)-421.9(out)-431.5(its)]TJ
0 -1.0471 TD
[(compl)-9.7(iant)-344(walls)-344.2(and)-338.4(rema)-8.6(ining)-338.6(there)-344.3([1)31(1)-6.5(])0(;)-335.6(4)0(\))-338.9(i)0(t)-342(can)-338.8(leak)]TJ
0 -1.0527 TD
[(into)-337.9(the)-340.8(digestiv)-9.2(e)-331.2(tract)-11(,)-330.4(throu)-7.8(gh)-337.3(the)-335.1(weak)-337.8(superi)-10.1(or)-333.2(oeso-)]TJ
0 -1.0471 TD
[(pha)-8.4(geal)-307.8(sphincter;)-314.3(and)-304.3(final)-10.6(ly)64.4(,)-307.7(5)0(\))-304.7(i)0(t)-302.2(c)0(a)-8(n)-302.4(flow)-306.9(throu)-7.8(gh)-303.1(the)]TJ
0 -1.0527 TD
[(glot)-7.8(tis)-230.2(into)-235.4(the)-232.7(respi)-9.4(ratory)-232.5(tract)-11(,)-228(the)-232.7(only)-233.1(useful)-237.8(route.)-236.2(The)]TJ
0 -1.0471 TD
[(glot)-7.8(tis)-469.2(is)-466(an)-468.6(essential)-472.8(stru)-8.2(cture)-469.5(in)-464.8(nIPPV)117.4(,)-467(since,)-469.5(in)-464.8(re-)]TJ
0 -1.0528 TD
[(sponse)-382.9(to)-373.8(assi)-8.2(sted)-376.9(ventilat)-10.7(ion)-374.6(with)-381.6(positive)-384.7(pressures,)-384.7(it)]TJ
0 -1.0471 TD
[(can)-247.8(substanti)-11.1(ally)-247.2(narrow)-245.4(and)-247.4(even,)-243.2(compl)-9.7(etely)-242.7(close)-8.2(,)-239.4(thus)]TJ
0 -1.0527 TD
[(incre)-8.6(asing)-275.2(the)-266.8(risk)-8.2(s)-263.7(o)0(f)-270.6(leaks)-8.2(,)-267.8(decreas)-9.7(ing)-266.4(the)-272.5(usefuln)-10.9(ess)-266.8(of)]TJ
0 -1.0471 TD
[(nIP)-8.8(PV)-255.1(and)-361.2(impairin)-12.7(g)-353.6(sleep)-366.7(quality)-365.7([12,)-362.8(13].)-362.8(It)-358.3(has)-362.4(been)]TJ
0 -1.0527 TD
[(show)-8.2(n)-308.1(that)-315.5(changin)-8.5(g)-308.1(the)-312.4(delivered)-316(tida)-8.2(l)-304.7(volum)-9.3(e,)-308.8(inspira-)]TJ
T*
[(tory)-268.8(flow)-261.3(and)-264.5(ventilat)-10.7(ory)-260(freque)-8.6(ncy)59.9(,)-262.2(o)0(r)-259.2(the)-261.2(posit)-9.8(ive)-261.2(inspi-)]TJ
0 -1.0471 TD
[(rator)-9.8(y)-387.7(press)-8.2(ure)-396.9(\(as)-392.4(well)-393.4(as)-395.8(manipulat)-12.3(ing)-391.6(the)-392(venti)-9(latory)]TJ
0 -1.0527 TD
[(mode\))-9(,)-222.3(can)-225(infl)-9.4(uence)-227(the)-227(glottic)-231.5(respon)-7.8(se)-225.1(and)-224.6(improve)-229.1(the)]TJ
0 -1.0471 TD
[(ven)-8.4(tilation)-496.4(effectively)-492.7(reachi)-9.8(ng)-490.9(the)-494.5(lungs)-496.8(during)-492.3(sleep)]TJ
0 -1.0527 TD
[([14,)-385.5(15].)-379.8(T)]TJ
6.974 0 0 6.974 354.274 562.394 Tm
0.0001 Tc
[(ESCHL)-9.9(ER)]TJ
/F7 1 Tf
