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A large red apple with a white highlight contains a green anthropomorphic worm with a smirking human face smoking a cigarette, rendered in a mid-century cartoon mascot style

As mentioned, smoking has already been linked to other health risks including Cardiovascular disease Type 2 diabetes Stroke Respiratory illness These health risks are also present in sleep apnea patients, so smokers with these other health factors could also be living with undiagnosed sleep apnea

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Of the clues which eschewed a relevant surface reading, I was intrigued by MaleficOpus's unconventional "Down----- down------"