Sleep Apnea Then and Now

Continuous Positive Airway Pressure machine

Literature has often described obstructive sleep apnea without a full and proper understanding of the condition. The earliest reference to sleep apnea was by Charles Dickens. He mentioned a typical sleep apnea patient in one of his novels as “sleepy Joe”. This was an obese man who would be always snoring during sleep. Because of his condition, he was always snoozing and would be found in a corner of the bar snoring away. This was mentioned in the book “The Posthumous papers of the Pickwick club” and hence the name Pickwickian syndrome was often used to describe this condition during the past.

In fact, history shows that Duron, in France and Jung in Germany were the first to make detailed descriptions of sleep apnea in the 20th century (around 1965). Just 5 years after this, Elio Lugaresi, in Italy first used tracheostomy, to successfully treat sleep apnea. In this method, the trachea or windpipe was punctured creating an artificial hole for the patient to breathe, bypassing the obstructed upper airway. This method was reasonably successful for the next decade and supported the theories about the cause of sleep apnea being primarily due to obstruction of the upper airway. Along with tracheostomy, Lugaresi advocated reduction of obesity as a method of management of obstructive sleep apnea. Along with being a remedy for apnea, the trachoestomy helped reduce the marked elevation of blood pressure that is often associated with this disease.

A little later (in 1981), doctors and biomedical experts created CPAP (continuous positive airway pressure) devices. They were first used by Sullivan followed by several others. Within a very short time Continuous positive airway pressure devices were at the forefront of management of sleep apnea. This was indeed a revolution in the treatment and management of sleep disorders. Around this time another remarkable advance was made in the management of sleep apnea. This was in the form of a corrective surgery to treat the condition and was called uvulopalatopharyngoplasty or UPPP. This surgical method found ready acceptance in the west and was a common surgical alternative to the more drastic tracheostomy practiced much earlier. UPPP is a method of surgically removing tissues in the throat such as all or part of the uvula, soft palate, tonsils and adenoids. This surgery was modified by surgeons at Stanford University who developed what is now called the Stanford protocol, where multiple areas in the upper airway are surgically tackled to remove the airway obstruction. Unfortunately, this method was found to have many complications and many patients suffered recurrence after the surgery. One the most feared complications of UPPP was that of post surgical constriction of the airway due to fibrosis, resulting in even greater airway obstruction. Slowly many centers gave up this method.

Still later, medical experts came up with oral appliance therapy which has turned out to be much more promising with many hospitals eagerly trying this new technique.

Sleep apnea signs, risk factors and treatments.

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