Who was the first to use the term Pickwickian in connection with sleepy patients? History of sleep apnoea syndrome

The symptoms and characteristics of steep apnoea syndrome-excessive daytime sleepiness, loud snoring, restless and non-restorative steep-are so impressive that it is difficult to understand why its recognition was delayed until the 1970s. The Centennial book of the American Thoracic Society credited Sidney Burwell for the discovery of Obstructive Steep Apnoea Syndrome. This is only one of the many mistakes and misattributions regarding the history of steep apnoea syndrome. The earliest descriptions of patients who presumably suffered from steep apnoea were made in the 19th century. The term Pickwickian in connection with sleepy patients was introduced in 1889. The first electrophysiological steep recordings of Pickwickian patients and the understanding of the syndrome as disordered breathing in sleep, were made during the late 1950s and 1960s. Its recognition as a public health problem was facilitated by Young et at.'s [Young T, Palta M, Dempsey J, et at. The occurrence of steep-disordered breathing among middle-aged adulte. N Engl J Med 1993;328:1230-5] seminal paper documenting the prevalence of the syndrome in the general population, and by the accumulated evidence that the syndrome is a major cardiovascular risk factor. Bibliometric analysis of the literature on steep apnoea reveals that future research will focus on the tong-term outcomes of the syndrome, on the effects of treatment, and on the underlying mechanisms linking it with cardiovascular morbidity. (C) 2007 Elsevier Ltd. All rights reserved.