🎧 Episode 7: How Sleep Apnea Secretly Sabotages Fertility: What You Need to Know
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In this episode of The WOVA Circle, I sit down with Dr. Samanta Dall Agnese, a board-certified ENT (ear, nose, throat) doctor and sleep medicine specialist with over 18 years of experience, helping patients transform their sleep, located in Spain. We dive into why addressing sleep and breathing issues is essential for fertility, hormonal balance, and overall well-being, often beyond what most people realize.
This grounded conversation explores how sleep apnea can subtly disrupt ovulation, sperm quality, hormone regulation, and even pregnancy outcomes. Dr. Samanta explains why symptoms often go undiagnosed and how early recognition and intervention can dramatically improve reproductive health and long-term health for both partners.
What You'll Learn in This Episode
How sleep quality and sleep apnea can impact hormones, ovulation, egg quality, sperm health, and fertility outcomes
The connection between sleep, insulin resistance, inflammation, and reproductive health
Why symptoms like fatigue, snoring, or poor sleep are often overlooked during the fertility journey
How sleep apnea is diagnosed and why it frequently goes undetected in people trying to conceive
Treatment options including CPAP therapy, mandibular devices, lifestyle changes, and nutrition support
Practical strategies to improve sleep quality and support overall fertility health
How stress, nervous system regulation, and sleep all work together in whole-body wellness
Common myths and misconceptions around sleep, snoring, and reproductive health
Why addressing sleep early may support both fertility outcomes and long-term health
⏱ Listen time: 57 minutes
🎧 Format: Video & Audio
📍 Best for: Individuals and couples considering or undergoing IVF, those wanting to better understand fertility treatment, and anyone looking for a more informed, balanced approach to reproductive health
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Podcast Transcript
Introduction
Gabie: Welcome to The WOVA Circle: real talk on fertility, wellness, and trying to conceive. I'm Gabie Peytchev, founder of WOVA Health and fertility educator. This podcast is your community space for navigating the path to parenthood with evidence-based insights, authentic conversations, and genuine support. I'm dedicated to being here with you through every part of your journey.
One of the most shocking things about sleep and fertility is how quietly and profoundly poor sleep can sabotage reproductive health. For women, even moderate sleep disruption can double the risk of infertility, disrupt hormones, trigger irregular periods, and increase the risk of early pregnancy loss. For men, poor sleep is linked to lower testosterone, reduced sperm motility, and can even damage reproductive cells directly. Yet sleep is rarely discussed in OB/GYN offices or fertility clinics, despite its powerful impact on outcomes.
That's why I'm excited to have Dr. Samanta Dall Agnese with us today. She's a board-certified ear, nose, throat, and sleep medicine specialist with over 18 years of experience helping patients transform their sleep health. She's also part of the WOVA expert network, where she supports individuals and couples as a sleep coach while they're trying to conceive. She's a member of the World Association of Sleep Medicine and the European Sleep Research Society.
Samanta, there's so much people don't know about how sleep actually affects fertility. What are some of the biggest sleep issues affecting fertility, and why don't people hear about this more often?
Why Sleep Matters So Much for Fertility
Samanta: Thank you so much, Gabie, for the invitation. It's a pleasure to be here talking about sleep. We all sleep, right? So we should be talking about sleep in any circumstance — and when it comes to fertility, sleep has a huge impact on our ability to conceive. We talk about nutrition, we talk about exercise, we talk about mental health — but we barely talk about something we all do that takes about a third of our day.
Sleep is related to pretty much every function in our body. It affects mental health and the way we process emotions. We know the impact of mental health on infertility — it's well known that when a couple cannot conceive, adopts a child, reduces the pressure to get pregnant, they often then conceive. That's how much our emotions impact fertility. And the role of sleep in emotional processing is very clear in science today — better sleep means better processing of positive emotions.
Then there's the body. Hormone production has a circadian rhythm — almost every hormone we produce has a moment of the day when it peaks and a moment when it reaches its nadir, the lowest level. That correlates with our circadian rhythm, sometimes even with specific sleep stages. So if we're talking about fertility, we have to talk about sex hormones, and if we talk about sex hormones, we have to talk about sleep.
