Over 18 Million Americans Adults have sleep apnea. It is estimated that 2 to 3% of children have it and over 42 million Americans have some sort of Sleep Disordered Breathing according to the national sleep foundation. The statistics are similar to having asthma or diabetes. Sleep Apnea doesn’t discriminate. It affects all shapes and sizes, people of all ages and races throughout the world with all different health issues from professional athletes to the very ill.
1781 - Peiroidic breathing is described by a world renowned surgeon named John Hunter.
1820’s - A physician named John Cheynes identifies a respiration pattern in patients that describes Central Sleep Apnea. In 1854 William Stokes publishes a description of a respiration pattern described by Cheynes earlier that century. The breathing pattern is named Cheynee Stokes Respiratoin. It is common in Central Sleep Apnea, heart failure, and the stroke population.
1836 - Doctors termed the phrase pickwickian syndrome for people who had the condition known today as “Sleep Apnea” from the 1836 Charles Darwin Book “The Pickwick Papers”. The novel’s main character Samuel Pickwick had sleep apnea and a quote from the book is as follows:
“Sleep!” said the old gentleman, ‘he’s always asleep. Goes on errands fast asleep, and snores as he waits at table.”
It was believed for the last 2000 years that this condition was the result of being overly overweight. where people couldn’t breath correctly resulting in low oxygen leves/high CO2 which today is termed Obesity Hypoventilation Syndrome.
It would be much later that Sleep Apnea wasn’t entirely based on Pickwickian Syndrome. Later it would be discovered that it is related not not just obesity but overly relaxed throat and neck muscles , brain dysfunctiontion, heart disease, nasal and pharyngeal blockages, or anatomyncal structures of the jaw and throat.
1880 - Narcolepsy is first named by a Physican named Jean Baptiste Edouard Gelineau
1889- The First medical description of obstructive sleep apnea syndrome is given by a British Physician name Richard Caton, speaking to the Clincal Society of London. .
1903 - Willem Einthoven invented the EKG(Electrocardiogram) that tests the electrical activity of the heart. This is important in Sleep Medicine and one of the components in a sleep study because the heart is put under a lot of stress during APNEAS and Hypopneas that make up the AHI index. PVC’s, AFIB, tachycardia, and severe bradycardia can take place during these episodes. Studies show that most heart attacks happen between 6am and 12 noon. There is mounting evidence pointing towards sleep apnea as the culprit for this.
1906- Dr Sutherland Simpson & JJ Galbraith theorize on circadian biology.
Circadian rhythms are physical, mental, and behavioral changes that follow a daily cycle for all living things. For instance when it’s dark we sleep, when it’s light we are awake. This is the bodies natural circadian rhythm at work. Circadian rhythms can influence sleep-wake cycles, hormone release, eating habits, digestion, body temperature, and other important bodily functions. Biological clocks that run fast or slow can result in disrupted or abnormal circadian rhythms. Irregular rhythms have been linked to various chronic health conditions, such as sleep disorders, obesity, diabetes, depression, bipolar disorder, and seasonal affective disorder. This is important because Sleep Apnea directly affects this. There is more evidence that sleep and circadian rhythm regulate nearly all biological and behavioral processes from cells to your entire physiology and function.
1929 - Dr. Johannes Berger uses EEG (electroencephalogram) for the first time on humans and tracks brain waves. It is used extensively in medicine today to help diagnose tumors, strokes, seizures, encephalotis, and REM Sleep. An EEG is important as it’s used as one of the tools in a sleep study to determine how many arousals and what stages of sleep you are in within the REM Cycle. REM sleep is the most important part of sleep as it’s the part of sleep that the body restores itself. Sleep Apnea interferes with this restorative cycle to take place. It would be in 1937 that Dr. Alfred Loomis defines these brainwave patterns with non-REM Sleep.
1939- This was the birth of Sleep Disorder Medicine as we know it. Nathaniel Kleitman would publish a text called “Sleep and Wakefulness which would be the beginning of sleep disorder medicine.
1945-Dr. Karl Axel Ekbom discovers Restless Leg Syndrome. There are studies showing a direct correlation between sleep disorders such as Sleep Apnea and Restless Leg Syndrome. This is one of the tests used in modern sleep study today.
In 1953 Nathaniel Kleitman and one of his graduate students Eugene Aserinsky discovered Rapid Eye movement during sleep, also called REM Sleep. There are 5 stages of a healthy sleep cycle and during Sleep Apnea these are interrupted drastically. As stated previously, we need REM sleep for the restorative processes to take place in our bodies. What’s interesting is Nathaniel Kleitman lived to be a 104 years old and passed away in 1999. Remarkable life and career
1957 - Dr. William C. Dement discovers the relationship between dreaming and REM Sleep and in 1958 in he publishes a paper on the sleep cycles of cats. The paper on cats believe it or not would cause sleep research to go absolutely viral. Over the next 20 years it would bring researchers from all different fields from electro physiology, pharmacology, biochemistry and will ventually lead to Michel Jouvet’s identification of REM sleep as an independent state of alertness which he called “paradoxical sleep”
1962 - Dr Dement and Mary Caskardon develop the MSLT test to identify and diagnose narcolepsy. Narcolepsy is a chronic sleep disorder that causes overwhelming daytime drowsiness. This can be seen in people with untreated sleep apnea.
1964 - Dr. Tanenosuke Ikematsu first tries an operation called UPPP (Uvulopalatopharyngoplasty) which is a surgical procedure that typically removes the adenoids and tonsils. This surgery will be used in the future to be one of the treatments of sleep apnea.