9.963 0 0 9.963 388.857 562.394 Tm
0 Tc
[(et)-379.9(al.)]TJ
/F4 1 Tf
2.4868 0 TD
[([10])-381.8(attr)-9.8(ibuted)-379.6(the)-380.7(decreas)-9.8(e)-376.7(i)0(n)]TJ
-10.4706 -1.0471 TD
[(ven)-8.4(tilation)-342.8(and)-338.4(the)-340.8(poor)-340.4(sleep)-343.9(quality)-342.9(to)-334(the)-340.8(presen)-8.2(ce)-338.1(of)]TJ
0 -1.0527 TD
[(leaks)-491.9(\()]TJ
/F7 1 Tf
2.8453 0 TD
(i.e.)Tj
/F4 1 Tf
1.6958 0 TD
[(once)-487.6(a)-484.9(leak)-489.9(appears)-9.3(,)-484.1(ventilat)-10.7(ion)-482.7(decreas)-9.8(es\).)]TJ
-4.5411 -1.0471 TD
[(Indeed,)-252.1(they)-250.5(include)-249.9(a)-240.2(study)-252.1(in)-242.9(norm)-7.8(al)-243.3(subje)-7.8(cts)-245.3(and)-247.4(a)-240.2(ma-)]TJ
0 -1.0527 TD
[(them)-9(atical)-365.7(model)-362.6(showing)-360(that)-8.2(,)-353.2(durin)-7.8(g)-359.3(voluntary)-366.4(mouth)]TJ
0 -1.0471 TD
[(leaks)-247.2(pha)-8.4(ryngeal)-249.1(pressure)-251.5(swings)-246.6(decreas)-9.7(e,)-240.6(thus)-245.6(loweri)-9.6(ng)]TJ
0 -1.0528 TD
[(the)-221.3(positive)-219.7(press)-8.2(ure)-214.8(avail)-9.4(able)-216.8(to)-214.5(move)-222.8(gas)-214.4(molec)-10.1(ules)-217.6(into)]TJ
0 -1.0471 TD
[(the)-301(lungs.)-298(This)-301(is)-295.3(simply)-303.9(natural,)-303.1(but)-294.9(does)-300.6(not)-294.9(prove)-301.7(that)]TJ
0 -1.0527 TD
[(ven)-8.4(tilation)-268.8(decreas)-9.7(es)-259.2(durin)-7.8(g)-262.5(sleep)-264.3(because)-269.9(of)-264.9(leaks.)-264.7(W)72(ere)]TJ
T*
[(the)-312.4(glottis)-312(to)-311.2(narrow)-313.7(during)-310.2(sleep)-8.2(,)-307.7(the)-306.7(glottic)-316.9(route)-309.8(resis-)]TJ
0 -1.0471 TD
[(tance)-246.4(would)-243.4(incre)-8.6(ase,)-243.7(and)-241.7(for)-238.8(a)-240.2(given)-245.6(inspirat)-10.7(ory)-242.9(pressure)]TJ
0 -1.0528 TD
[(less)-252.9(air)-257.1(would)-249.1(flow)-255.7(into)-252.5(the)-255.5(larynx)-253.7(and)-247.4(ulti)-10.2(mately)-252.3(into)-252.5(the)]TJ
0 -1.0471 TD
[(lungs)-7.4(.)-307.7(I)0(t)-307.1(has)-311.2(been)-311.2(show)-8.2(n)-302.4(that)-315.5(this)-310.6(increase)-314.5(in)-311.2(glottic)-311.2(res-)]TJ
0 -1.0527 TD
[(ist)-8.2(ance)-322.9(can)-321.8(be)-320.6(substanti)-11.1(al)-317.3(using)-326.1(both)-324.1(volume-cyc)-10.3(led)-323.7(and)]TJ
0 -1.0471 TD
[(press)-8.2(ure-cy)-8.6(cled)-245.2(ventilat)-10.7(ors)-238.4([12,)-243.3(16].)-243.3(Thu)-6.4(s,)-241.3(the)-244.1(continuous)]TJ
0 -1.0527 TD