Then we have metabolism. Sleep is important for controlling blood sugar. Appetite has a strong correlation with the amount of sleep we get at night. So if we're talking about having a healthy body to be pregnant and to carry a baby, we need to talk about metabolism and glycemic regulation. In just those three dimensions, we can already see how fundamental sleep is to a successful fertility treatment.
Gabie: Sleep is one of those fundamental things — sleeping, eating, breathing, eliminating. They're so fundamental we take them for granted. But your brain always picks survival. If you're not sleeping well or eating poorly, your brain picks survival over reproduction. That's why this matters so much, even though we don't always think of it as fertility-related.
Samanta: Exactly. And another one I just remembered — sexual drive. When our body isn't working well, it preserves minimal functions for survival, and fertility isn't going to be a fundamental task. Same with sexual drive — when we're not well-rested, fed, or exercising, we're not going to be interested in a sexual encounter. That's important for fertility too — fertility is a treatment, but sexual health is just as essential.
Chronotypes and the 10pm Bedtime Myth
Gabie: You mentioned hormones — I've read multiple times that it's very important to go to bed by 10 or 10:30 PM because of how hormones peak. Is that why?
Samanta: That's actually a misconception. We have what we call chronotypes. Not everyone has to go to bed at the same time, because everyone is a bit different.
Let me give my own example. I'm what we call a morning chronotype — I prefer to go to bed early and wake up early. My ideal bedtime is around 10 PM, and my wake time is around 6 AM. If I can do that, I have the best mood and energy throughout the day. I'm most active and creative in the morning, so I do my most important tasks then. My energy starts to drop in the afternoon, and by 8 PM my brain is already shutting off.
Then there are evening chronotypes who like to go to bed late and wake up late. If you wake them up early, their brain isn't processing yet — they need coffee, they need time. But in the late afternoon, that's when they're most active and creative.
There's also an intermediate type — someone who can adjust a little better between morning and evening, and is usually less susceptible to sleep deprivation.
These chronotypes are partially genetically determined. We have some genetic load and some environmental load. I live in Spain, and Spanish people do things late — having dinner at 7 PM is way too early for a Spanish person. So when I'm in Spain I adjust slightly later — bed around 11 or 12, wake up around 7 or 8. We have some flexibility, but a morning type will never be an evening type, and an evening type will never be a morning type. Someone who likes to go to bed late and wake up late will never be productive waking up at 6 — no matter what they do. There are limits to our genetics.
So saying everyone should go to bed at 10 PM is really for morning types. Evening types would be a little later. They'll have a perfect hormonal production, but on their own schedule.
Gabie: So the 10 PM cutoff is a misconception. It's individual.
Samanta: Yes. Another way I explain this to patients is the equivalent to the phototype — the color of your skin, how easily you sunburn or tan. I'm phototype 1, you might be phototype 2 — we rarely get a tan. To get color in the summer, we have to expose ourselves to the sun for weeks, and there's a high probability of burning. No matter what you do, that's your phototype. You can't change it. Someone with darker skin can get a tan very easily. We already understand this with skin. It's the same concept for chronotype — we have some variability, some things we can change, but only within limits. With sleep, we don't have the same awareness that we have for skin color.
Sleep Through the Lens of Evolution
Gabie: Last question before we move to sleep apnea. Evolutionarily, if you go back to when we only relied on natural light — maybe a candle — and you have different skin tones and people living in different parts of the world where it gets dark earlier or later, is that impacting who is a morning person versus an evening person?
Samanta: Your view is perfect. This comes from evolution. When we lived in tribes, we needed someone awake to be vigilant — alert for risks. This is well documented even in the pre-industrial societies we still have today — groups of people who live without the influence of the industrial revolution. That's where we study most of evolution around sleep, and it's very clear. It was a safety adaptation.
Just like other species. For example — do you know how ducks sleep? They sleep in a row. The ducks at either end of the row sleep with only half of their brain at a time. One hemisphere is always keeping an eye on the outside, and after some time they switch positions so the other hemisphere can rest. That's an adaptation that ducks evolved to preserve their species. We humans had our own.
A Personal Story and the Science of Sleep Apnea
Gabie: Let's talk about a topic that's very personal to me — sleep apnea. When my husband and I were trying to conceive, I noticed over the years that he was always exhausted. He would nap late in the day, sometimes sleeping eight hours, sometimes 12 or 13 in a day. He could nap at 5 PM and still go to sleep at 9. I wondered why he was never rested. He also had weight, blood pressure, and cholesterol issues. At the time we didn't connect the dots, but I started suspecting sleep apnea.
