Sleep-Related Breathing Disorders

Abstract

The sleep apnea syndromes comprise the single most common diagnosis in contemporary sleep disorder centers. Although there has been a resurgence of interest in this area in recent years, reports have been in the literature since the last half of the nineteenth century (Lavie, 1984). After individual cases of what might now be considered sleep apnea were described by Broadbent (1877), Caton (1889), and Morrison (1889), the first account viewing this as a specific sleep disorder was written by Silas Weir Mitchell in 1890. He described patients in whom breathing was normal only in the waking state, during which voluntary efforts supplement automatic mechanisms. During sleep, when voluntary control diminished, the disordered automatic activity was not adequate, and respiratory failure would occur. As a consequence, the patient would awaken with a sense of suffocation. Accounts also appeared linking upper airway obstruction with somnolence and sleep disturbance (Lamacq, 1897; Wells, 1898). In 1889 Christopher Heath, commenting on the presentation of Caton’s patient, pointed out the resemblance to Joe, a character in Charles Dickens’ Pickwick Papers (1837). After later references by Bramwell (1909) and Osier, and a detailed modern description by Burwell et al. (1956), the Pickwickian syndrome of obesity and hypersomnolence became part of our medical heritage.