The History of the Diagnosis and Treatment of Sleep-Disordered Breathing

The enormous development of sleep medicine in the last 30 years makes many of us living witnesses of the history of this medical specialty. For the author, being in the audience while the electroencephalography (EEG)-pioneer Nataniel Kleitman at the age of 102 years, giving the opening speech at an annual meeting of the American Professional Sleep Societies, was such a moment of being part of history. But we too easily forget that the history of sleep-disordered breathing (SDB) medicine dates way back into ancient times. Greek and Roman physicians gave clear descriptions of the pathophysiology and treatment options of snoring and sleep apnea. In the middle age, surgical methods for the removal of large uvulae, adenoids, and nasal polyps in heavy snorers flourished. The nineteenth century brought not only the first clear description of a Pickwickian patient by Charles Dickens, but also important physiological findings of the respiratory system. In the roaring 1920s, the most important invention to diagnose sleep and later, sleep and breathing disturbances, was made by Hans Berger: the electroencephalograph. After World War II, sleep medicine became an important medical field, culminating with diagnostic (i.e., computerized polysomnography), therapeutic (i.e., continuous positive airway pressure (CPAP)), and epidemiologic (i.e., large-scale studies of the prevalence of obstructive sleep apnea) advances in the last two decades of the century.