I encouraged him to get tested, and he was diagnosed with severe sleep apnea. He began using a CPAP machine — the kind you put over your nose. Looking back, I believe sleep apnea was one of the major missing pieces in our fertility journey.
In the US, about 11% of women and 22% of men of reproductive age have obstructive sleep apnea, but many cases go undiagnosed. Over 90% of women and over 80% of men with moderate to severe sleep apnea are unaware and untreated. That's why I want to focus on sleep apnea — a lot of people think they don't have it, but if you look closer you might. And there are ways to treat it that absolutely affect your chances of conception. So first: what is sleep apnea?
Samanta: You've touched on one of the most common sleep disorders — it's the second most common after insomnia.
Let me go back a little. We have muscles in our throat that protect the airway — we call them constrictors — and muscles that open the airway — dilators. The constrictors close the airway when something might enter the lungs. When we swallow food or drink, those muscles act to send it to the stomach instead of the lungs. Coughing is a reflex that also closes the airway to protect us.
Sleep apnea happens when there's an imbalance between these two forces — the constrictors win. That's the physiological explanation.
What causes it? It's a complex disease with many drivers. One is genetic — if your parents had sleep apnea, there's a bigger chance you might have it. There are environmental and lifestyle factors. Obesity is one of the most common causes, because excess fat tissue accumulates around the muscles of the throat, making the airway shorter and tighter. We can actually see on MRI that these muscles are infiltrated by fat, so they're not working properly. I mention obesity because it's the number one factor we can intervene on — and it's why we're having such an epidemic of sleep apnea today.
Some people have anatomical differences in their face — for example, a mandible (jaw) that is positioned posteriorly, leaving less space at the back of the tongue for air to pass. We also see anatomical issues in the soft tissues — enlarged tonsils, for example, which narrow the airway. These are things we can address surgically. Those are the main causes that explain the prevalence numbers you mentioned.
Sleep Apnea, Diet, and Modern Jaw Structure
Gabie: You talked about the jaw — that reminds me of the book Breath by James Nestor. It talks about how our jaw has changed evolutionarily because of the food we eat. Modern food is much more processed and softer, so we don't exercise the jaw the way we should. The whole structure of the face is changing, and our airways are becoming more narrow.
Samanta: That's correct. We've been seeing changes in the bone structure of the face. We're eating much more processed food — which is also bad for our gut health, and gut health has its own relationship with sleep. There are many reasons we should consider going back to more raw, unprocessed food. It also helps with sleep apnea, because losing weight has an impact on the apnea index.
Gabie: And the more you exercise the jaw, that probably impacts how narrow or wide your airways are. There's a lot you can do to help with sleep apnea.
Samanta: Yes. There are specific treatments for many of these causes. One is the mandibular advancement device — a device customized by odontologists (dentists) that brings the jaw forward so the base of the tongue doesn't collapse at night, keeping the airway open.
The Hormonal Impact of Untreated Sleep Apnea
Gabie: What happens hormonally when a man has untreated sleep apnea — testosterone, cortisol spikes, insulin resistance?
Samanta: There's an important link between sleep apnea and several diseases and dysfunctions. When the muscles in the throat collapse, oxygen levels in the blood and tissues start dropping to a point where the brain has to wake us up so we can breathe. Sometimes these are micro-awakenings we don't perceive, but they're happening. Our sleep is not stable.
In sleep apnea, we're not going through normal sleep architecture — the phases of non-REM and REM sleep. We're constantly being woken up. When we look at the polysomnography (sleep study) of someone with sleep apnea, we see a lot of intrusions in brain activity because the body keeps telling the brain it needs to breathe. So we wake up, the airway opens, we go back to sleep, the problem returns. The main issue is that sleep becomes extremely fragmented. We lose a lot of the deep sleep phases, including REM, which is also a deep sleep. These patients have a much more superficial sleep.
This causes several problems for hormonal production, because many hormones are linked to specific sleep phases. If you lose normal sleep architecture, you make a mess of your hormones. What we typically see is a decrease in sex hormones. Sleep apnea is chronic — many people have it for years or even decades before they come to a doctor — so they're experiencing chronic sleep deprivation and chronic sleep fragmentation. That usually means a decrease in all sex hormone production.