[(gas)-277(flow)51.6(,)-273.5(coming)-278(from)-282.5(a)-274.3(two-le)-9.6(vel)-272.5(posit)-9.8(ive)-272.5(p)-6.5(ressure)-279.2(ven-)]TJ
0 -1.0471 TD
[(tilator)17.3(,)-307.7(would)-311.7(foll)-9.4(ow)-307.1(the)-312.4(route)-8.2(s)-309.2(o)0(f)-310.4(low)-8.6(er)-310.8(resistanc)-11.1(e,)-308.8(such)]TJ
0 -1.0528 TD
[(as)-378.7(the)-380.7(mout)-8.6(h,)-376.7(and)-378.3(mout)-8.6(h)-376.3(leaks)-383.8(\(amongst)-384.7(other)-8.2(s\))-379.9(would)]TJ
0 -1.0471 TD
[(incre)-8.6(ase)-419.7(follo)-10.2(wing)-419.1(\(not)-422.4(precedi)-10.5(ng)-416.9(and)-418.1(causi)-8.2(ng\))-419.3(the)-420.5(de-)]TJ
0 -1.0528 TD
[(crease)-287.8(in)-277.1(ve)-7.6(ntilation.)-287(Once)-280.9(the)-283.9(leak)-279.4(is)-283.9(established,)-287(phary-)]TJ
0 -1.0471 TD
[(nge)-8.4(al)-277.5(press)-8.2(ure)-277.4(swings)-286.4(would)-283.3(of)-282(course)-281.3(decreas)-9.8(e.)-280.4(For)-281.9(this)]TJ
0 -1.0527 TD
[(to)-459.2(be)-457.2(true,)-457.4(the)-454.6(pati)-8.2(ents)-456.6(shoul)-7.4(d)-450.3(hav)-8.4(e)-450.7(stopp)-7.4(ed)-457.2(breathing)]TJ
T*
[(spont)-7.4(aneousl)-9.7(y)61.8(,)]TJ
/F7 1 Tf
6.2368 0 TD
(i.e.)Tj
/F4 1 Tf
1.5535 0 TD
[(the)-352.2(venti)-9(lator)-352(set)-347.7(in)-351(the)-352.2(spontaneous/)]TJ
-7.7904 -1.0471 TD
[(time)-11.4(d)-507.2(\(S/T\))-519.2(mode)-513.1(shoul)-7.4(d)-507.2(behave)-517.9(in)-510.4(the)-511.5(tim)-10.2(ed)-508.4(mode.)]TJ
0 -1.0528 TD
[(Indeed,)-508.1(in)-504.7(the)-505.8(spontaneous)-509(mode,)-507.8(the)-505.8(glottic)-504.7(ap)-7.6(erture)]TJ
0 -1.0471 TD
[(rema)-8.6(ins)-341.6(norm)-7.8(al)-340.1(durin)-7.8(g)-342.2(nIPPV)-292.3(in)-339.6(sleep)-343.9([10].)-348.1(It)-341.2(is,)-341.2(again,)]TJ
0 -1.0528 TD
[(unfort)-10.1(unate)-359.8(that)-366.7(T)]TJ
6.974 0 0 6.974 382.79 290.381 Tm
0.0001 Tc
[(ESCHL)-9.9(ER)]TJ
/F7 1 Tf
9.963 0 0 9.963 417.203 290.381 Tm
0 Tc
[(et)-357.1(al.)]TJ
/F4 1 Tf
2.4469 0 TD
[([10])-359.1(did)-363.2(not)-357.5(infor)-9.4(m)-356.7(the)]TJ
-13.2761 -1.0471 TD
[(reader)-452.8(whet)-9.8(her)-448.2(the)-443.3(ve)-7.6(ntilator)-450.1(was)-451.7(triggered)-453.8(by)-445.4(the)-448.9(pa-)]TJ
0 -1.0528 TD
[(tien)-8.2(ts)-289.6(or)-287.6(funct)-8.2(ioned)-291.1(in)-288.4(the)-289.6(tim)-10.2(ed)-286.5(mode)-291.1(\(both)-292.3(are)-294.9(possible)]TJ
0 -1.0471 TD
