History of Sleep Apnea: Developments in Diagnosis and Treatment

People have been suffering from sleep disorders since the beginning of time. Medical professionals, however, did not pay much attention to the disorder until beginning of the twentieth century. Early medical knowledge of sleeping disorders was quite limited; scientists and medical researchers did not have the equipment necessary for easy testing and diagnosis of sleeping disorders in their patients. Sleep Apnea research and documentation started at a rather slow pace, but scientific exploration and understanding of the disorder exploded after the 1950’s.

The first documented recordings of Sleep Apnea were published in 1836.

• THE INNOVATOR: In 1836, famed author, Charles Dickens, published The Posthumous Papers of the Pickwick Club; the novel was also commonly referred to as The Pickwick Papers. It was Charles Dickens’s very first novel and was published in monthly installments.
• THE RESEARCH: The Pickwick Papers featured a character, Joe, a “fat boy” who showed all of the classic symptoms of Sleep Apnea. Joe’s character was an overweight male who was constantly eating and then falling asleep. Joe’s vocals are described as nasal in tonal quality. The boy was constantly red in the face and he snored profusely.
• THE SIGNIFICANCE: Joe’s character, and the observation of his medical symptoms, was the first published documentation of a serious sleeping condition. The condition is now referred to as Sleep Apnea. The novel brought public and medical attention to sleeping disorders and daytime sleepiness.

The first medical identification of respiratory failure during sleep came in 1918 with the invention of the term, “Pickwickian”.

• THE INNOVATOR: Sir William Osler, a physician in the early 1900’s, was the first man to give respiratory sleeping disorders an identifiable name.
• THE RESEARCH: Osler dubbed the term “Pickwickian syndrome” to describe a character in The Posthumous Papers of the Pickwick Club. The term was used to describe the overweight Joe, the “fat boy” character.. Osler used the term “Pickwickian” to describe his obese and hyper-somnolent patients that exhibited the characteristics we now associate with Sleep Apnea.
• THE SIGNIFICANCE: When Osler coined the term “Pickwickian”, it finally gave an identifiable name to common problem. Sleep Apnea was grossly overstated during this period in time, but Osler’s contribution gave the medical world an understandable linguistic term that could be used to identify and classify respiratory sleeping disorders.

In 1956, the term “Pickwickian syndrome” became more inclusive. It began to identify additional problems commonly associated with Sleep Apnea.

• THE INNOVATOR: Dr. Sidney Burwell and his research team completed medical research and testing that helped identify other symptoms of what is now called Sleep Apnea.
• THE RESEARCH: In the 1950’s, Burwell was treating multiple patients that were experiencing improper airflow in the lungs, respiratory failure, extreme daytime sleepiness, fatigue, and congestive heart failure. He called the patients that exhibited these symptoms, “Victims of Pickwickian Syndrome”.
• THE SIGNIFICANCE: The research completed by Burwell and his colleagues was the first significant medical breakthrough surrounding the study of sleep apnea. It was the first time that “Pickwickian Syndrome” was classified and recorded as a legitimate medical condition.

Obstructive Sleep Apnea was officially tested and recognized as a disorder in 1965. These tests were the first polysomnographic descriptions of OSA.

• THE INNOVATOR: Dr. Henri Gastaut led a team of French and German doctors in Europe in the 60’s. His research revolved around what is now considered to be OSA.
• THE RESEARCH: Gastaut and his team based their research on a sub-group of “Pickwickian” patients. They monitored and recorded the sleeping and breathing patterns of the “Pickwickian” patients. The research provided data identifying the distinct unique breathing patterns of patients diagnosed with the syndrome.
• THE SIGNIFICANCE: Not only was apnea documented for the first time, but the data showed separate and distinct breathing patterns in the patients. Three distinct and unique patterns of breath were found in “Pickwickian” patients. Identifying the differences in the breathing and sleeping patterns led to the identification of the three separate types of Sleep Apnea: Obstructive Sleep Apnea, Central Sleep Apnea, and Complex Sleep Apnea. The identification of the separate syndromes would help medical professionals learn how to treat each one uniquely.

In 1969, surgery became a popular treatment for Obstructive Sleep Apnea.

• THE INNOVATOR: The medical world began treating OSA with surgery in 1969.
• THE RESEARCH: Apnea cases were often treated by passing through the upper airway completely with a Tracheostomy. During the surgery, the windpipe (trachea) was opened through an incision; a breathing tube was placed in the incision. This was a popular choice among OSA patients because they no longer had to rely on the strength and functioning of the upper airway. Some of the first Tracheostomies performed on apnea patients showed that it was possible for symptoms to return.
• THE SIGNIFICANCE: This surgery was a huge relief for many suffering people. In the eyes of many patients, it no longer mattered if there was a physical obstruction of the airway above the level of the chest, because the space itself was no longer necessary for inspiration. This surgery led to the exploration of surgery as an efficient treatment. Other surgeries are now used to treat apnea; Tracheostomy is a last resort in modern medicine.

Continuous Positive Airway Pressure therapy was developed in 1981. It was the first non-invasive treatment option for apnea sufferers.

• THE INNOVATOR: The CPAP machine was introduced in 1981 by Australian researcher Dr. Colin Sullivan and his team of colleagues: Eves, Issa, and Berthon-Jones.
• THE RESEARCH: The Continuous Positive Airway Pressure machine was introduced as a new treatment for victims with Obstructive Sleep Apnea. The machine was constructed from the motor of a vacuum cleaner that had been reversed and Silastic tubing that was used in the nasal passage. Because the vacuum motor was reversed, it blew pressurized air out instead of sucking it in. The air was pushed into the patient’s nasal passage through the tubing in an effort to keep the airway open and free of obstruction. In addition to nasal tubing, they later applied the technology to a ventilation mask. Sullivan’s CPAP machine was quite noisy, bulky, and difficult to travel with; it was not accepted as an efficient or effective medical treatment procedure until the middle of the 1980s. In the latter portion of the decade, all of the components of the CPAP machine (tubing, mask, vacuum, etc.) were improved and remodeled.
• THE SIGNIFICANCE: Sullivan’s team published research papers centered on the newly developed CPAP treatment; these papers were a giant milestone for the treatment and understanding of Sleep Apnea. Not only is the CPAP machine still used today, it is the most commonly preferred method of treatment for people suffering from sleep apnea. Although Sleep Apnea had been identified prior to 1981, there was no method of apnea treatment that showed a significant change in the severity or frequency of apnea occurrences.