So when someone with untreated sleep apnea goes to a fertility doctor and gets hormonal labs done, the levels are likely to be lower than normal. The main issue is that we need to look at this in the context of sleep apnea — and not just try to replace the hormones, but address the cause. That's a big issue today: we don't talk about sleep, and we don't investigate sleep in the context of a fertility clinic. You might have seen this in your own experience.
Gabie: Yes — I was actually the one who diagnosed it first. I was noticing his symptoms over the years and reading about it before we even went to the doctor. If it hadn't been for me, my husband probably would have gone on for years undiagnosed. He's talked to his friends about it — many of them have similar symptoms — and he tells them, "I sleep so much better with the CPAP." He's been encouraging them to see a doctor, and a lot of them resist. Maybe because they're so used to feeling that way, even though it would completely change their quality of life.
When you don't feel rested, that affects what you eat. You crave sugar. Your cortisol is all over the place. All your hormones become a mess. But you're so used to it. Do you see a lot of resistance? Is that why so many people go undiagnosed and untreated?
Treatment Options Beyond the CPAP
Samanta: Yes. I'm a sleep doctor with an ENT background, so when patients come to me, it's usually because they're looking for surgical alternatives to CPAP. I see a lot of resistance to CPAP, mainly because of misinformation. Today, CPAP machines are very compact — most are quiet or completely silent, many have travel versions. CPAP technology has evolved a lot.
We also have many treatments that are not CPAP. Surgical procedures have evolved significantly. There are procedures to correct anatomy — addressing enlarged tonsils, for example. There's plastic surgery of the throat muscles called pharyngoplasty. There are implantable devices that stimulate the dilator muscles — the ones that open the airway. So today we have many options beyond CPAP. We don't talk about these alternatives as much as we should — it would reduce the resistance people feel about seeing a doctor.
Gabie: In the movies, when you see someone with a CPAP, it's always one of those old, huge machines. That contributes to the fear factor. But like you said, there are so many options. Even a dentist can give you a device for mild sleep apnea.
Samanta: Exactly. For mild sleep apnea, the mandibular advancement device is something a dentist will customize. It's a device you wear at night that brings the jaw forward. The most important thing is for people to be aware and start investigating.
How Sleep Apnea Affects Sperm Quality and Male Fertility
Gabie: How does sleep apnea affect sperm production and sperm quality?
Samanta: We use a measure called the apnea-hypopnea index — the number of times per hour you have an apnea (complete blockage of the airway) or hypopnea (partial blockage that disrupts sleep). If someone has an index of 20, that's 20 events per hour — completely fragmented sleep. We sometimes see indices as high as 100. At that level of sleep apnea, your body is not thinking about reproduction. Sperm count will drop. Sexual drive will be reduced. Your brain and body are optimizing for survival — sperm production is not a priority.
Gabie: Can treating sleep apnea reverse or improve testosterone and sperm quality?
Samanta: Yes. There are a few articles on reversing this and increasing sperm production. It takes some time — you don't see results overnight — but in a few weeks the body can restore blood pressure and hormone production. Especially when combined with other interventions. Someone with obesity and sleep apnea who starts treating both can see a huge positive impact on sperm count, hormone production, and energy levels.
Gabie: I can confirm that from our experience. Our first IVF failed. After that, we found out about the sleep apnea. My husband started using CPAP, but he also started working out, training for a marathon. He lost weight, focused on nutrition, and stopped drinking alcohol altogether. I think all of this had a really positive impact. We had success with the next round. So yes — you can see results within just a few weeks.
Samanta: How long did it take for him to get better sleep quality and feel more energy?
Gabie: We didn't retest his sleep, but he was monitoring it himself. He saw an improvement not just in sleep but overall — after he lost weight, his quality of life improved. I think it took about two to three months.
Samanta: That's a very reasonable timeframe.
Gabie: With a lot of people it's hard to stay consistent, so things go on and off. He's still using the CPAP and likes it so much he'll probably keep using it even when his sleep improves, just because he's seen the difference. He carries it everywhere.