1964 - Dr. Henri Gastaut presents a polysomnograph to give the complete picture of obstructive sleep apnea that is published in 1965. This is the the first official sleep study with the diagnosis of obstructive sleep apnea.
1968 Manual for scoring sleep is developed by Rechtschaffen and Kales. What’s interesting here is that they only meant for this to be a reference method but unintentionally this became the gold standard in the industry.
By 1969 Obstructive Sleep Apnea was treated experimentally by tracheostomyomy.
1970 - Effectiveness of tracheostomy for treatment of OSA is reported by Lugaresi and colleagues. This would be the gold standard of treatment for OSA for the next decade.
1972 - Takuo Aoyagi develops the pulse oximeter and is used on patients in 1975. This is a vital invention to the sleep medicine world. Oxygen desaturation is the biggest side effect of sleep apnea and causes the most damage to the bodyBeing able to measure this. This is a key component and is regarded as one of the most valuable pieces of information in a sleep study.
1975 - Association of Sleep Disorders is established with five centers as charter members.
1975- Insurance companies are allowing Polysomnograph tests to be a a medical test worth medical reimbursement.
1976 - Respironics is founded by Gerald McGinnis and started manufacturing anesthesia masks along with endotracheal and tracheostomy products. They will eventually in time become the first company to make CPAP commercially available.
1979. The gold standard of treatment of Obstructive Sleep Apnea was a Tracheotomy. A physician named Colin Sullivan invents the first CPAP machine. It took Sullivan and his team awhile to find a subject that suffered from sleep apnea to test his invention out on. He spent three years studying the breathing patterns of dogs such as pugs and bulldogs with pushed in faces that suffer from sleep apnea. Colin invented a mask to fit over the dog’s nose and continually pumped air into it’s snout. Colin noted that this improved sleep for the dog dramatically. Colin now needed to find a human to try this out on.
1980- Colin Sullivan found a patient who had severe sleep apnea. Sullivan recommended a tracheotomy but the patient refused. Sullivan negotiated with the patient saying if you are going refuse the gold standard treatment, how about being part of my experiment. Sullivan told him about his dog experiment with positive pressure. The patient volunteered for Sullivan’s experiment. Sullivan used a motor of a vacuum cleaner with plastic tubes to create a positive pressure along with a diving mask. He put silicone around the mask to prevent leaks. Sullivan started this process at 9pm that night and expected to be out of the lab by 11pm as this would be a very short research experiment for him. As the patient was sleeping the patient began to have apnea episodes right away even with positive pressure. Sullivan experimented by using different pressures and noted as he increased pressure, the apneas went away and as he went down in pressure that the apneas returned. This was the first official CPAP titration in history. Colin noted while the patient was sleeping that he went into REM sleep as well. When the patient woke up, he told Sullivan that he felt awake and alert for the first time in many years. What was supposed to be a 2 hour experiment ended up going all night and would eventually lead to CPAP being the gold standard of treatment over a tracehotomy.
1981 - Dr. Shiro Fujita first uses the UPPP procedure to correct Obstructive Sleep Apnea.
Tissues which are typically removed in this procedure are the adenoids and tonsils. Research has showed that 60-70% of patients who undergo this have been cured completely and 90% have shown significant improvement.
1983. Dr. Allan Rechtschaffen demonstrates that humans need sleep and without it that there are severe health consequences and we ultimately die.
By 1985, Colin Sullivan had over 100 patients on long term home CPAP therapy. That year Respironics introduced the first commercially available FDA approved CPAP Machines. They received a patent for “BiLevel Technology” and they own the rights to the name “BiPap”. At that time they were 15 pounds! Today the Airmini CPAP Machines are less than a pound.
1987 - American Sleep Disorders Association is founded.
1989 - ResCare Company which is known by ResMed today was formed by Peter Farrell in 1989 that manufactured CPAP machines and equipment.
1990. The NTSB research showing that sleepy driving causes more than 50% of fatal crashes involving truck drivers.
2003 - New Jersey becomes the first state to make drowsy driving illegal.
2003- Behavioral Sleep Medicine Certification is started.
2004 - Dr. Czeisler and colleagues first publish sleep deprivation as a public and safety problem in the New England Journal of Medicine.
2007- Respironics merged with Philips to be called Philips Respironics in a 5 billion dollar blockbuster deal. Today ResMed & Philips Respironics are the two biggest CPAP Manufacturers in the world. We call them the Big 2 here at Footit.
2007- Auto CPAP becomes commercially available. This will optimize therapy as we know by regulating different pressures to give the patient the best interval pressures throughout the night while helping keep their AHI minimal.
2007- Examination for sleep medicine board certification is offered under the American Board of Medical Subspecialties.
2015. The FAA & NTSB come out with new guidelines for Sleep Apnea listing it on it’s “Most Wanted” list of Transportation and Safety Improvements for North America.
2018 - The NTSB determined that two commuter railroad terminal accidents in New York in 2016 were caused by undiagnosed severe obstructive sleep apnea.
“Obstructive sleep apnea has been in the probable cause of 10 highway and rail accidents investigated by the NTSB in the past 17 years
In 1985 there were 100 people being treated by Colin Sullivan for Sleep Apnea. Today there are over 22 million Americans who are estimated to have sleep apnea but only 20% of them have been diagnosed.
According to the National Heart, Lung, and Blood Institute Sleep Apnea can lead to serious health complications such as heart attack, glaucoma, deabetes, cancer, and cognitive and behaviorsl disorders.