[(in)-339.7(the)-335.1(S/T)-338.1(mode\))-339(durin)-7.8(g)-330.8(perio)-8.2(ds)-332.8(with)-341.8(lar)10.4(ge)-337.7(leaks)-8.2(.)]TJ
1.0015 -1.0528 TD
[(It)-307.1(is)-306.7(us)14.4(ef)19.2(ul)-305.5(to)-311.2(st)17.7(re)19.2(ss)-305.5(th)18.9(at)-311.6(no)21.2(ct)18.4(ur)13.9(na)20.8(l)-316.1(n)0(o)15.5(n)0(i)18.9(n)0(v)21.2(a)0(s)13.9(i)0(v)18.8(e)-314.1(ve)15.1(nt)18.8(il)16.5(a-)]TJ
-1.0015 -1.0471 TD
[(ti)16.5(on)-229.2(is)-227(no)21.2(t)-236.5(a)-240.2(t)13.9(r)0(e)13.5(a)0(t)18.4(m)0(e)17.7(n)0(t)-225.8(f)0(o)13.9(r)-235.7(no)21.2(ct)12.8(ur)19.6(na)15.1(l)-236.5(r)0(e)19.2(s)0(p)20(i)0(r)17.3(a)0(t)12.8(o)0(r)19.6(y)-234.1(fa)13.5(i)13.9(l)0(u)13.2(r)0(e)19.2(.)-233.7(It)-227.4(is)]TJ
0 -1.0527 TD
[(a)-234.5(t)0(r)17.3(e)0(a)20.4(t)0(m)15.7(e)0(n)15.1(t)-230.8(fo)19.6(r)-230(p)0(e)15.1(r)0(m)16.5(a)0(n)20.8(e)0(n)15.1(t)-230.8(re)19.2(sp)14.3(ir)17.3(at)18.5(or)19.6(y)-234.1(f)0(a)19.2(i)0(l)16.5(u)0(r)19.6(e)-234.5(t)13.9(h)0(a)15.1(t)-230.8(is)-221.3(ap)15.1(pl)18.8(ie)18.4(d)]TJ
0 -1.0471 TD
[(du)15.5(ri)17.3(ng)-434(sl)17.7(ee)20.4(p.)-433.6(It)-432.3(is)17.7(,)-444.2(i)0(n)18.8(d)0(e)15.1(e)0(d)20.8(,)-444.2(du)21.2(ri)17.3(ng)-434(sl)17.7(ee)14.7(p)-438.9(t)0(h)18.9(a)0(t)-436.8(r)0(e)19.2(s)0(p)20(i)0(r)17.3(a)0(t)12.8(o)0(r)19.6(y)]TJ
0 -1.0528 TD
[(fa)13.5(il)16.5(ur)19.6(e)-319.8(i)0(s)-312.4(m)0(o)18.1(s)0(t)-312.4(s)0(e)14(v)0(e)20.8(r)0(e)-310.8(b)0(e)15.1(c)0(a)14.7(u)0(s)20(e)-319.8(of)-310.4(th)13.2(e)-319.8(a)0(d)20.8(d)0(e)15.1(d)-319.4(im)15.7(pa)20.8(ct)-317.3(of)-310.4(th)18.9(e)]TJ
T*
[(sl)17.7(ee)14.7(p-)19.6(de)15.1(pe)20.8(nd)15.5(en)15.1(t)-373(d)0(e)20.8(c)0(r)13.5(e)0(a)20.4(s)0(e)-367.3(i)0(n)-368.1(v)0(e)20.8(n)0(t)13.2(i)13.9(la)12.8(ti)16.5(on)-360(up)15.5(on)-365.7(th)18.9(e)-376.7(a)0(l)18.5(r)0(e)19.2(a)0(d)15.1(y)]TJ
0 -1.0471 TD
[(ex)15.1(is)17.7(ti)16.5(ng)-399.9(re)19.2(sp)14.4(ir)17.3(at)18.4(or)19.6(y)-410.5(f)0(a)19.2(i)0(l)16.5(u)0(r)13.9(e)-405.2(in)-402.3(wa)16.9(ke)15.1(fu)19.6(ln)18.9(es)13.9(s.)-395(It)-403.8(is)-397.8(in)13.2(t)13.9(e)0(r)13.5(e)0(s)19.6(t)0(-)]TJ
0 -1.0527 TD
[(in)13.2(g)-404.8(t)0(o)-396.6(n)0(o)15.5(t)0(e)-397(t)0(h)18.9(a)0(t)-402.6(T)]TJ
6.974 0 0 6.974 382.734 175.294 Tm
0.0001 Tc
[(ES)18(CHL)20.9(ER)]TJ
/F7 1 Tf
9.963 0 0 9.963 417.26 175.294 Tm
0 Tc
[(et)-397(al)13.2(.)]TJ
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