Samanta: When you've been prescribed the correct treatment, the first few nights you're so sleep-deprived — because someone with sleep apnea may have been sleeping many hours but with poor quality, like your husband sleeping 10 or 12. That's the body trying to compensate. He was effectively sleep-deprived even though he was sleeping many hours, because the quality was so poor. The first few nights of correct treatment — CPAP, surgery, or any other type — you immediately start seeing improvements. That experience is crucial for treatment success, because it makes such a positive impression that you keep using it. Adherence to treatment is closely tied to that first-night experience.
Recognizing the Symptoms
Gabie: What are the common symptoms of sleep apnea?
Samanta: Someone who wakes up always tired regardless of hours slept. Sometimes waking up with a headache. Often a dry mouth, because they're mouth-breathing all night. They wake up feeling their sleep wasn't restorative. They're more likely to be somnolent during the day — sleepy. The severity of the daytime sleepiness usually correlates with the severity of the sleep apnea. This person is more likely to have an accident, less productive at work, has memory issues — because memory is closely tied to good sleep. Cognitive skills aren't at their best.
At night, this is someone who snores. 100% of patients with sleep apnea have some degree of snoring. The loudness doesn't have a linear correlation with severity, but snoring is there. The partner might mention waking suffocated, waking up many times a night, agitated sleep, suffocating sensations. Some patients even mention waking up feeling like they can't breathe. Many of these patients are overweight or obese — though not all. There's a phenotype of sleep apnea in thinner people too.
Gabie: Can you have sleep apnea if you don't snore?
Samanta: I would not say so — snoring is a hallmark. The person might not know they snore if they don't have a partner, but it's very unlikely to have sleep apnea without snoring.
Sleep Apnea in Women
Gabie: Do you see different symptoms between men and women? Women often have a higher prevalence than people realize, even though men have more cases overall.
Samanta: The symptoms can shift. Women often have more mood issues — a tendency toward worse mood when sleep apnea is involved. Both men and women experience cognitive impairment — memory and comprehension are affected. But mood issues, irritability, are more pronounced in women.
Kids have their own picture too.
Sleep Apnea in Children
Gabie: Let's talk about kids. My child is two and a half. I actually think she might have sleep apnea. She snores a little, mostly when she's sick. I've noticed when she sleeps on my chest that she has breathing pauses — sometimes when she's sick, sometimes not. We're going to do a sleep study soon. Maybe you can talk about sleep apnea in children — how common it is and what symptoms you see.
Samanta: Sleep apnea happens in kids too, and it's different from adults. I'm talking about kids with normal neurological development, not kids with neurological diseases.
In kids, almost all cases are related to tonsils — hypertrophic tonsils that block the airway. And unlike adults, who are usually tired and sleepy during the day, kids with sleep apnea are often the opposite. They're extremely alert, hyperactive, and irritable. They don't need to nap during the day. They're not tired the way adults are — they're wired.
This is something we discuss a lot with pediatricians, because there's a differential diagnosis with ADHD. Any kid being evaluated for ADHD should also be evaluated for their sleep. We should check that they're sleeping properly at an appropriate time for a kid, and we should rule out sleep apnea, because the daytime presentation looks very similar — irritability, moodiness, hyperactivity.
Gabie: We checked for tonsils — they're not enlarged. She also doesn't have weight issues. But sleep has always been a problem for us, and she stopped napping. I see some of the signs. We'll find out with the sleep study, or maybe I'm making it up. She's developing well, so we'll see.
Samanta: Apart from the tonsils — which we can easily see at the back of the mouth — there's another lymphoid structure called the adenoids, at the back of the nose. We can only see them with a small endoscope or imaging. In kids we look at both. If either is hypertrophic, there can be a blockage.
Gabie: Got it — one more thing to check.
Sleep Apnea and Female Fertility
Gabie: Going back to female fertility — how does sleep apnea disrupt it? Ovulation, progesterone, insulin resistance, inflammation in the body?
Samanta: All of that, together. Poor sleep quality compromises pretty much all of our hormone production — sex hormones, metabolic hormones, thyroid hormones — and all of them impact fertility.
When you have poor sleep quality for any reason — and we're talking about sleep apnea, but it could also just be insufficient sleep, which is the most prevalent issue today (people not sleeping enough hours because of work, study, modern society) — you compromise hormonal production. That affects fertility treatment. It can imbalance ovulation, produce fewer eggs in a stimulation cycle, and impact metabolism.
