"Everyone knows what we have called the uvula fallen; but we may not imagine that this disease, which in general does not appear to be too dangerous, could eventually cost the life of the patient. A lady of about 40 years, residing in Province (France), showed herself having a fallen uvula. She consulted a surgeon who ordered usual medication, known gargles, etc. The disease gradually increased, but to the point that the lady had trouble swallowing. Without constantly occupied his throat, taking little food, not sleeping, she fell in a thinness and a state of languor to fear for his life. She was taken to Paris where I was not long to acknowledge the cause of her unfortunate state, I thought it attributed to the fall of the uvula. I promised her a certain and prompt recovery by cutting the uvula, and I successfully kept my word." [1]
The French surgeon Sauveur François Morand thus described in the 18th century the first pharyngotomy in a case that certainly presented severe symptoms of sleep apnea. But the first true description of the disease was made almost a century later, not by an illustrious physician but by English novelist no less illustrious: Charles Dickens.
The Fat Joe Story
In his novel: the posthumous Pickwick Club papers or the adventures of Mr. Pickwick, the famous English writer Charles Dickens described as one of his characters: "His head was slumped on his chest; only a continuous snoring and occasionally, a partial suffocation noise, revealed at the hearing the presence of the great man." It was an obese teenager to whom he had given the name of Fat Joe and was server to the Pickwick Club.
It was not until the early 20th century that the disease is medically recognized and we owe to the great Canadian physician William Osler to have named it: Pickwick syndrome.
William Osler
Dr. Osler is a great Canadian doctor. Pastor's son, he was born in Ontario July 12th, 1849. He began religious studies in order to succeed his father but quickly changed career and attended medical studies at the Toronto School of Medicine. After two years in this institution, he moved to Montreal and completed his medical studies at McGill University who was then reputed to be the best in Canada and even the United States. He completed post-doctoral studies in Europe and returned to teach at McGill University. He has been a professor at the University of Pennsylvania, then head doctor at Johns Hopkins Hospital to complete his career as dean of the Faculty of Medicine at Oxford University.
His book: The Principles and Practice of Medicine did figure in the Bible teaching of medicine and has had multiple editions until 2001. Fascinated by the history of medicine, he bequeathed his collection of books to McGill University. At 70 years old, he was a victim of the Spanish flu and died December 29, 1919.
Henri Gastaut
In 1965, a French doctor who specializes in epilepsy, Dr. Henri Gastaut, finds for the first time in patients suffering from the Pickwick syndrome the occurrence of frequent pauses in breathing during sleep. He classified sleep apnea as obstructive sleep apnea, central and mixed. A few years later, in 1972, another French physician, Dr. Christian Guilleminault, refine diagnostic criteria. He then defined the sleep apnea as: five stops breathing at the time whether or not alveolar hypoventilation and presence or absence of obesity.
Snoring, a symptom forgotten
A rather amazing fact remains noteworthy in the case of sleep apnea syndrome. Of all doctors who have studied the disease since doctors Morand in the 19th century, Osler in the early 20th century, and even Gastaut Guilleminault in the years 1960, 1970, none had noted snoring as a symptom of the disease. And this, although the writer Charles Dickens has been clearly identified with her character: "It was evening: MM. Pickwick Winkle, and Snodgrass went their merry host attend the nearby feast of Muggleton; Isabelle and Emily walked with Mr. Trundle; the deaf old lady had fallen asleep in her armchair; the hum of the big boy was coming, slow and monotonous, from the distant kitchen." It was not until the early 1980s that the pulmonologist, S. Fujita, notes that by treating sleep apnea, snoring also disappeared.
But snoring was also attracting the attention of researchers. Thus, the Italian pulmonologist, E. Lugaresi, was a pioneer in this field by the realization of the largest study on the subject. This specialist had an accurate census of the population of the Republic of San Marino snorers. This is the largest systematic study allowing to ascertain all demographics information's on snoring for a population of 22 800 people.
Thus we learned that:
"Among the entire population, including children, we found 35% of snorers, 20% consistently and 15% intermittently. Men snore more than women: 25% of men and 15% of women snore every night, while 15% of men and 13% of women snore only once in a time of triggering factors (alcohol, large meals, fatigue) "
The study also allowed to highlight the relationship between snoring and various other factors including age, obesity and other health problems including cardiovascular disorders.
Apnea: solutions.
Since the removal of the uvula by Dr. Morand in the 18th century, we will have to wait here until the mid-20th century until less radical solutions were considered. The first breakthrough in this sense was born in the late 1970s in Chicago with a pianist and her husband psychiatrist for the less clever.
To stop snoring, which prevented his wife to sleep at night and was affecting his musical ear pianist, Dr. Charles Samelson concocted a beeswax mold of his tongue, which, by suction, opens the respiratory tracts during the night. Following the success of his personal device, he undertakes study at Rush University Medical School. Today, more than forty devices operating on similar principles are on the market.
A few years later, in 1982, Dr. Colin Sullivan an Australian researcher makes the first device of positive airway pressure, better known here under the acronym CPAP (Continuous Positive Airway Pressure) and in 1985, Dr. John E. Remmers, a professor at the University of Calgary invented the first CPAP under electronic controls. Dr. Remmers is known in Canada and the United States as the renaissance man, because he combines all the talents of the scientists of that time: researcher, therapist, inventor, manufacturer and distributor of its own inventions.
Oral-pharyngeal devices, CPAP and surgeries are now part of the therapeutic arsenal to fight effectively against sleep apnea.
Reference:
[1] M. Morand & Berrier. Taille au Haut Appareil, Compagnie des Libraires, Paris, 1728, p. 29
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