You'll have increased glucose intolerance — your body doesn't manage dietary sugar well. You'll be hungrier, and you'll crave more processed and fatty food. Not only do you want to eat more, you want to eat worse. A bad metabolism combined with poor sex hormone production is definitely not a good thing for someone going through a fertility treatment.
Gabie: Right — if you don't have good quality sleep, your insulin resistance goes up, and you crave sugary processed foods. You don't have enough energy because you're not rested, so what's the quickest way to make up for the lack of energy? Carbs, simple carbs. So you go for all the bad foods, which interferes with your fertility.
Sleep Apnea, Pregnancy, and Gestational Diabetes
Gabie: Can we talk about how sleep apnea affects early pregnancy? Does it have to do with implantation or miscarriage risk?
Samanta: Yes — and also metabolism during pregnancy, which is something we talk more about now. Sugar metabolism during pregnancy can impact not just the pregnancy itself but the health of the child. A pregnant woman diagnosed with gestational diabetes has a child with a higher likelihood of developing diabetes over their lifetime. So this doesn't just affect pregnancy — it affects the baby and their adult life.
Poor sleep quality makes pregnancy less likely and puts more risk into the treatment. It can happen early in pregnancy or later. It depends on the severity of sleep apnea. Severe sleep apnea means very fragmented sleep — someone snoring a lot, very sleepy, complaining about their sleep. That person tends to come to us faster. Mild and moderate cases are harder to catch.
What can happen during pregnancy — usually in the second or third trimester — is weight gain. If a woman didn't have a great diet or nutritional support in the early months, she may gain more weight than she should. That weight gain can cause sleep apnea by increasing fat tissue around the throat. So someone who didn't have sleep apnea before pregnancy can develop it during pregnancy — mostly from weight gain, with a small contribution from fluid retention.
Gabie: Is there something you can do about it during pregnancy?
Samanta: Nutrition is huge — if you're overweight or obese, work with a nutritionist 100% of the time, and get a sleep study. For moderate or severe sleep apnea during pregnancy, the treatment is CPAP. Surgery is not done during pregnancy unless something is very remarkable. CPAP can bring sleep back during pregnancy in a safer way, and after pregnancy, other treatments can be reconsidered.
The Hunger Hormones: Leptin, Ghrelin, and Sleep
Gabie: You mentioned gestational diabetes and sleep apnea. How are these two connected?
Samanta: Gestational diabetes is a diagnosis given during pregnancy because pregnancy puts a woman's body to the test. If you have any degree of glucose intolerance or diabetes before pregnancy, it tends to get worse during pregnancy. Even without a prior diagnosis, pregnancy alone puts the body to the limit, so some glucose intolerance is more likely. Sleep apnea can make this worse, because by fragmenting sleep we don't produce the right hormones for appetite and metabolism.
Two important hormones here: leptin and ghrelin. Leptin is produced by fat tissue cells and signals to the body that we've had enough food — it makes us feel satiated. Ghrelin is produced by cells in the stomach and signals that we're hungry. They counterbalance each other, and we usually maintain balance between them.
When we sleep well, we have higher leptin and lower ghrelin. When we have untreated sleep apnea, we have higher ghrelin levels, meaning we're hungrier during the day. And we don't just want to eat more — we want to eat worse food: pizza, burgers, sugary food. A good night of sleep keeps appetite much more controlled.
So if a pregnant woman has undiagnosed sleep apnea, she's more likely to eat more, and to eat worse-quality food — which is something we definitely don't want to see during pregnancy.
Closing: Watch for the Signs
Gabie: To summarize — look for symptoms. If you're in a partnership, ask your partner to watch for them too. Snoring, whether loud or quiet. How many times you wake up at night. Do you wake up needing the bathroom or needing water? Do you have a dry mouth? Do you have breathing pauses? Do you crave sugary foods during the day? Do you feel rested? Look out for these signs. Get tested. Talk to a professional. Get a nutritionist on board. There are a lot of people who can help you manage this so you can improve your quality of life, your chances of conception, your pregnancy, and the health of your children.
Samanta: Exactly. This extends to the whole life of your child. You summarized it perfectly, Gabie.
Gabie: Thank you so much, Dr. Samanta Dall Agnese. That was so interesting.
Samanta: Thank you, Gabie. Sleep is so important, and we need to talk more about these issues. Thank you for this opportunity.
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